[The J.E. Purkyne Czech Medical Society and the Czech Internal Medicine Society in cooperation with the Slovak Internal Medicine Society presents the 120th Internal Medicine Seminar. "Nutrition and tumor diseases". Held 29 November 2001 at Hradec Kralove].

Vnitr Lek 2002, 48(7):593-628

[Nutritional support and tumor diseases].

Z Zadák, R Hyspler, V Dytrych

Vnitr Lek 2002, 48(7):595-597

The evidence of the use of artificial nutrition in the patients suffering from malignant disease is inconsistent due to ethics and possible support of malignant cells by supplemented substrates. On the contrary, tumor cachexia from various causes is one of the most frequent manifestation of tumor. The indications and composition of artificial nutrition in the intensive care of patients suffering from tumors are discussed owing to the therapy.

[Chemotherapy of primary and secondary liver tumors].

B Melichar

Vnitr Lek 2002, 48(7):598-604

Liver is the most common site of metastatic disease. Although primary liver tumors are relatively rare in the Czech Republic, liver tumors represent a frequently encountered problem because of high incidence of colorectal and pancreatic cancer. Regimens of systemic chemotherapy or biologic therapy are used for secondary liver tumors according the primary site. It was demonstrated in randomized clinical studies that some of these regimens significantly prolong survival. Although only palliative therapy is possible for most of the patients with liver metastases, resection should be considered in patients with isolated liver involvement. Liver resection...

[Chemoprevention in oncology].

Z Wilhelm

Vnitr Lek 2002, 48(7):605-610

The importance of chemoprevention is increasing nowadays because these substances have important biological effects, e.g. anti-inflammatory, immunomodulating and immunostimulating, they influence blood pressure regulation, blood sugar and cholesterol levels. Their anticancerogenic effects are also important as nowadays with regard to the type of tumourous disease it is assumed that by chemoprevention it is possible to restrict the development of new oncological diseases within a range of 30-60%. The large number of oncological patients in the Czech Republic (260,000 in 1997) is associated also with an adverse incidence (58,000 in 1997). By application...

[Ethical aspects of treatment in patients with advanced oncologic diseases].

M Munzarová

Vnitr Lek 2002, 48(7):611-613

Ethical aspects of treatment are discussed from the aspect of medical objectives and the doctor-patient relationship. The authors draws attention to various dangers of incorrect approaches which may ensue for the patient: unnecessary and excessively burdening antitumourous treatment, inadequate treatment--in particular of pain, queer views on palliative treatment, a paternalistic approach of the physician with insufficient respect for the patient's wishes, inadequate information provided to the patient, "abuse" of patients for different experimental treatments etc. The author discusses in detail the double effect principle and draws attention to classification...

[Changes in hemostasis in malignant diseases].

J Malý, M Blazek, M Bláha, M Pecka

Vnitr Lek 2002, 48(7):614-618

Tumourous diseases are associated with haemorrhagic as well as thrombotic complications. The most frequent cause of haemorrhagic states in tumourous diseases is thrombocytopenic haemorrhage, consumption coagulopathy and activated fibrinolysis. Trousseau described in 1865 a mutual association between tumourous diseases and venous thromboembolism. As many as 15-20% patients with venous thromboembolism have an undetected malignity which is a prevalence of 2-3% in the population. From this ensues the relative risk of a newly diagnosed malignity which is higher during the first year after venous thromboembolism. The prevalence varies between 2% and 6%....

[Disorders of the cardiovascular system during treatment of oncologic diseases].

L Elbl

Vnitr Lek 2002, 48(7):619-625

The author presents a review of cardiovascular complications of anti-tumourous treatment. Cardiovascular toxicity is an interdisciplinary problem which can lead to serious complications of oncological treatment and considerably reduce its benefit for the patient. Cytostatics can produce a number of undesirable side-effects such as arrhythmias, angina pectoris, acute myocardial infarction, sudden death, cardiac failure. The most serious cardiotoxicity is probably chronic cardiac failure after anthracycline treatment. Interest in the diagnosis, monitoring and treatment of cardiotoxicity was aroused by new findings of cardiac complications after some...

[Puncture gastrostomy in oncologic patients].

P Kohout, J Manák, Z Vacek, D Tucek

Vnitr Lek 2002, 48(7):626-628

Puncture gastrostomies--percutaneous endoscopic gastrostomy and radiologically assisted gastrostomy--are minimally invasive methods to ensure an approach for the administration of enteral nutrition. These methods replaced the insertion of tubes during surgery (surgical gastrostomy). Percutaneous endoscopic gastrostomy (PEG) is inserted by means of a gastroscope, usually by the pull method, radiologically assisted gastrostomy (RAG) is implemented after insufflation of the stomach by a thin tube directly across the abdominal wall by the push method. In oncological patients it is preferable to administer enteral nutrition via puncture gastrostomy in case...

[Prevalence of thyroid gland disorders in pregnant women in the West Bohemia Region during their 2nd trimester of pregnancy in the year 2000--pilot study].

D Hauerová, R Pikner, O Topolcan, D Mrázová, L Holubec, L Pecen

Vnitr Lek 2002, 48(7):629-631

The diagnostics and the treatment of the disorders of the thyroid gland in pregnancy belong to the most important topics for most endocrinologists in the whole world. Untreated or mistreated thyroid gland disorders may influence the course of pregnancy and development of the foetus and child. Autoimmune thyroiditis, hyperthyroidism and hypothyroidism represent the most common thyreopaties in pregnancy and that is why the aim of the study was to establish their prevalence in population of pregnant women of the West Bohemia region. In our study we assessed serum levels of thyrotropin (TSH), free tyroxin (fT4) and antithyroid peroxidase antibodies (antiTPO)...

[Immunofluorescence determination using flow cytometry of platelet surface antigens in peripheral blood of healthy individuals (pilot study)].

M Loudová, D Vokurková, J Hosková, J Krejsek

Vnitr Lek 2002, 48(7):632-637

The authors present normal values of selected constitutive and activating platelet surface antigens expression. The results were obtained by flow cytometry analysis after immunofluorescent staining of the peripheral whole blood specimens from 25 healthy adults. Data are presented as a mean value and standard deviation (SD) of percentage of positive labelled platelets: constitutively expressed molecules CD9: 94.97% (+/- 2.95), CD31: 92.78% (+/- 2.97), CD36: 90.98% (+/- 5.25), CD41: 95.62% (+/- 2.23), CD42a: 94.98% (+/- 2.62), CD42b: 94.13% (+/- 2.58), activation molecules CD62P: 0.45% (+/- 0.33), CD63: 0.32% (+/- 0.22). This study is the first report...

[Chronic pancreatitis as a risk factor for pancreatic carcinoma].

P Dítě, M Pazourková, M Růzicka, M Precechtělová, I Novotný, M Dastych

Vnitr Lek 2002, 48(7):638-641

Carcinoma of the pancreas is a very serious disease as regards early diagnosis, effective therapy and screening of the disease. Possible risk factors of development of carcinoma of the pancreas include chronic pancreatitis. In the submitted investigation the authors evaluated 213 patients under long-term (more than 5 years) dispensary care with the diagnosis of chronic pancreatitis. In these patients they proved unequivocally carcinoma of the pancreas on the background of chronic pancreatitis in 11 instances, incl. 71.8% where from the etiological aspect chronic alcoholic pancreatitis was involved. Practically all patients were smokers, incl. 8 who...

[Bone changes in multiple myeloma--current etiopathogenic, diagnostic and therapeutic aspects].

A Sakalová, M Mistrík, S Gazová, I Chabronová, M Hrubisko, D Skultétyová, H Mociková

Vnitr Lek 2002, 48(7):642-648

Myelomatous bone disease affects about 90% patients with multiple myeloma and solitary myeloma as well. In initial stage it is manifested as osteopenia with osteoporosis or osteolytic foci, pathologic fractures followed by neurologic complications. Ethiopathogenitically a role is played by cytokine interactions with local chemokines produced by myeloma cells and activated stromal and hemopoietic cells (osteoblasts, monocytes, macrophages) resp. From the TNF-alpha family glycoprotein complexes are liberated (RANK-L), which support activation and proliferation or are inhibitory (osteoprotegerins). Similarly in the family TGF-beta several izotypes of...

[Monitoring cardiotoxicity of anthracyclines in children and possibilities of its prevention].

T Sromová, V Strnadová, H Hrstková

Vnitr Lek 2002, 48(7):649-656

UNLABELLED: Chemotherapy is the basic therapeutic method in pediatric oncology. Encouraging results of treatment of tumours in children may be adversely influenced by late side effects of cytostatics. Most serious is the late cardiotoxicity of anthracyclines. The authors analyzed and evaluated in a retrospective study clinical and laboratory findings in patients treated during childhood on account of malignity by chemotherapy containing anthracyclines, and focused their attention on late toxicity and evaluation of the effect of cardioprotection of dexrazoxane (ICRF-187, Cardioxane). The investigation comprised 73 patients aged 15 +/- 4.7 years who...

[The role of infection and inflammation in the pathogenesis of atherosclerosis].

J Jaber, J Murín, S Kinová, P Gavorník, M A Ghanem Wisam, A Radman, A Gharaibeh, P Richter

Vnitr Lek 2002, 48(7):657-666

Pathogenesis of the atherosclerotic process is deemed as multifactorial. To the most important risk factors, besides certain family predisposition, there belongs hypercholesterolemia, arterial hypertension, obesity, diabetes mellitus, smoking and others. In the last years there are more and more data about the role of inflammation and infection in the whole development of atherosclerosis. The witness for this hypothesis is the findings of high parameters of inflammation in involved vessels as well as in the blood of atherosclerosis suffering persons. Opinions about the inflammation theory appear from the 90th. Local sterile inflammation in the subendotelium...

[Ethical questions in organ transplantation].

P Nĕmec

Vnitr Lek 2002, 48(7):667-670

Increased numbers of organ transplantations entailed several ethical dilemmas. The principles of brain death, clinical signs and a confirmation tests are well established and accepted by the public. The transplantation society laid down the principles of organ allocation, but some ethical controversies may rise in the situation of the significant shortage of the donors. Even if the transplantation law exists, the ethical problems with the opting-in or the opting-out donation are still open to discussion. Also the problems associated with the organ shortage carry several ethical controversies. The tension between increasing demand and steady numbers...

[Portal vein thrombosis in a patient with hyperhomocysteinemia].

M Svehlová, L Stěpánková, P Kaupeová, J Sýkora

Vnitr Lek 2002, 48(7):671-674

The authors present the case of a 18-year-old boy examined on account of accidentally detected splenomegaly and suspected venous convolute in the region of the porta hepatis. Coeliacography revealed cavernous reconstruction of the portal vein due to an old thrombosis and thrombosis of the lineal vein. At the time of assessment of this diagnosis the patient had no apparent risk factor for the development of venous thromboembolic disease. With regard to the serious character of the finding and the patients age later detailed haemocoagulation, biochemical and genetic examinations were made. The only risk factor for the development of thrombosis which...

[Intravascular ultrasound guided direct stent implantation in the treatment of significant stenosis of the left coronary artery].

J Veselka, D Tesar, T Eisner, T Honěk

Vnitr Lek 2002, 48(7):675-677

The authors present the case of a 52-year-old patient with the symptomatology of unstable angina pectoris where they diagnosed a major stenosis of the trunk of the left coronary artery as the only significant lesion in the coronary circulation. The patient was successfully treated by means of an intravascular ultrasound--guided coronary stent implanted into the trunk of the left coronary artery. The authors discuss the possibilities and trends of contemporary catheterization treatment of major coronary affections.