Délka antikoagulační léčby a riziko recidiv u TEN - editorial

J. Malý

Vnitr Lek 2007, 53(6):629-631  

Clinical experience in treatment with the long-term insulin analogue glargin in a diabetes centre

I. Haladová, S. Lacigová, Z. Jankovec, D. Čechurová, M. Žourek, M. Krčma, Z. Rušavý

Vnitr Lek 2007, 53(6):632-636  

Objective:To assess the experience obtained by a diabetes centre in the treatment of patients with type 1 diabetes with the long-term insulin analogue glargin. Patient sample and method:136 patients with type 1 diabetes mellitus (DM) were evaluated on a retrospective basis for the period from March 2004 to march 2005. We monitored HbA_1c before the treatment with glargin, after 3 months, again after 6 months, and finally after 1 year of therapy. We evaluated the effectiveness of treatment with glargin insulin based upon diabetes compensation at the start of treatment. We also compared glycaemia variability in the...

The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI)

J. Olšovský, M. Beránek

Vnitr Lek 2007, 53(6):637-645  

The principal objective of this paper is to verify, in clinical practice, the long-term affect (7 to 8 year follow up) and safety of insulin pump treatment in type 1 diabetes mellitus patients and to compare the results for diabetes compensation in patients treated with the insulin pump with a control group of patients treated with intensified insulin therapy using the MDI (multiple daily injection) method. Patient sample and method:We followed up 35 patients treated with the insulin pump and 35 patients in the control group. We evaluated the monitored parameters for both patient groups at the beginning and at the end of the follow up...

The subpopulation of CD34⁺ cells and their importance in the healing of grafts in family-related allogenic transplants of peripheral stem cells.

M. Klabusay, V. Suková, Z. Kořístek, J. Mayer, J. Vorlíček

Vnitr Lek 2007, 53(6):646-651  

Current status:The determination of concentration of CD34⁺ cells is the standard method for evaluation of the quality of a bone marrow graft and of peripheral stem cells. Although the relationship between the dose of CD34⁺ cells and the speed of graft healing in autologous transplants is a proven fact, it may not always be the case in allogenic transplants. Patients and method:The correlation between the dose of CD34⁺ cell subpopulations and the speed of healing was monitored in patients indicated for allogenic transplantation of haematopoietic stem cells. The patients were divided according...

Essential thrombocytemia and other myeloproliferations with thrombocytemia in the data of the register of patients treated with Thromboreductin® till the end of 2006

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

Vnitr Lek 2007, 53(6):653-661  

Since 2005, registers of patients treated with Thromboreductin® (anagrelid) kept by some centres in the Czech Republic have been supplied with data concerning patients whose treatment with this preparation started in 2004. The purpose of the register is to record responses to therapy by Thromboreductin® and adverse events in patients with essential thrombocytemia and other myeloproliferations, and to subsequently analyse the data. Another objective is to detect predisposition to clinical symptomatology and disease complications. Apart from thrombocyte count, additional risk factors are monitored. The database currently contains data for 336...

The optimum length of anticoagulation therapy after venous thromboembolism - universal or individualised approach?

J. Hirmerová

Vnitr Lek 2007, 53(6):662-668  

Long-term peroral anticoagulation treatment is indicated after a thromboembolic event. The length of treatment should be based on balancing the risk of recurrence against the risk of bleeding complications. The minimum period of treatment is 3 months and can be reduced in certain cases; however, for many patients, a longer period of treatment may be recommendable. The presence or absence of a provoking factor and the nature of such a factor are of primary relevance when deciding on the length of treatment. Patients after a thromboembolic event provoked by a transitory (reversible) risk factor (surgery, accident, estrogen treatment etc.) have a very...

Cardiotoxicity of antracycline treatment in the light of new biochemical diagnostic options

D. Urbanová, B. Mladosievičová

Vnitr Lek 2007, 53(6):669-677  

Oncologic patients often receive treatment which is potentially cardiotoxic. Cardiotoxic complications range from fairly mild (relatively benign arrhythmias) to life threatening conditions (ischemia/myocardial infarction, heart failure, cardiomyopathy). The toxic effect of chemotherapy drugs may impair the integrity of the sarcomere, cause the release of bioactive substances into both tissues and the circulatory system and, consequently, cause necrosis/apoptosis of myocytes. A marker of the scope and severity of damage to the myocardium can be assessed by measuring the levels of cardiac markers in the serum. Cardiologic research is currently focused...

Genetic factors and the risk of cardiovascular diseases

A. Teren, P. Gavorník

Vnitr Lek 2007, 53(6):678-693  

The objective of the study is to summarise the hereditary factors of cardiovascular diseases based on current knowledge, focus will be applied to genetic markers of multifactorial forms of cardiovascular diseases based on atherosclerosis, including their interaction with traditional risk factors.

New knowledge in the heredity of autoimmune diabetes. 1st part - Monogenetically determined types of autoimmune diabetes

J. Vavřinec, J. Vosáhlo

Vnitr Lek 2007, 53(6):694-701  

The incidence of type 1 diabetes (DM1) varies greatly among different nations and ethnic groups. Precise mapping of DM1 incidence and its trends is useful in the study of the interaction of genetic and non-genetic factors which influence the manifestation and course of the disease. Important progress has been made in the understanding of the mechanisms of autoimmune diabetes by the study of genes and autoimmune forms of monogenetic diabetes.

Is familial hypercholesterolemia under control in the Czech Republic?

T. Freiberger, R. Češka

Vnitr Lek 2007, 53(6):703-708  

In 1997, the Czech Republic joined the international project MedPed (Make early diagnosis to Prevent early deaths), the principal objective of which is to dramatically reduce the number of deaths caused by the premature clinical manifestations of atherosclerosis in patients with familial hypercholesterolemia (FH). Stress has been laid on a timely diagnosis, especially in family members of patients who have already been diagnosed with the disease, and on timely application of adequate hypolipidemic therapy. A network of centres dealing with severe inborn dyslipidemias has been set up under the auspices of the Czech Society for Atherosclerosis. As many...

Hypogonadism, a serious complication of chronic renal insufficiency

I. Žofková, P. Bubeníček, I. Sotorník

Vnitr Lek 2007, 53(6):709-714  

Hypogonadism is a frequent complication in patients with chronic renal insufficiency (CHRI). From a pathogenetic point of view, it is a disorder at the level of the hypothalamus caused by central inhibition of the pulsatile generation of gonadotropin releasing hormone (GnRH) and by a primary disorder of gonads. The cause of hypogonadism in dialysed patients is not completely known. The effect of inhibition of erythropoietin production is believed to be one of the factors, as well as the adverse effects of complicated therapeutic procedures and malnutrition. In men, the affection manifests itself as a disorder of sexual functions, inhibition of spermatogenesis,...

The position of neoadjuvant chemotherapy in the treatment of non-small-cell lung carcinoma

I. Špásová

Vnitr Lek 2007, 53(6):715-723  

Surgical treatment of patients with non-small-cell lung carcinoma (NSCLC) offers greatest chances for long-term survival. However, the treatment is applicable only to patients diagnosed at an early stage of the disease, i.e. at stage I or II. The five year survival rate of patients operated at stage IIIA is as low as 23 %. Hence there is a great need for improving survival results, especially in the sphere of systemic chemotherapy, as most tumour relapses involve the formation of metastases. Even though neoadjuvant chemotherapy in the operable stages of NSCLC still appeared very promising as a method of treatment a couple of years ago, recently published...

Malignant arrhythmia in a patient with variant (Prinzmetal's) angina pectoris

T. Skála, M. Hutyra, J. Galuszka, M. Fedorco, R. Husár, M. Richter, J. Lukl

Vnitr Lek 2007, 53(6):724-728  

Malignant arrhythmia is a frequent complication of myocardial ischemia due to the occurrence of coronary artery spasm. The paper describes a patient with variant angina pectoris with an ICD implant who was repeatedly resuscitated for circulatory arrest in malignant arrhythmia. During myocardial ischemia the ECG showed elevations in the ST segments in the region of the ventral cardiac wall, with the formation of permanent polymorphous chamber tachycardia. External defibrillation was necessary due to recurrent tachyarrhythmias. A spasm developed when the RIA (radio immuno assay) was introduced during coronarography. The spasm started in the periphery...

Occurrence of an exceptional complication in an attempt to apply temporary pacemaking

D. Richter, M. Hutyra, J. Lukl, P. Němec

Vnitr Lek 2007, 53(6):729-732  

The case study reports the case of a female patient who, during an admission exam in an area medical centre, presented with severe symptomatic bradyarrhythmia and the need for temporary external pacemaking. The first attempt to perform temporary transvenous pacemaking failed and was accompanied by a rare but serious iatrogenic complication which necessitated heart surgery. The case study is completed with illustrative figures.

Zamrazil V. Hypotyreóza. Průvodce ošetřujícího lékaře

Karola Balšíková

Vnitr Lek 2007, 53(6):778  

Vondráček L, Dvořáková V. Pochybení a sankce při poskytování lékařské péče

Lukáš Prudil

Vnitr Lek 2007, 53(6):778  

Contribution of Department of nephrology of L. Pasteur Teaching Hospital and the UPJŠ Medical Faculty, Košice (SK), to Czech nephrology

M. Mydlík, K. Derzsiová

Vnitr Lek 2007, 53(6):775-777  

The paper deals with the contribution of L. Pasteur Teaching Hospital and the UPJŠ Medical Faculty, Košice, to Czech nephrology studies between 1954 and 2006. Specific reference is made to cooperation with different clinics, wards and institutes in Prague, Hradec Králové, Pilsen and Brno in the sphere of therapeutic and proactive care, teaching activities, lecturing and publishing activities, as well as active involvement in research projects. Cooperation in all the above spheres attained and maintained high level, promoted the creation of friendly relations between Czech nephrology experts and the staff of the 1st and 4th Internal Clinics and, beginning...

Improvement in the results of treatment of selected blood diseases and changes in the costs of such treatment. Issues for economists and other experts

Z. Adam, J. Vorlíček, Z. Kořístek, Z. Adamová

Vnitr Lek 2007, 53(6):735-749  

The text maps the changes in treatment results and costs for three haematological diseases; multiple myeloma; diffuse large B-cell lymphoma and chronic myeloid leukaemia. At the beginning of the 1990's, the alkeran - prednisone combination was the golden standard in the treatment of myeloma. In the mid 1990's, the treatment results in younger patients were dramatically improved by high-dose chemotherapy with autologous transplantation. The first decade of the new millennium has brought about even better results after the introduction of thalidomide in the initial treatment in patients not indicated for transplantation. Improvement is also expected...

Qualified decisions based on credible data are necessary

J. Holčík

Vnitr Lek 2007, 53(6):750-759  

This paper is a reaction to an article giving evidence on the growth in the cost of treatment of selected malignant blood diseases. The relationship between the market and health care is explained, as well as the principles of public and private health insurance. Principal decision-making factors such as scientifically proven data, personal or group values and preferences and political and logistic potential are referred to. Private health insurance in Great Britain is used to exemplify the strong and weak points of private health insurance in general. The author brings attention to the need for systematic negotiation with health insurance companies...

Cost of medication in the Czech Republic - causes of growth in costs and solution proposals

Z. Zigová

Vnitr Lek 2007, 53(6):760-774  

The costs of medication represent a great part of total health costs in the Czech Republic. In the sphere of drugs, as in other segments of the health sector in this country, constant pressure is put on the growth in expenditure irrespective of the actual growth of the economy. The article is a reaction to the paper by Adam Z et al, Improvement in the results of treatment of selected blood diseases and changes in the costs of such treatment Issues for economists and other experts. The article presents data on the trend towards a growth of costs in the health sector and the causes of such a trend, with special focus on expenditure for expensive cancer...