[Comparison of short-term and long-term results after aortocoronary bypass in ischemic heart disease in diabetics and non-diabetics].

J Charvát, M Stríteský, M Semrád, I Vaněk, M Kvapil, T Vaněcek

Vnitr Lek 2002, 48(4):279-284

In the presented study we have evaluated short-term and long-term results of the multiple aortocoronary bypass surgery in the patients with ischemic heart disease. We have compared the incidence of the preoperative and postoperative complications, short-term and long-term mortality in the group of diabetics in comparison to nondiabetics as well as the entry characteristics of both groups. Among 2518 patients who were treated with aortocoronary bypass surgery there were 773 (30.6%) diabetics. The diabetic patients were significantly elder, we have found more women among them, more frequent presence of hypertension, chronic heart failure and peripheral...

[Treatment of diabetic neuropathic defect at the surgery department and at the center for diabetic foot care].

Z Rusavý, D Cechurová, L Holubec, S Lacigová, Z Jankovec, V Treska

Vnitr Lek 2002, 48(4):285-289

UNLABELLED: The aim of the study was to evaluate the treatment of neuropathic diabetic ulcer at the surgery department and the treatment at the diabetic foot centre at dismissal time and 3 months after the dismissal.METHODS: For assessment of treatment success parameters of glucose control were used (average of daily blood glucose values, glycosylated haemoglobin--HbA1C and glycosylated protein), healing of ulcers (Wagner classification), hospitalisation time and number of amputations. 22 diabetic patients at the centre and 17 patients at the surgical department were observed in this investigation. There was no difference between the groups as...

[Importance of selected laboratory indicators in the differential diagnosis and monitoring of multiple myeloma].

V Maisnar, M Tousková, J Malý, J Krejsek, M Kmonícek, O Kopecký

Vnitr Lek 2002, 48(4):290-297

Multiple myeloma is one of the most common haematologic malignancies. Currently there are numerous studies looking for new prognostic markers in multiple myeloma. The most important of them are the markers related to proliferative activity of neoplastic cells or to size of tumor mass. The subject of this paper are the results obtained from investigation of some such laboratory markers in a group of patients with monoclonal gammopathies diagnosed at our department in the last 3 years. We analyzed blood and bone marrow samples from 51 patients with new diagnosed monoclonal gammopathies, 14 of them were patients with monoclonal gammopathy of undetermined...

[Effect of composition of enteral nutrition on energy expenditure and CO2 production during periods of average and excessive energy intake].

Z Rusavý, H Kordová, M Cepelák, P Těsínský, P Zolková, M Zourek

Vnitr Lek 2002, 48(4):298-301

UNLABELLED: The objective of the presented work is to evaluate to what extent the CO2 production and O2 utilization and energy metabolism at rest (REE) are influenced by an excessive nutrient intake and to what extent by the composition of enteral nutrition. REE, CO2 production and O2 utilization were investigated in 9 patients on complete enteral nutrition by indirect calorimetry in four modifications: I--nutrition with 40% kJ fat in a ration 1.2x the energy output at rest at the onset of the trial; II--40% kJ and high energy intake (2.4x energy output at rest; III--60% kJ fat in ration of 1.2x energy output at rest; IV--60% kJ fat and energy intake...

[Pathogen resistance and other risk factors in the frequency of lower limb amputations in patients with the diabetic foot syndrome].

V Fejfarová, A Jirkovská, J Skibová, V Petkov

Vnitr Lek 2002, 48(4):302-306

UNLABELLED: Patients with diabetes mellitus undergo more amputations due to peripheral vascular disease, neuropathy and especially to infection requiring long-lasting antibiotic therapy than non diabetic patients. The aim of our study was to assess the association between the presence of resistant pathogens presented in diabetic ulcers and the frequency of lower limb amputations.METHODS: 191 diabetic patients consecutively treated for the diabetic foot in our foot clinic were included into two years retrospective study. Peripheral ischemia, the presence of osteomyelitis and the incidence of all Gram positive and negative resistant pathogens (defined...

[Parenteral nutrition in catabolic states using Neonutrin 15%, a new amino acid solution].

L Vokrouhlický, Z Zadák, L Sobotka, R Soucek, L Sprongl, Z Masek

Vnitr Lek 2002, 48(4):307-313

Development of amino acid solutions for i.v. use proceeds worldwide, the main stimulus being the expanding physiological and pathophysiological findings of specific effects of some amino acids and their metabolism and the need to improve intensive metabolic care. New Czech preparations in this respect are the series of NEONUTRINS 5%, 10% and 15% (Infusia Ltd. Horátev). They are modern preparations which meet the pretentious criteria of contemporary amino acid solutions (balanced ratio of all essential, semiessential and assisting amino acids, a high content of essential and branched-chain amino acids, amino acids with specific pharmacodynamic effects)....

[Analysis of heart rate variability during the head-up tilt test in patients with vasovagal syncope].

P Mitro, R Rybár

Vnitr Lek 2002, 48(4):314-319

Changes of the autonomous nervous tonus are considered the most important factor in the pathogenesis of vasovagal syncope. In order to investigate changes of the autonomous tonus the authors examined in patients with vasovagal syncope the variability during the head-up tilt test (HUT). In 35 patients with assumed vasovagal syncope the authors used a passive HUT (45 mins., 60 degrees) and subsequently nitroglycerin-stimulated HUT (0.4 mg s.l, 15 mins.). The heart rate variability was evaluated before the onset of the test in a horizontal position, immediately after tilting the patient (0 min.), during the 5th, 10th, 15th minute of the passive test,...

[Relation between pulmonary ventilation parameters, exercise tolerance and quality of life in patients with chronic obstructive lung disease].

J Chlumský, L Stěrbová, L Smolíková, M Matous, F Salajka

Vnitr Lek 2002, 48(4):320-324

Patients with chronic obstructive pulmonary disease (COPD) do usually have decreased tolerance of exercise capacity and impaired quality of life. Several studies have shown that exercise capacity is related relatively weakly to lung functions in this group of patients. The aim of the present study was to find parameter which could better reflect or predict maximal exercise capacity. 19 patients with the diagnosis COPD with mean value of forced expiratory volume in one second (FEV1) 46% predicted (range 21-79%) entering pulmonary rehabilitation program were included into the study. Enrolled patients were chosen to cover the whole range of airway obstruction...

[Splenomegaly (clinical importance, diagnosis and therapy)].

L Chrobák

Vnitr Lek 2002, 48(4):325-331

An enlarged spleen is a frequent and important clinical sign. It may be a presenting or dominant feature of a number of primary blood diseases as well as other clinical disorders of different etiology. The splenic structure consisting of the white pulp, the red pulp and intermediate marginal zone together with a complicated splenic blood flow enable the spleen to fulfill its functions: filtration (phagocytosis), immunological function, reservoir of blood and its corpuscules and extramedullary hematopoiesis in certain diseases. Enlargement of the spleen may occur as a result of various pathological conditions. This article is based on the history, physical...

[Diagnosis and therapy of pancreatic tumors].

R Soumarová, H Perková, Z Seneklová, H Horová, J Růzicková, P Karásek

Vnitr Lek 2002, 48(4):332-343

Pancreatic tumours belong among oncological diseases with a very poor prognosis. The total five-year survival is 1-2%. Surgical resection with a curative intention increases the probability of five-year survival to 10-20%. However only some 10% tumours are diagnosed in the resectable stage. The reason is the low specificity of initial symptoms. Earlier diagnosis and improvement of survival could be promoted by improvement of imaging methods and endoscopic techniques. Improvement of therapeutic results in selected indications can be achieved by adjuvant treatment (chemotherapy, radiotherapy, possibly their combination). Treatment of inoperable stages...

[Ankle pressure as an indicator of risk for systemic atherosclerosis].

J Spácil

Vnitr Lek 2002, 48(4):344-348

Contemporary methods of assessment of possible cardiovascular disease based on traditional risk factors are not perfect. Therefore new ways are sought. Simple and cheap methods include assessment of the blood pressure on the lower extremities above the ankles. The finding of a reduced index of ankle pressure (ratio of blood pressure above the ankles and pressure on the arm) indicates affection of the arteries of the lower extremities and a significantly increased risk of cardiovascular diseases (in particular myocardial infarction and stroke), independently on other risk factors. Therefore this simple examination should be made in middle aged and elderly...

[Obesity and disorders of the menstrual cycle].

I Lazúrová, I Dravecká

Vnitr Lek 2002, 48(4):349-352

Obesity, the result of combined genetic and environmental factors, is in recent decades one of the most frequent diseases and is encountered mainly in Europe and North America. In women it is associated with the risk of several diseases, such as diabetes mellitus, osteoarthritis, cardiovascular diseases, sleep apnoea syndromee, breast cancer, cancer of the uterus and also with impairment of reproductive functions. Already during the last century some observations confirmed that a very low or very high body weight is more frequently associated with disorders of the menstrual cycle (MC), infertility and poor reproductive capacity. However only during...

[Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) leading to the diagnosis of Wilson's disease].

T Szotkowski, Z Frysák, T Papajík, M Dusková, J Zahálková, I Tozzi, K Indrák

Vnitr Lek 2002, 48(4):353-356

Authors describe the case of a patient suffering from Thrombotic Thrombocytopenic Purpura--Hemolytic-Uremic syndromee. Any cause of the disease was not found, except signs of liver injury. The etiology of indefinite liver disease that had been diagnosed several years before was examined. Wilson's disease was considered as a final eventuality. The finding of 488 micrograms of copper in the dry liver tissue confirmed the diagnosis of Wilson's disease in the end.

[Is pamidronate or clodronate better?].

Z Adam

Vnitr Lek 2002, 48(4):357