Vnitřní lékařství, 2011 (vol. 57), issue 3

60th birthday of prof. Mudr. Jiřího Vítovce, CSc, FESC

Jubilant prof. MUDr. Jiří Vítovec, CSc., FESC

Jindřich Špinar

Vnitr Lek 2011, 57(3):237-238

Internal medicine and cardiology, internists and cardiologists

M. Štejfa

Vnitr Lek 2011, 57(3):239-242

A retrospective on the development of internal medicine as a base from which other specific fields of medicine, including cardiology as one of the largest, branched as consequence of technological progress and transformation from an empirical to a scientific discipline. Similar to the internal medicine tree, cardiology also branches into a number of subspecialities. This is because no one human brain has a capacity to remember and know everything. This has also resulted in a segregation of the operational curricula of internal medicine physicians and cardilogists. However, a close collaboration of all the disciplines is essential as it is the very...

Left ventricular end-systolic wall stress during antihypertensive treatment

J. Bulas, J. Murín, I. Janiga, K. Kozlíková

Vnitr Lek 2011, 57(3):243-247

Introduction:The mechanical load of left the ventricular wall by blood pressure generated during systole causes a strain associated with the impedance to ventricular emptying. Among several indices, the circumferential systolic wall stress is used to describe this load. The calculated stress depends on systolic blood pressure, wall thickness and ventricular cavity dimension. Methods enabling noninvasive quantification of those indices are based on echocardiographic examinations and blood pressure measurements. Left ventricular hypertrophy in hypertension is considered as a compensatory mechanism allowing the heart to withstand the hemodynamic...

Dyslipidemia and obesity 2011. Similarities and differences

R. Češka, M. Vrablík, P. Sucharda

Vnitr Lek 2011, 57(3):248-253

We shall open our overview of issues related to obesity and hyperlipoproteinemia (HLP) or dyslipidemia with a notoriously known truth (that some are still reluctant to accept): HLP/DLP is not obesity. It is certainly not possible to put an equal sign between subcutaneous fat and the level of plasma lipids and lipoproteins. On the other hand, it is obvious that there is a number of connecting links between HLP/DLP and obesity. These associations on one side and differences on the other are the focus of this review paper. (1) HLP/DLP as well as obesity represent a group of high incidence metabolic diseases (gradually evolving from epidemic to pandemic)...

Autoimmune pancreatitis and IgG-positive sclerosing cholangitis

P. Dítě, I. Novotný, J. Lata, M. Růžička, E. Geryk, B. Kianička

Vnitr Lek 2011, 57(3):254-257

Sclerosing cholangitis is a heterogenous disease. Sclerosing cholangitis with an unknown cause is abbreviated PSC. PSC affects extra- as well as intra-hepatic bile ducts and since this is a permanently progressing fibrous condition, it leads to liver cirrhosis. The disease is often associated with a development of cholangocarcinoma and idiopathic intestinal inflammation. Causal therapy does not exist; liver transplantation is indicated. IgG4 cholangitis differs from PSC in a number of features. This form is, unlike PSC, linked to autoimmune pancreatitis (AIP) as well as other IgG4 sclerosing diseases. Anatomically, distal region of ductus choledochus...

The incidence of dyslipidemia in a sample of asymptomatic probands established by the means of Lipoprint system

A. Dukát, S. Oravec, M. Wawruch, P. Gavorník, P. Sabaka

Vnitr Lek 2011, 57(3):258-260

Method of lipoprotein determination on polyamideacryl gel Lipoprint enables an exact quantification nonatherogenic and atherogenic plasma lipoproteins. For its use in human medicine this method was recently approved by FDA. According to majority of nonatherogenic, or atherogenic lipoproteins in their spectrum this method can distinguish nonatherogenic type A vs atherogenic type B. After their identification, there is the possibility for exact means of interventions among patients with higher cardiovascular risk. Also in the group of clinically healthy asymptomatic controls with normolipemia it is possible using this method to estimate the certain group...

External factors catalyzing the development of tumours or providing protection against them

J. Fiala, J. Vorlíček, Z. Mechl, Z. Adam

Vnitr Lek 2011, 57(3):261-284

The number of malignant diseases increases and the question is why. Why is there an increasing incidence of certain cancers and why an increasing number of people dies from them? We do not have a clear answer to these questions. We just know that a development of cancer depends on certain internal predispositions as well as external conditions. We are unable to change our genetic predisposition but we are able, to some extent, influence the intensity of external factors. This paper summarizes information on the effects of external environment on the development of malignant diseases.

Does the medicine have its "trendy" diseases?

A. Hep

Vnitr Lek 2011, 57(3):285-287

The development of new knowledge in medicine is associated with periodical changes in frequency with which certain "interesting" diseases are being diagnosed. Their frequency might be determined by accessibility of information as well as, to a certain extent, by "popularity" of these conditions within the society.

A growing problem - human papillomavirus and head and neck cancers

Z. Mechl, J. Neuwirthová, D. Brančíková

Vnitr Lek 2011, 57(3):288-292

High-risk human papillomavirus (HPV) are implicated in the development of a subset of head and neck cancers, especially those arising from the lingual or palatine tonsils. HPV-associated cancer of the head and neck represent a different disease entity from those associated with the traditional risk factors of tobacco and alcohol use. There has been as increase in the annual incidence of HPV-related cancers in Europe and USA in the past years. It has now become clear that a subset of the head and neck tumors is a sexually transmitted disease with distinct pathogenesis and clinical and pathological features. Research efforts are now focusing on deintensification...

Microalbuminuria. From diabetes to cardiovascular risk

V. Monhart

Vnitr Lek 2011, 57(3):293-298

An increased albuminuria level, known as microalbuminuria is associated with a range of diseases, most frequently with diabetes mellitus and hypertension. Microalbuminuria in type 1 diabetes is an early sign of diabetic nephropathy onset, while it tends to be an indicator of the level of cardiovascular risk in type 2 diabetes and essential hypertension. At present, an increased albumin excretion is considered to be a renal symptom of generalized endothelial dysfunction. A simple investigation, not bothersome to a patient, should be performed early and repeatedly in all patients with diabetes and hypertension, as low microalbuminaemia levels can be...

The ankle brachial index in type 2 diabetes

B. Nussbaumerová, H. Rosolová, J. Ferda, P. Šifalda, I. Šípová, F. Šefrna

Vnitr Lek 2011, 57(3):299-305

Introduction:The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated. Methods:We examined 253 T2DM subjects (135 males, 118 females, aged 66 ± 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined...

Thrombohaemorrhagic syndrome in patients with a myeloproliferative disease with thrombocythemia

M. Penka, J. Kissová, A. Buliková, J. Zavřelová, J. Ovesná, T. Pavlík

Vnitr Lek 2011, 57(3):306-311

Thrombohaemorrhagic syndrome is a clinical syndrome manifesting with concurrent bleeding and thrombosis. It is associated with a range of pathological states, typically with myeloproliferative diseases, paraproteinaemia, liver disease as well as disseminated intravascular coagulation and similar syndromes (so called DIC-like syndrome). Thrombohaemorrhagic syndrome might be a symptom of chronic myeloproliferations, particularly if these are associated with thrombocythemia. It is most frequently linked to essential thrombocythemia. However, in this disease, it seems that the clinical symptoms of bleeding and thrombosis might not be directly determined...

Residual risk of cardiovascular complications and its reduction with a combination of lipid lowering agents

V. Soška

Vnitr Lek 2011, 57(3):313-316

Most patients treated with statins die due to cardiovascular events. The risk of cardiovascular event during statin treatment is called residual risk. The source of residual risk are some risk factors including dyslipidemia, characterized by low HDL-cholesterol, elevated triglycerides and apolipoprotein B, small dense LDL and sometimes also high lipoprotein(a). High residual risk is common in patients with metabolic syndrom, type 2 diabetes mellitus, insulinoresistance and abdominal obesity. Residual risk can be decreased by combination therapy statins with fibrates or statins with niacin; niacin can affect almost all lipids and lipoproteins that participate...

A network of comprehensive cancer care centres in the Czech Republic

J. Vorlíček, J. Fínek, L. Dušek

Vnitr Lek 2011, 57(3):317-319

The exponential growth in medical knowledge is closely followed by expanding range of therapeutic options as well as increasing expenses associated with the use of new diagnostic techniques and treatments. This development requires organizational steps that would ensure that the expenditure is associated with the maximum benefit. The following text discusses foundation and development of a network of cancer care centres in the Czech Republic.

Variability in blood pressure and arterial hypertension

J. Widimský jr.

Vnitr Lek 2011, 57(3):320-324

Blood pressure variability in hypertension is an independent risk factor of cardiovascular complications, especially of stroke. Antihypertensive drugs/classes with powerful antihypertensive effect and suppression of blood pressure variability might have additional impact on the cardiovascular risk in clinical practice. Current evidence suggests that calcium channel blockers (CCB) decrease blood pressure variability more than all other antihypertensive classes. Combination of CCB with ACE-inhibitors suppresses blood pressure variability more than diuretics plus beta-blockers. Within-visit blood pressure variability (measured as coeficient of standard...