Konsenzuální stanovisko k poskytování paliativní péče u nemocných s nezvratným orgánovým selháním

V. Černý, K. Cvachovec, R. Pařízková, P. Ševčík, L. Rožnovská, J. Šimek, O. Dostál, L. Heger, J. Maláska, M. Matějovič, D. Nalos, I. Novák, J. Payne, K. Rusinová, P. Tavel, M. Vácha

Vnitr Lek 2009, 55(9):846-849  

XVI. kongres České internistické společnosti ČLS J. E. Purkyně. Praha, 13.-16. 9. 2009

Vnitr Lek 2009, 55(9):851-906  

Prof. MUDr. Miloš Štejfa, DrSc., FESC (*28. 5. 1929)

Jiří Vítovec, Jindřich Špinar

Vnitr Lek 2009, 55(9):694-695  

Zamyšlení nad internou

M. Štejfa

Vnitr Lek 2009, 55(9):696-701  

Myocarditis

J. Vítovec, J. Lipoldová

Vnitr Lek 2009, 55(9):702-709  

Myocarditis is a disorder with a wide range of symptoms spanning from light breathlessness or chest pain, ceasing without specific treatment, through cardiogenic shock, requiring left ventricular assistance, to sudden death. Dilated cardiomyopathy with chronic cardiac failure might be the very consequence of the precedent myocarditis. Myocarditis is the most frequently caused by viral infections, less frequently by specific infections, toxic or hypersensitivity reactions to medicines, giant cell myocarditis or sarcoidosis. Prognosis and treatment differ according to the cause, clinical or haemodynamic signs inform decision-making on care provided by...

Heart transplantation

P. Hude, L. Špinarová, J. Krejčí, H. Bedáňová, P. Němec, J. Vítovec

Vnitr Lek 2009, 55(9):711-717  

The first heart transplantation (SHT) was performed by Professor Ch. Barnard in 1967 but it was not until 1980s that this method became an established approach to treatment of patients with end-stage heart failure. Considering the limited number of donor organs and the number of potential post-transplantation complications, the decision to perform heart transplantation at the right time in an indicated patient is difficult and complex. Subsequent pharmacological management with immunosuppressive agents and other medication becomes everyday life reality. Knowledge of drug interactions and collaboration with cardiologists are necessary in order to maintain...

Hypertension combination therapy with rennin-angiotenzin system blockers

M. Souček

Vnitr Lek 2009, 55(9):719-723  

Target blood pressure levels are not being achieved with the current hypertension treatment. Monotherapy that normalizes BP in about 20% of patients does not provide sufficient control to reach this goal and thus combination therapy is required. Results from recent clinical studies showed that a combination of an angiotenzin-converting enzyme inhibitor (ACEi) with a calcium channel blocker (CCB) provide better results and reduced incidence of cardiovascular events than a combination of a diuretic with an ACE inhibitor. Combination therapy based on rennin-angiotenzin system blockade: ACEi with a CCB, ACEi with a diuretic or angiotenzin receptor blocker...

Cholesterol levels according to age

J. Špinar, O. Ludka, M. Šenkyříková, J. Vítovec, L. Špinarová, L. Dušek

Vnitr Lek 2009, 55(9):724-729  

Cholesterol levels were measured at public places (mostly department stores) from 2005 to 2008. Sampling was conducted at random, from volunteers, without any prior dietary restrictions. In total, 14,539 persons were assessed. We did not find any significant differences between sexes in cholesterol levels (overall median was 5 mmol/l; 4.9 mmol/l in men and 5.1 mmol/l in women). Smaller proportion of women than men had cholesterol levels lower than 5.0 mmol/l (53.0% of men and 45.2% of women). Cholesterol levels raise with age in both sexes, stagnate at a certain point and subsequently decline; we identified a significant difference in this between...

Echocardiography in patients with ischemic heart disease

V. Chaloupka

Vnitr Lek 2009, 55(9):730-736  

The assessment of the patients with coronary artery disease is one of the most important clinical applications of echocardiography. The importance of this application lies in the fact that coronary artery disease is the most common form of heart disease and the leading cause of death in all industrial countries. Echocardiography plays a diagnostic role at all stages of the disease from the early detection of transient, stress-induced, ischemic dysfunction, through the phase of acute myocardial infarction and its attendant complications, to the development of chronic ischemic heart disease and heart failure. Finally, echocardiography often provides...

Transplantation of haematopoietic cells

M. Krejčí, J. Mayer, Z. Adam, J. Vorlíček

Vnitr Lek 2009, 55(9):738-745  

Autologous and allogeneic transplantations of haematopoietic cells form an important part of treatment of, particularly haematological, malignancies but have their place in the treatment of other diseases as well. Transplantation brings permanent remission in a number of patients. However, transplantation, and the allogeneic one in particular, is associated with a range of complications. The following review paper provides information on the types of transplants, their collection and processing, on the options for and ways to seek suitable donors of haematopoietic cells. Other sections of the paper focus on preparatory pre-transplantation regimens...

B-cell chronic lymphocytic leukaemia and the similar states

M. Krejčí, Z. Adam, L. Pour, Y. Brychtová, J. Mayer, J. Vorlíček

Vnitr Lek 2009, 55(9):746-765  

B-cell chronic lymphocytic leukaemia and the similar diseases are seen predominantly in patients above the age 50 years, i.e. at the age when the patients also have other co-morbidities. The knowledge of these diseases on molecular level has improved significantly over the last decade. Molecular and biological prognostic factors are available in routine everyday practice. Assessment of these factors enables prediction of prognosis and, in some cases, also the response to therapy. The aim of the present review is to provide the medical community with the main information on this disease as patients with B-cell chronic lymphocytic leukaemia and similar...

The importance of autologous transplantation in multiple myeloma

L. Pour, R. Hájek, Z. Adam, M. Krejčí, J. Vorlíček

Vnitr Lek 2009, 55(9):767-772  

Several randomized clinical trials in multiple myeloma (MM) completed in the last two decades have clearly shown that high-dose chemotherapy with hematopoietic stem cell support significantly increases the number of complete remissions and median overall survival in comparison to conventional chemotherapy. The median survival of MM patients treated with conventional chemotherapy is approximately 4 years in contrast to 5 to 6 years with autologous transplantation. Although high-dose chemotherapy with autologous transplantation is not curative and most patients will eventually relapse, more than 20% of patients treated using this strategy experience...

Liver cirrhosis and its treatment

J. Lata, T. Vaňásek, O. Stibůrek

Vnitr Lek 2009, 55(9):774-778  

Cirrhosis is an end-stage liver disease. It is necessary to always search for the cause, attempt to initiate suitable causal treatment and assess the severity of hepatopathy by evaluating hepatic functional reserve (according to the Child-Pugh classification). It is necessary to continually monitor possible complications of cirrhosis, some can be prevented. Regular clinical and laboratory monitoring as well as ultrasound and endoscopic examinations are required. The paper discusses the treatment of the disease as well as its complications. Cure can only be achieved with a liver transplant; this option should be evaluated by a hepatologist in each patient...

Surgical treatment of pulmonary embolism

P. Němec, B. Uchytil, J. Černý, J. Ondrášek, J. Pol, P. Pokorný

Vnitr Lek 2009, 55(9):779-782  

Background:Surgical embolectomy is established method of treatment of pulmonary embolism. The aim of the study is to evaluate the experience with this procedure. Patients and methods:Twenty two patients, aged 22-77 years, were operated on in Centre of cardiovascular surgery and transplantation in Brno from 1999 to 2009. Nine patients suffered from massive pulmonary embolism with hemodynamic instability, 13 were stable. All the operations were performed in cardiopulmonary bypass with cross clampimg time 50.4 minutes on average. In six patients the retrograde perfusion via pulmonary veins were used. Emboli in the main trunk...

The most common heart valve diseases: aortic stenosis and mitral regurgitation. A few comments on guidelines and recommendations by societies of cardiology

R. Čerbák

Vnitr Lek 2009, 55(9):784-787  

Recommendations of professional societies, frequently called guidelines as per the English translation, provide help to the general practice as well as specialized physicians. These are recommendations, not a legislative norm. Societies of cardiology have issued 3 new guidelines over the recent years; American ACC/AHA in 2006 and European ESC and Czech CSC in 2007. Guidelines for diagnostics and therapy are presented as Class I to III according to the suitability of the procedure and the level of evidence is classified in groups A to C. Emphasised is the effort of societies of cardiology to provide unbiased guidelines. They request the authors to provide...

Diabetes and vascular diabetic disease

J. Murín, M. Yaghy

Vnitr Lek 2009, 55(9):788-791  

The prevalence of type 2 diabetes mellitus is growing. Vascular disease is here the main cause of morbidity and mortality, and accelerated atherosclerosis is responsible for about 80% of mortality and for about 75% of hospitalizations. In diabetics there is 2-4times greater risk of ischemic heart disease in comparison to non-diabetics, and this risk is even greater in diabetic-females. Authors put greater attention to pathophysiology of diabetic vascular disease (inflammation and adipose tissue, metabolic and other - AGEs, ADMA - abnormalities, their contribution to endothelial dysfunction). The main concern is devoted to the treatment possibilities...

Tako-tsubo cardiomyopathy

M. Aschermann, O. Aschermann

Vnitr Lek 2009, 55(9):792-796  

Tako-tsubo cardiomyopathy is new clinical syndrome which mimic acute myocardial infarction. The main characteristic is apical ballooning of the left ventricular wall during systole and normal findings on coronary arteries. Pathophysiology is not known, very important is definitively the role of catecholamines. The electrocardiography, echocardiography, left ventricular angiography and coronary angiography are methods used in diagnosis of this syndrome. The therapy is only symptomatic, in cases with severe complications mechanical support of circulation should be used.

Reducing food salt content - a neglected approach to hypertension prevention and treatment in the population

K. Horký

Vnitr Lek 2009, 55(9):797-801  

Long-term dietary salt supply, disproportional to the high metabolic requirements, plays an important role in pathogenesis of arterial hypertension. BP, its rise with age and hypertension prevalence in the population are directly proportional to sodium supply. Consistent effect of salt supply on the BP values is documented from observational as well as randomised controlled studies. It is, therefore, possible to assume that decrease in salt intake in the population could positively affect population BP mean, age-related increase in BP as well as a range of cardiovascular complications of hypertension and could thus contribute to improving the course...

To treat or not to treat with statins patients with chronic heart failure?

J. Hradec

Vnitr Lek 2009, 55(9):802-807  

Two clinical trials - CORONA and GISSI-HF - have been conducted to resolve uncertainties about the effects of statins in patients with chronic heart failure and justified suspicions that treatment with statins in these patients might be detrimental. The CORONA trial researched the effects of 10 mg rosuvastatin compared to placebo on the incidence of serious cardiovascular events in 5,011 patients with systolic heart failure of ischemic aetiology, above 60 years of age and in the NYHA functional class II-IV. Even though rosuvastatin reduced the mean LDL-cholesterol plasma concentrations by 45.0% (p < 0.001) and high-sensitivity C-reactive protein...

How to improve response to cardiac resynchronization therapy?

J. Lukl

Vnitr Lek 2009, 55(9):808-811  

Cardiac resynchronization therapy decreases mortality and rehospitalization for heart failure. However, around 30% of patients do not respond to this therapy. The paper analyses factors, with a possible impact on the response to this therapy. It is a left ventricular lead proximity to the left ventricle segment with the latest activity, presence and size of postinfarction scar and a percentage of fully captured paced beats. Methods of optimalization of these factors are described as well as circumstances, under which some patients should be indicated for cardiosurgical lead implantation or if a cardiac resynchronization therapy should be ommited.

Monitoring of cardiovascular risk factors in patients with diabetes type 2

B. Petrlová, H. Rosolová, J. Šimon, F. Šefrna, P. Šifalda, I. Šípová

Vnitr Lek 2009, 55(9):812-818  

The control of basic cardiovascular risk factors was examined in a sample of 415 diabetes type 2 patients, aged 66 ± 10 years, with a 9.4 ± 8 years long history of diabetes, both genders represented proportionally; 95% of the sample were hypertensive. The recommended blood pressure value was achieved by 13% males and 17% females. Antihypertensive monotherapy was indicated in 40% of the sample. Renin-angiotensin-aldosteron system inhibitors were prescibed to 90% of the sample. The fasting glycaemia ≤ 6 mmol/L were achieved in 10% males and 11% females; glycosilated hemoglobin < 4.5 % in 20% males and 24% females; 60% of the sample...

Prediabetes - 2009

J. Rybka

Vnitr Lek 2009, 55(9):819-826  

The concept of prediabetes has been discussed since the 1950's. After 1980, WHO expert guidelines on the classification of diabetes according to its stages of development became common. These guidelines also included statistically significant risk groups with diabetes likely to develop in the future. The term Impaired Glucose Tolerance (IGT) was officially introduced by WHO in 1979, with an additional category referring to changes in glucose metabolism to be included later on - the Impaired Fasting Glucose - IFG. The term prediabetes mellitus began to be used again after 2000, and after 2003 diagnostic criteria to delimit diabetes and prediabetes came...

Some current views on chronic ischemic heart disease

J. Vojáček

Vnitr Lek 2009, 55(9):827-831  

Chronic myocardial ischemia results from a temporary disbalance between supply of oxygen to myocardium and consumption of oxygen by myocardium. The most frequent cause of ischemic heart disease is atherosclerosis of the coronary arteries. At present, diagnosis of coronary impairment is for practical reasons not possible until myocardial ischemia is detectable. Despite the current pharmacological treatments, data from the recent studies justify stratification of prognosis of patients with chronic ischemic heart disease into subgroups with low, medium and high risk. Mean annual mortality is below 1% in patients with low risk, 1-2% in patients with medium...

Target values in hypertension treatment. Will they apply in older patients with hypertension, diabetics and in patients with IHD?

J. Widimský

Vnitr Lek 2009, 55(9):833-840  

The incidence of isolated systolic hypertension increases with age since 50 years. Systolic pressure appears to have higher prognostic importance than diastolic pressure in patients older than 50 years. Treatment of isolated systolic hypertension importantly decreases cerebrovascular events, coronary events as well as overall mortality. Studies providing the relevant evidence have mostly been conducted at the beginning of 1990s. The baseline systolic pressure in all these studies was 160 mmHg and higher. This is because the isolated systolic hypertension then was defined as systolic pressure of 160 mmHg or higher and diastolic hypertension as pressure...

AT₁-blockers in the treatment of hypertension

J. Widimský jr.

Vnitr Lek 2009, 55(9):841-844  

Angiotensin receptor antagonists (AT₁-blockers) are considered as one of the major classes of antihypertensive drugs suitable for monotherapy as well as for combination treatment. Mechanisms of antihypertensive effects of AT₁-blockers are discussed altogether with the results of large clinical trials and indication in hypertension.