7. celostátní diabetologické sympozium Diabetes a další obory (infekce, dermatovenerologie a revmatologie). Hradec Králové, 3.- 4. června 2005

Vnitr Lek 2006, 52(5):409  

Dejme tradici nový rozměr!

Richard Češka

Vnitr Lek 2006, 52(5):407-408  

Úvodník

Alena Šmahelová

Vnitr Lek 2006, 52(5):410  

Komentář: Normoglykemie, přívod glukózy a inzulin u kriticky nemocných

V. Šrámek

Vnitr Lek 2006, 52(5):433  

Anagrelide in the treatment of essential thrombocythemia (ET) and other myeloproliferative disorders with thrombocythemia based on data from patient register in the CR

M. Penka, M. Doubek, J. Schwarz, R. Pytlík, P. Dulíček, J. Kissová, A. Hluší, V. Vozobulová, O. Černá, Y. Brychtová, T. Szotkowski, Z. Volková, J. Seghetová, M. Schützová, I. Hadačová, I. Hochová, J. Voglová, O. Široký, D. Belada, T. Lhoťanová, B. Bubeník, M. Vránová, M. Mičaníková, L. Dušek

Vnitr Lek 2006, 52(5):498-503  

Anagrelide hydrochloride is an effective drug used in patients with ET and other myeloproliferative disorders with thrombocythemia to selectively decrease the number of thrombocytes. Indications for use of anagrelide were described in detail in Czech medical literature. Since 2005 data concerning treatment with anagrelide in some medical clinics have been collected in patient register showing course of treatment from 2004, when the medicament obtained marketing authorization from State Institute for Drug Control to be used in the treatment of thrombocythemia in myeloproliferative disorders. Aim of patient register is to monitor medical effect of anagrelide...

Z odborné literatury

Vnitr Lek 2006, 52(5):507-512  

50. narozeniny Jiřího Widimského juniora

Štěpán Svačina

Vnitr Lek 2006, 52(5):504  

Odišiel prof. MUDr. Stanislav Cagáň, DrSc.

Milan Pavlovič

Vnitr Lek 2006, 52(5):505-506  

XXV. dni mladých internistov, Martin, Slovenská republika, 25.-26. 5. 2006

Vnitr Lek 2006, 52(5):513-542  

Infections and diabetic foot syndrome in field practice

E. Záhumenský

Vnitr Lek 2006, 52(5):411-416  

In diabetic foot syndrome, the infection of diabetic ulceration is the critical parameter of classification, the most frequent reason of hospitalization and the main cause of amputations. Debridement and release of pressure are the critical steps of initial therapy of neuropathic ulceration showing no clinical signs of infection. Infection of neuroischemic foot is much more serious condition: in case of positive microbiological finding, antibiotic therapy is recommended even without any clinical signs of infection. Healing can be accelerated by ozone and Dermacyn therapy. Prevention of ulceration should be based on using appropriate shoes (with respect...

Sodium hyaluronate and an iodine complex - Hyiodine® - new method of diabetic defects treatment

L. Sobotka, V. Velebný, A. Šmahelová, M. Kusalová

Vnitr Lek 2006, 52(5):417-422  

Complicated diabetic defects are difficult to heal and frequently result in leg amputation. We have developed a new and unique system for wound treatment, which is based on combination of high molecular weight sodium hyaluronate with an iodine complex - Hyiodine®. The aim of our study was to assess the effect of this new method of wound dressing on infected diabetic defects healing. Methods:The effect of Hyiodine® was studied on 22 patients suffering from complicated foot diabetic wounds. Hyiodine® was either spread directly over the wound, or (more frequently) gauze was immersed in Hyiodine® and then put on/into the...

Urinary tract infection in patients with diabetes mellitus

M. Merta, R. Ryšavá, V. Tesař

Vnitr Lek 2006, 52(5):423-425  

Urinary tract infection is an important infection in patients with diabetes mellitus. Asymptomatic and symptomatic infections of urinary tract, and also some rarer serious complications of urinary tract infections (papillary necrosis, renal and perirenal abscess, emphysematous and xantogranulomatous pyelonephritis and s.o.). Incidence, outcome and treatment in patients with diabetes, which deserve special clinical attention, are commonly viewed by prism of personal opinion, and should be based on clinical studies, focused on this topic.

Respiratory infections and inhalation insulin therapy

Š. Svačina

Vnitr Lek 2006, 52(5):426-428  

A very important change in diabetology will come soon - introduction of inhalation insulin to the market. Experiences with this therapy are now more than 4 years long and no severe complications are present. Respiratory infections are not more frequent and it is not necessary to change insulin dosing during these infections. Insulin is more absorbed in smokers. The research of inhalation insulin brought again attention to diabetic pneumopathy. This disease has no clinical importance as has no relation to inhalation insulin therapy.

Effects of insulin on glucose metabolism in sepsis

Z. Rušavý, S. Lacigová, Z. Jankovec, M. Žourek, M. Krčma

Vnitr Lek 2006, 52(5):429-432  

The study surveys potential effects of hyperglycemia on prognosis, complications and mortality of critical patients. Normalization of glycemia seems to be an effective therapeutic approach that influences morbidity and mortality of critical patients. Although insulin therapy has many positive effects, it is rather a way how to achieve normoglycemia. Authors present their own research of the impact of plasmatic insulin levels on glucose metabolism. It seems that the ability of critical patients to utilise and store glucose is significantly decreased due to their insulin resistance. Glucose oxidation is decreased only slightly. Glucose utilisation and...

The nosocomial infections and diabetes

E. Míčková

Vnitr Lek 2006, 52(5):434-437  

The higher incidence of the nosocomial infections is induced of the advances in the diagnostic and therapeutic medicine. The nosocomial infections are divided in non-specific, specific, endogenous and exogenous infections. Diabetes comes under the risk factors of these infections. The rigid adherences to the epidemiological measures and regular control of them may lower the ocurence of the nosocomial infections.

Diabetes mellitus and immunization

J. Beran

Vnitr Lek 2006, 52(5):438-442  

Principles of prevention of infectious diseases have been known for several thousands of years. One of the most significant tools of infection prophylaxis is immunization. Vaccines containing thymus-dependent antigens produce massive and complex immune response and feature immunologic memory. That is why they can successfully protect patients with diabetes. Lately, it has been thought by general public and even experts that application of vaccines within national immunization programmes is one of the etiopathogenetic factors in the development of type 1 diabetes mellitus (DM). However, analysis of extensive studies performed by the experts of the Institute...

A role of diabetologist in management of infections in diabtics

A. Šmahelová

Vnitr Lek 2006, 52(5):443-445  

The important role of diabetologists in management of infections in diabetics is the quality diabetes control and compensation. There are two main arrangements in the management, the correction of the former antidiabetic therapy and the quality nutrition. The insulin resistance is higher by any infection and the insulin requirement is higher in such conditions. It is necessary to stop the metformin therapy, provide basal insulinemia and level up the insulin dose at least by one third. In the heavy infections the continuous intravenous insulin infusion is recommend. The specialities of the infection in diabetics, the prevention of infection and acute...

Pathogenesis of the connective tissue in diabetes

J. Škrha

Vnitr Lek 2006, 52(5):446-450  

Non-enzymatic glycation and oxidative stress are main contributors in pathogenesis of the connective tissue changes in diabetes. Properties of separate parts in the connective tissue and particularly those of intercellular matrix may be impaired by both mechanisms. In addition, changes in microcirculation including endothelial dysfunction and also diabetic neuropathy further aggravate tissue impairment. Despite known pathogenic mechanisms in development of diabetic microangiopathy there are series of unresolved questions in the pathogenesis of diabetic skin disorders.

Metabolic PPAR receptors and skin

Š. Svačina

Vnitr Lek 2006, 52(5):451-453  

Activators of metabolic PPAR receptors are used in diabetology and lipidology. Many substance influancing PPAR (β/δ) are in research. These substances will be perhaps used in obesitology and in atherosclerosis treatment. Much quicker is approaching the use in dermatology. The effect of receptor stimulation will be used in wound healing and in the treatment of allergic and proliferative diseases. Some realeted substancies influencing heterodimers with RXR or RAR receptors are used in the treatment of acne and skin lymfomas. Dermatology will be after internal medicine the second field where influencing of PPAR receptors will be very important.

Diabetic skin changes from the dermatological point of view

K. Ettler

Vnitr Lek 2006, 52(5):454-458  

Even a half of diabetic patients are suffering from skin troubles. Hyperglykemia causes skin changes leading to higher incidence of bacterial and mycotic infections, provokes skin degenerative processes, macro- and microangiopathy and neuropathy. Diabetic dermopathy, rubeosis, bullousis and scleredema are based on these changes. Other skin diseases including necrobiosis lipoidica, granuloma anulare, vitiligo, perforating folliculitis accompany diabetes frequently but their etiopathogenesis is not clear.

Healing of skin lesions in diabetic foot syndrome during hospitalization

A. Jirkovská

Vnitr Lek 2006, 52(5):459-464  

Wound healing during the diabetic foot disease is indicated to in-patient treatment in case of non-healing wound, in case of serious infection and/or critical ischemia and in case of necessity of surgical treatment. Diabetic foot disease is the main reason for in-patient treatment of people with diabetes, which our experience confirms. Chronic wound is characterised by non-healing for at least 4 weeks. Ischemia and recurrent trauma caused by incomplete off-loading, prolong inflammation and infection are the main reasons for difficult healing of chronic wound. Infection is also leading cause for prolonged hospitalisation of patients with diabetic foot...

Internist's view on skin manifestations of hyperlipidemia in diabetic patients

Z. Zadák

Vnitr Lek 2006, 52(5):465-469  

Xanthoma and xanthelasma are typical symptoms of lipid and lipoprotein metabolism impairment. On the basis of their incidence and morphology, it is even possible to specify the impairment type. Hypercholesterolemia or certain liver dysfunctions are characterized by slow development of surface xanthelasmas usually located on mechanically stressed regions (e.g. eyelids). Tuberous and tendinous xanthomas are typical for familiar hypercholesterolemia and are common symptoms of homozygous familiar hypercholesterolemia. Small and quickly developing eruptive xanthomas are typical for mixed hyperlipoproteinemia (secondary hyperlipoproteinemia is typical for...

Mycoses and diabetes

M. Skořepová

Vnitr Lek 2006, 52(5):470-473  

Generally, diabetic patients are more susceptible to skin infections. Although the overall incidence of skin mycoses in diabetics is not higher as compared with healthy population, diabetics seem to suffer from certain types of mycoses more frequently. They are not only tinea pedum and onychomycosis, but also candidoses (especially candidal balanitis). In older patients, sole tinea is often overlooked. Nevertheless, it impairs integrity of skin and lets in bacterial infections causing diabetic foot and aggravates nail infections. Onychomycosis in diabetics is far from being a cosmetic problem only. On the contrary, it is potentially a...

Skin complications of diabetes mellitus therapy

J. Olšovský

Vnitr Lek 2006, 52(5):474-476  

Author summarizes potential skin complications related to the therapy with insulin or peroral antidiabetics. These are mainly allergic reactions and lipodystrophic changes complicating or even precluding the therapy.

Diffuse idiopathic skeletal hyperostosis and its relation to metabolic parameters

A. Pavelková, K. Pavelka

Vnitr Lek 2006, 52(5):477-480  

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory disease of skeleton characterized by hyperostosis of axial and peripheral skeleton. The association of DISH with type 2 diabetes mellitus and other metabolic alterations (e.g. impaired lipid metabolism) has been known for many years. However, it has not been explained satisfactorily yet. It seems that this pathological process is significantly influenced by hyperglycemia and insulin resistance. Also, it is affected by growth hormone (GH) and its action mediated by insulin-like growth factor (IGF) and its binding proteins (IGFBP2, IGFBP3). From the point of symptomatic therapy, patients...

Rheumatologic manifestations in diabetes

J. Vencovský

Vnitr Lek 2006, 52(5):481-484  

Patients with diabetes mellitus may encounter various musculoskeletal complications. Typical manifestations can be seen in the hand, such as limited joint mobility, flexor tendon synovitis, Dupuytren's contracture and carpal tunnel syndrome. Humeral periarthropathy is also more frequent. The most serious complications can occur in the form of diabetic foot, which may lead to severe deformities and disability. Diabetic amyotrophy and muscle infarction are more rare complications. While osteopenia has a well recognized association with type I diabetes mellitus, this probably is not true for type II. Similarly, the association between diabetes mellitus...

Metabolic bone diseases and diabetes

P. Řehořková

Vnitr Lek 2006, 52(5):485-487  

Generalized osteoporosis, as one of the metabolic bone diseases, is often diagnosed in diabetics as late as after their first fracture. Alterations of bone metabolism should be therefore taken into account also in early stages of the basic disease. The risk of osteoporosis development is relatively high even in younger age groups of type 1 diabetics who suffer from defect of bone regeneration. In type 2 diabetics, the fractures are predominantly caused by more frequent falls and alterations of bone quality with normal or higher bone density. Therapy of osteoporosis in diabetics should include specific treatment regimes, supplementation with vitamin...

Gout and diabetes

P. Bradna

Vnitr Lek 2006, 52(5):488-492  

Gout is the most frequent cause of acute arthritis in men over 40 years of age. In the recent years, gout incidence has been increasing in developed countries probably due to dietary changes, alcohol consumption, ageing of population and also application of high-risk medications. Hyperuricemia is one of the symptoms of hyperinsulinism and metabolic syndrome. The level of uricemia correlates with the degree of insulin resistance. Correlation of uric acid levels and the risk of coronary and cerebral accidents were reported both in diabetic and non-diabetic population. It has not been explained satisfactorily whether this is the direct result of hyperuricemia...

Glucocorticoids and diabetes mellitus

K. Vondra, R. Hampl

Vnitr Lek 2006, 52(5):493-497  

Diabetogenic effect of glucocorticoids is determined by dose volume, duration of administration and structure and type of particular preparation. The effect is influenced also by the state of glucocorticoid receptors (increased sensitivity of some gene mutations, resistance syndromes) and times of year and day when glucocorticoids are administered. Development of impaired glucose tolerance or diabetes mellitus depends on the ability of islets of Langerhans to control insulin resistance induced by glucocorticoids. The compensatory function of islets of Langerhans decreases with age and that is why steroid diabetes mellitus affects mostly seniors. Besides...