Vnitřní lékařství, 2011 (vol. 57), issue 11

Personalia

Životní jubileum prof. MUDr. Jaroslava Rybky, DrSc.

K. Horký

Vnitr Lek 2011, 57(11):886-887

80. narozeniny prof. MUDr. Jaroslava Rybky, DrSc.

Current and future options for treatment of osteoporosis

J. Blahoš

Vnitr Lek 2011, 57(11):888-890

The author describes actual and perspective treatment of osteoporosis. Basic treatment consists in calcium, vitamin D, physical activity, restriction of risk factors and prevention of falls. Actual treatment includes antiresorptive drugs (calcitonin, bisphosphonates, estrogens and SERM) and denosumab. Perspective emerging drugs are also mentioned.

Chronic pancreatitis in 2011

P. Dítě, J. Trna, I. Novotný, K. Floreanová, H. Nechutová, E. Geryk

Vnitr Lek 2011, 57(11):891-896

The incidence of chronic pancreatitis grows slowly but steadily. At present, alcohol is the most frequent risk factor, although the new forms of so called non-alcoholic chronic pancreatitis, such as genetically induced pancreatitis and its autoimmune variety, are carefully watched. Alcohol consumption continues to be most closely associated with the disease, though it is no more than a risk factor and other aspects, e.g. genetic predisposition, are prerequisite to the disease development. Imaging methods play a fundamental role in diagnosing the disease; non-invasive magnetic resonance and CT, invasive but safe endosonography, and diagnostically rarely...

Pathophysiological background for incretin therapy: is it capable of more than we think?

M. Haluzík, M. Urbanová, D. Haluzíková, P. Trachta

Vnitr Lek 2011, 57(11):897-902

Incretin-based therapy functions through the increase of endogenous glucagon-like peptide-1 (GLP-1) levels due to inhibition of dipeptidyl peptidase-4 - an enzyme degrading GLP-1 (gliptins) or through the administration of drugs activating GLP-1 receptor (GLP-1 agonists). Both approaches increase insulin and decrease glucagon secretion leading to improved diabetes compensation. The advantages of gliptins include little side effects, body weight neutrality and potential protective effects on pancreatic β cells. GLP-1 agonists on the top of that consistently decrease body weight and blood pressure and their effects on diabetes compensation and likelihood...

How should we perceive psychosomatic medicine

R. Honzák

Vnitr Lek 2011, 57(11):903-907

Psychosomatic (behavioral) medicine is a field of medicine concerned with the development, integration, and application of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. It offers a broader view on the problem than EBM because in addition to disease also focuses on the patient.

Adherence to the international guidelines on the treatment of diabetic leg syndrome - options available in the Czech Republic

A. Jirkovská

Vnitr Lek 2011, 57(11):908-912

Possibilities of fulfilling of the practical guidelines on the management of the diabetic foot in the Czech Republic are limited by lack of experts and specialized place of work in podiatry, inconsiderable are economic problems, too. Foot care is of highest quality when is directed by a multidisciplinary foot team. In the Czech Republic, there is an urgent need for podiatry training programme and foot clinic support. Investing in diabetic foot programme can be one of the most cost-effective forms of healthcare expenditure, provided the programme is goal-focused and properly implemented. Paper deal with key points of the podiatry programme - organization,...

Antibiotic treatment of acute bacterial infections

M. Kolář

Vnitr Lek 2011, 57(11):913-915

The presented text is concerned with the basic approaches to antibiotic treatment of acute bacterial infections in both community and hospital settings.

Incretins have changed and continue to change treatment strategy for type 2 diabetes

M. Kvapil

Vnitr Lek 2011, 57(11):916-918

Incretins are a novel class of drugs indicated for therapeutic intervention in patients with type 2 diabetes. They provide effective and safe therapy. Their advantages include low risk of hypoglycaemia and positive effect on body weight. Literature published so far consistently evidences reduced cardiovascular risk. If long-term prospective studies confirm such an effect, incretin therapy will, together with metformin, become the first line treatment for type 2 diabetes.

Modern technologies in diabetology. CSII (Continuous Subcutaneous Insulin Infusion) and CGM (Continuous Glucose Monitoring) in clinical practice

J. Olšovský

Vnitr Lek 2011, 57(11):919-922

Modern diabetology is closely associated with the use of modern technologies; glucometres are now widely clinically used and it is difficult to envisage diabetology without these devices. At present, CSII and CGM are less frequently used but they certainly are equally exciting. The author discusses both methods individually as well their interrelationship, mainly from the perspective of their optimal use.

Is retardation of radiologic progression of ankylosing spondylitis possible?

K. Pavelka

Vnitr Lek 2011, 57(11):923-929

In the introduction is the author dealing with problems of early diagnosis of ankylosing spondylitis and he is explaining the advantages of new ASAS/EULAR criteria for diagnosis of axial spondylarthritis. Than he continues with discussion about new "Recommendations for treatment of ankylosing spondylitis", stressing the modification of recommendations for anti-TNF therapy. Despite the fact, that high symptomatic efficacy of anti-TNF therapy was confirmed, there is no clear evidence that anti-TNF drugs delay radiologic progression. On the contrary, study with nonsteroidal antirheumatic drugs in duration 24 months was performed and have documented that...

Insulin therapy in 2011

J. Perušičová

Vnitr Lek 2011, 57(11):930-936

Current medicine, including insulin therapy of type 1 and type 2 diabetes, emphasises "individualized" treatment approach. The basic requirements for such approach include: early initiation of insulin therapy, minimizing adverse drug reactions (hypoglycaemia, weight gain, poorer quality of life) and selection of the best insulin regimen. Therapy has to achieve long-term satisfactory diabetes control to prevent chronic vascular complications. Treatment should aim at reducing HbA_1c levels as well as limiting postprandial glycaemia (fluctuations of glucose levels before and after food increase the risk of vascular complications). It has been...

Genetics of monogenic forms of diabetes

J. Staník, M. Hučková, D. Staníková, I. Mašindová, L. Valentínová, D. Gašperíková, I. Klimeš

Vnitr Lek 2011, 57(11):937-945

Monogenic diabetes mellitus is a type of diabetes, where genetics without any other factors is strong enough to cause the disease. According to the clinical features monogenic diabetes can be divided to the mild familial early onset diabetes, familial fasting hyperglycemia, diabetes with extrapancreatic features and neonatal diabetes mellitus. During the last several years the number of genes causing monogenic diabetes has continuously increased. The clinical picture of the monogenic diabetes is very heterogeneous, thus DNA analysis is required for identification of the diabetes etiology, which influences also the choice of treatment. This article...

Management of obesity - options, effectiveness and perspectives

Š. Svačina

Vnitr Lek 2011, 57(11):946-948

Weight reduction is an obvious aim of the obesity treatment. However, modern obesitology emphasises prevention of complications associated with obesity and improving the quality of life of obese patients. Consequently, obesity is a difficult to treat disease with respect to permanent weight reduction and easier to treat condition with respect to the quality of life. Life style changes usually fail as a treatment option, unless they are accompanied with personally demanding psychotherapy and motivational support. Compliance with the requirements for diabetes prevention is effective even without weight reduction. Treatment with anti-obesity medication...

Pathogenesis of type 1 and type 2 diabetes in 2011 - the unifying model of glucoregulation disorder

J. Škrha

Vnitr Lek 2011, 57(11):949-953

Present knowledge on pathogenic mechanisms in type 1 and type 2 diabetes mellitus may offer the identical scheme of the cascade steps disturbing B-cell and its organells. The only one difference is based in the initiation of the whole cascade by cytokines activated in previous infection (Type 1 DM) or by increased concentration of free fatty acids (Type 2 DM) in the individuals with different genetic background for both types of diabetes. Impaired function and structure of mitochondria causes cell failure and its following apoptosis. The elucidation of the cause of changes in developed diabetes enables to suggest some perspective therapeutic approaches...

An outlook to the future of pharmacotherapy for type 2 diabetes mellitus

A. Šmahelová

Vnitr Lek 2011, 57(11):954-958

A new class of drugs that affect incretin system has been introduced in clinical practice, and renal glucose reabsorption inhibitors are soon to follow. Clinical practice thus has an access to drugs with mechanisms of action that differ from those of the currently available antidiabetics, and extend our ability to influence the multifaceted metabolic disorder associated with the type 2 diabetes. Non-peptide molecules affecting GLP1 receptor and insulin mimetics are being tested in clinical trials. Research also continues in metabolic modulators of nuclear receptors, glucagon receptor antagonists and cellular glucocorticoid inhibitors. Promising are...

Pharmacotherapy of chronic heart failure after the first decade of 21^st century

J. Špinar, J. Vítovec, L. Špinarová

Vnitr Lek 2011, 57(11):959-965

We provide an overview of the main principles of pharmacological treatment of chronic heart failure. Chronic heart failure is considered to be an epidemic of the 21^st century; in the Czech Republic, around 200,000 persons suffer from this condition. Over the last decade, pharmacological and non-pharmacological treatment of heart failure has undergone significant progress and new knowledge arises every year. Generally accepted pharmacological treatment steps include administration of ACE inhibitors, AII antagonists (ARB) or beta-blockers, discussions exists on an indication for digoxin, diuretics and lipid-lowering drugs as well as on the...

Pharmacotherapy following myocardial infarction

L. Špinarová, J. Špinar, J. Vítovec

Vnitr Lek 2011, 57(11):966-969

Early reperfusion is the treatment of choice for acute coronary syndrome. In the Czech Republic, reperfusion therapy is well accessible thanks to the network of 22 catheterization centres. Every year, 28,000 patients are treated using this technique. Successful reperfusion should be followed by life style changes - smoking cessation, maintenance of appropriate body weight etc. These steps than has to be accompanied by effective pharmacotherapy to prevent remodelling of the left ventricle, re-stenosis of the coronary artery, re-thrombosis and arrhythmias. Four drug groups provide the desired effects - renin-angiotensin-aldosterone system blockers, beta-blockers,...

Advances in metabolism and nutrition 2011 and the route to personalized treatment

Z. Zadák, A. Tichá, M. Hronek, R. Hyšpler

Vnitr Lek 2011, 57(11):970-974

Current model of metabolic and nutritional disorders management utilizes modern techniques that promote some of the nutritional techniques to pharmacoteherapy. This approach is demonstrated on an example of multiple organ failure and systemic inflammatory reaction managed with pharmacologically active nutritional substrates, such as arginine, glutamine, taurine, threonine and cysteine. Treatment of sarcopenia in older age is also discussed. Personalized nourishment as a component part of a wider term personalized medicine represents a new approach that requires recognition of individual differences in human genome and its expression. However, this...