K významnému životnímu jubileu prof. MUDr. Jaroslava Blahoše, DrSc.

Vnitr Lek 2010, 56(7):633  

Prof. MUDr. Jaroslav Blahoš, DrSc., jubilující

Vladimír Palička

Vnitr Lek 2010, 56(7):637-638  

Váženému pánovi prof. MUDr. Jaroslavovi Blahošovi, DrSc.

Ivan Ďuriš

Vnitr Lek 2010, 56(7):639  

Váženému pánovi profesorovi MUDr. Jaroslavovi Blahošovi, DrSc.

Ivan Hulín

Vnitr Lek 2010, 56(7):640  

Veda a medicína

I. Hulín, J. Blahoš

Vnitr Lek 2010, 56(7):641-645  

Hyperlipoproteinaemia and dyslipoproteinaemia II. Therapy: Non-pharmacological and pharmacological approaches

R. Češka, S. Krutská, L. Kašná, G. Šmelková, L. Zlatohlávek, M. Vrablík

Vnitr Lek 2010, 56(7):647-654  

At present, literally no one disputes hyperlipoproteinaemia and dyslipidemia (HLP and DLP) treatment as a rational therapeutic approach in the prevention of cardiovascular diseases (CVD). This approach is in line with the current principles of evidence-based medicine (EBM) and is sufficiently evidenced particularly by the results of large intervention studies. Nevertheless! When the results of the recent studies are critically appraised, these by no means are (mostly, there, obviously, are exceptions) as conclusive as the studies conducted in 1980s and 1990s. Consequently, positive results are being sought in subanalyses, subgroup evaluations and multiple-study...

Chronic pancreatitis and the skeleton

H. Dujsíková, I. Novotný, J. Tomandl, P. Dítě

Vnitr Lek 2010, 56(7):656-662  

The aim of our work was to determine the incidence of bone demineralization in patients with chronic pancreatitis, following the relation between the funcionality of the pancreatic tissue and etiological factors in the development of osteopathy and calciophosphate metabolism. Prospectivelly, during 1 year we followed 55 patients with chronic pancreatitis of different etiology verified by endoultrasound. Patients with other possible cause of osteopathy were not included in the group. In the following of calciophosphate metabolism we determined different biochemical parameters and we measured the bone mass with densitometry in standard locations. In...

Necessity of continuous health system development

J. Holčík

Vnitr Lek 2010, 56(7):663-668  

Increasing number of chronic diseases and accelerating costs of health care are important problems of health services system. Article presents four main methods of solving these difficulties: (a) more money to the system, (b) better effectiveness and efficiency of health services, (c) rationing, and (d) improvement of population health. The first three methods are limited, but increasing level of health is almost without any boundaries. The health education and professional training focused on better health literacy are important prerequisites of good health care system.

ECG markers in patients with hypertrophic cardiomyopathy

K. Hudecová, I. Šimková, M. Bernadič

Vnitr Lek 2010, 56(7):669-675  

Background:Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disease of the heart muscle whose main characteristic is unexplained hypertrophy of the left ventricle and/or right ventricle. It is considered to be the most common genetically determined cardiovascular disease with the prevalence in the population approximately 1 to 500 inhabitants. The disease is associated with severe complications such as heart failure, arrhythmias and sudden cardiac death (SCD). Nowadays the aim of intensive clinical research is to judge the contribution of noninvasive methods in the risk stratification of HCM patients. Abnormal electrocardiogram...

NATO international advanced course on best way of training for mass casualty situations

L. Klein, M. Michaelson

Vnitr Lek 2010, 56(7):676-680  

NATO Advanced Training Course on Best Way of Training for Mass Casualty Situations was held in Haifa, Israel in November 16-18, 2009. In total, 22 participants from 8 countries of the Partnership for Peace and Mediterranean Dialogue Programmes attended the course. The participants, divided within three groups, discussed and practised the training methods for the preshospital aspect, the hospital aspect and the non-conventional aspect of the mass casualty management. An international team of experts, among others, used following teaching methods: general lectures, guided discussions, utilization of advanced multimedia tools, tabletop drills, and large...

Survival and quality of life in burns

R. Königová

Vnitr Lek 2010, 56(7):681-685  

Advances in medical technology and practices have been associated with increasing medical specialization, but they have developed at a price. This price has included not only enormous financial costs, but the additional cost of dehumanized patient care, diminished confidence in the medical staff and, consequently, human suffering. Burn injuries are catastrophic in scope and require specialized, intensive and prolonged treatment from which ensure ethical and psychological problems often complicated by many individual factors. Some of them arising from the Code of Patients Rights not only in the Czech Republic and contribute to DNR decisions (do-not-resuscitate)....

Twelve years of continuing medical education in Slovakia

P. Krištúfek, J. Gajdošík

Vnitr Lek 2010, 56(7):686-689  

Continuing medical education (CME) is an important part of the medical practice today. After the pregraduate and postgraduate education each general practitioner and specialist should follow the CME to maintain, develop or increase the knowledge and professional skills [1]. In May of 2004 a Slovak accreditation council for continuing medical education (SACCME) was established on the base of mutual agreement among statutory representatives of Slovak Medical University, Association of Medical Schools, Slovak Medical Association, Slovak Medical Chamber, and Association of Private Physicians as non governmental non for profit organisations. During the...

Pituitary adenomas - where is the treatment heading at the beginning of the 21st century?

J. Marek

Vnitr Lek 2010, 56(7):690-694  

To treat pituitary adenomas, three modes of treatment are usually combined: neurosurgery, radiation and pharmacological. Prolactinomas are an exception with predominantly pharmacological management. Patients with acromegaly are usually diagnosed late and thus many neurosurgeries fail to completely remove the adenoma. Any residual tumour tissue is usually irradiated with the Leksell Gamma Knife, and dopamine agonists, somatostatine analogues or growth hormone receptor antagonists are used to normalize the hormonal hypersecretion until the complete effect of the radiation. The same surgical and Gamma Knife procedures are used in patients with the Cushing's...

Oxalic acid - important uremic toxin

M. Mydlík, K. Derzsiová

Vnitr Lek 2010, 56(7):695-701  

Introduction:Oxalic acid is thought to be a significant uremic toxin that participates in the pathogenesis of uremic syndrome. Aim of the study was to summarise results which we obtained during the study of oxalic acid in biological fluids (plasma, saliva, urine and dialysate) in patients suffering from chronic kidney diseases (CKD), stage 3-5 and after renal transplantation. Patients and methods:In the retrospective study were investigated 28 healthy subjects, 112 CKD stage 1-4 patients, 39 haemodialysis patients and 27 CAPD patients. Besides 21 patients were investigated after renal transplantation. We used the...

The influence of testosterone on cardiovascular disease in men

J. Payer, A. Baňárová

Vnitr Lek 2010, 56(7):702-708  

The influence of testosterone on cardiovascular disease is recently discussed question. Testosterone modulates vascular reactivity by genomic and nongenomic modes of action, it has an impact on endothelial function, production of proinflamatory cytokines and lipid profiles. The possible role of sex hormone binding globulin (SHBG) in androgen action by plasmatic membrane receptors breaks "the free hormone hypothesis", especially when clinical trials reveal strong association between SHBG and risk factors of cardiovascular disease. The results of last clinical trials mention that androgen deficiency is associated with obesity, insulin resistance and...

Current options and principles of pathomorphology-based tumour diagnostics

C. Povýšil

Vnitr Lek 2010, 56(7):709-714  

Modern pathomorphology tumour diagnostics involve comprehensive cytology cell examination and, importantly, tissue biopsy examination using the most up-to-date assessment techniques. To correctly classify a tumour process, it is essential not only to define its histological typology and identify its biological character but, at the same time, using immunohistochemistry and diagnostic molecular pathology, to evaluate prognostic and predictive indicators. As regards the prognostic indicators, it is mainly grading and staging as part of the TNM system, the sentinel lymph node assessment, if it is assessed, and other nodes extracted in this context. Histological...

Natriuretic peptides in patients with aortic stenosis

I. Riečanský, B. Líška, M. Vršanský, I. Pecháň, K. Daňová

Vnitr Lek 2010, 56(7):715-720  

Introduction:The aim of this research was to, in patients with severe (tight) aortic stenosis (AoS), evaluate a) an association between clinical and some haemodynamic characteristics and natriuretic peptides (ANP, BNP) concentrations and b) usefulness of these hormones in the decision making on the next therapeutic steps. Methods:Echocardiography and 6-minut exertion walking test were performed in 23 consecutive patients (12 men, 11 women; age 67 ± 7 years) and 20 controls together with ANP and BNP measurements from three plasma samples before, immediately after and 20 minutes after the exertion test. Results:There...

Cardiovascular diseases in rheumatoid arthritis

J. Rovenský, M. Vlček, R. Imrich

Vnitr Lek 2010, 56(7):721-723  

Risk of cardiovascular diseases is significantly higher in patients with rheumatoid arthritis (RA) than in normal population, leading to higher mortality of these patients. An accelerated atherosclerosis has been considered a basis for the increased cardiovascular risk in RA. Besides classical atherosclerosis risk factors, systemic inflammation plays a substantial role. Indirect mechanisms such as insulin resistance and dyslipidemia may play a role, however, inflammation probably causes direct damage to blood vessels. Thus, systemic inflammation has a primary role and other factors accelerate this process. An adequate anti-inflammatory therapy can...

The principles of care for patients with intermittent claudication

K. Roztočil

Vnitr Lek 2010, 56(7):724-726  

Patients with claudication have a high cardiovascular risk and, foremost, require an introduction of the appropriate procedures to stop the progression of the disease and to prevent cardiovascular events as if these were patients with a coronary or cerebrovascular disease. To manage the claudication-associated complaints, surgery and endovascular revascularization procedures, exercise therapy and vasoactive agents with proven clinical efficacy are used.

Distressful journey for the metabolic syndrome to its position in clinical practice

J. Rybka

Vnitr Lek 2010, 56(7):727-735  

MS is a major atherogenic syndrome in our population. The concept of MS has had a very positive effect on our knowledge of the most serious civilization diseases, the genotypic constellation of MS, although monogenic defects explain only a very small part of pathological defects. It is certain, however, that a crucial role played is by interactions between genetic factors and risk factors of external environment. Undoubtedly, insulin resistance, central obesity and impaired metabolism of adipose tissue play an important role in the pathogenesis of MS, and there are other pathogenetic theories. The author discusses briefly the history of MS and presents...

Diabetic osteopathy: previously disputed but most likely important ailment

Š. Svačina

Vnitr Lek 2010, 56(7):736-738  

Diabetic osteopathy is usually not mentioned in the list of diabetic complications. This osteopathy is very important in clinical medicine. In the pathogenesis many factors are involved - bone formation, hyperglycaemia, glycosuria, glycation of collagene etc. Clinically important is the high risk of fractures present in diabetic patients. This risk can be positively and negatively modified by antidiabetic drugs. It is important to find some markers for fracture risk in diabetes. Nowadays only bone densitometry can be used with some limitations to quantify this risk.

Will vaccines appear on the scene of oncology in the near future?

V. Vonka

Vnitr Lek 2010, 56(7):739-746  

In parallel with the increasing knowledge of the role played by the immune system in the control of tumour growth, the efforts to develop anti-cancer vaccines intensify. In the present time two highly efficient prophylactic vaccines against the virus-induced cancers are in use, but a rapid progress in the development of anti-cancer therapeutic vaccines can also be seen. It is conditioned by an increasing understanding of the biology of the tumor cells and the rapid progress in the field of immunology. Nevertheless, these developments are associated with a number of difficulties, among which the immunosuppressive activities of the tumor cells and the...

Current options for the treatment of osteoporosis

V. Vyskočil

Vnitr Lek 2010, 56(7):749-758  

The primary aim of osteoporosis treatment is prevention of osteoporotic fractures. The main factors in the development of these fractures are mechanic resistance of the bone and the bone quality. The importance of risk factor identification increases and it is important to consider the structural analysis of the hip-bone when evaluating and deciding whether to prescribe antiresorptive or osteoanabolic drugs or whether to just modify calcium and vitamin D intake. Various options are currently available for the pharmacological treatment of osteoporosis: calcium and vitamin D supplementation together with aminobisphosphonates, or osteoanabolic treatment...

Biofeedback load technique in the rehabilitation of osteoporotic patients (Biomechanical analysis)

J. Wendlová

Vnitr Lek 2010, 56(7):759-763  

Based on a simple biomechanical analysis, available to physicians, the article recommends carrying a backpack regularly as a part of the complex rehabilitation of osteoporotic patients. Carrying a backpack in front or on the back is recommended for patients with uncomplicated osteoporosis, carrying a backpack only on the back is recommended for patients with osteporotic vertebrae fractures. The importance of carrying a backpack is based upon remove the muscular dysbalance of the trunk muscles and upon increasing the bone strength by compressive force acting upon the vertebrae and proximal femur and activating osteoblasts to osteoformation. The backpack...

Femur strength index versus bone mineral density: new findings (Slovak epidemiological etudy)

J. Wendlová

Vnitr Lek 2010, 56(7):764-770  

Patients and methods:We analysed the data in the sample (n = 3,215) of East Slovak women with a primary or secondary osteopenia, osteoporosis and with risk factors for osteoporosis, aged 20-89 years, median 59 years, 95% C. I. (59.31; 60.07) obtained from dual energy X-ray absorptiometry device (Prodigy-Primo, GE, USA). Measured variables: 1. left proximal femur: T-score total hip, FSI (femur strength index), 2. lumbar vertebrae L₁-L₄: BMD (bone mineral density). Objectives:1. To estimate and to compare an expected frequency of pathological FSI < 1 and T-score total hip ≤ -2.5 SD values in the East...

Laboratory diagnostics and endocrinology

T. Zima

Vnitr Lek 2010, 56(7):771-773  

Laboratory testing is among the most important diagnostic approaches in modern endocrinology; the presented overview summarizes diagnostic algorithms for the core endocrinopaties.

Parvovirus B19 infection - the cause of severe anaemia after renal transplantation

Z. Žilinská, M. Chrastina, J. Breza, M. Drakulová

Vnitr Lek 2010, 56(7):774-778  

Anaemia belongs to the most frequent, mutlifactorial complications after kidney transplantation [1,2]. Blood loss during surgery, iron deficiency, inflammation, bone marrow suppression by immunosuppressants and antiviral medication, use of angiotensin-converting enzyme and/or angiotensin receptor blockers, hyperparathyroidism, allograft dysfunction and at last viral infections participate in the development of posttransplant anaemia [1-3]. Persistent aplastic anaemia after kidney transplantation could be caused by parvovirus B19 infection [1,2,4,5].