K životnímu jubileu prof. MUDr. Zdeňka Plachety, DrSc. (1931)

Pavel Homolka, Jarmila Siegelová, Petr Dobšák, Věra Linhartová

Vnitr Lek 2011, 57(4):422-423  

Předseda České angiologické společnosti, MUDr. Karel Roztočil, CSc., se dožívá 70 let

Jiří Spáčil

Vnitr Lek 2011, 57(4):424  

Úvodní slovo

Alena Šmahelová

Vnitr Lek 2011, 57(4):334  

Diabetes mellitus and the oral cavity

I. Dřízhal, A. Šmahelová, Z. Šustová, E. Kovalová

Vnitr Lek 2011, 57(4):335-338  

The paper summarizes current knowledge on the diseases of the oral cavity that may be related to diabetes mellitus. It draws the attention to the symptoms that signify potential association between the oral cavity disease and so far undiagnosed diabetes. Attention is paid to a connection between type 2 diabetes and periodontitis, as it is known that diabetes mellitus may contribute to the development of periodontitis, although a reciprocal link also exists and decompensated diabetes may be improved when periodontitis is cured.

Xerostomia, hyposialia, sicca syndrome - quantitative disturbances of the salivary flow rate

R. Slezák, I. Berglová, J. Krejsek

Vnitr Lek 2011, 57(4):339-346  

Diseases od salivary glands may be associated with salivary flow rate disturbances. Production of the saliva is evaluated by sialometric tests. The stress is putted on salivary flow rate disturbances in Sjögren's syndrome, drug-induced and postirradiative sialopathy, and diabetes mellitus. The possibility of the stimulation and substitution of the saliva is discussed.

Peptic ulcer disease in patients with diabetes mellitus

I. Tachecí, J. Bureš

Vnitr Lek 2011, 57(4):347-350  

Peptic ulcer disease and diabetes mellitus are the serious chronic diseases with many medicals and socioeconomic consequences. Although the changes leading to the mucosal vulnerability and prolonged healing of ulcers were many times demonstrated in experiment, the clinical data does not confirmed explicit association of those diseases. The patients with diabetes mellitus are threatened by complications of peptic ulcer disease (bleeding, perforation) above all. The Helicobacter pylori prevalence is in diabetics higher, the results of eradication of Helicobacter pylori are unsatisfactory.

Motility disorders and gastric emptying in diabetes mellitus. Current diagnostics and treatment

J. Bureš, A. Šmahelová, I. Tachecí, S. Rejchrt, M. Kopáčová

Vnitr Lek 2011, 57(4):351-355  

Autonomic neuropathy of the gastrointestinal tract is a common complication of diabetes mellitus. However, it is seldom recognised properly as it is rarely considered. In some patients, it might be asymptomatic or hardly compensatable diabetes can be the only one sign. There are non-invasive diagnostic methods to assess gastric emptying rate (¹³C-octanoic acid breath test) or myoelectric activity of the stomach (electrogastrography). The principle treatment comprises optimal control of diabetes and use of prokinetics.

Current trends of surgical therapy of focal liver and pancreatic lesions

Z. Šubrt, A. Ferko, F. Čečka, B. Jon

Vnitr Lek 2011, 57(4):356-363  

Focal liver and pancreatic lesions represent important therapeutic problem in a relatively huge group of patients. Secondary liver tumors are the crucial factor affecting morbidity and mortality in patients with malignancies. Radical surgery is the only therapeutic option that gives the chance of long term survival. The authors present current trends in surgical therapy of liver and pancreatic tumors as a review article.

Steatosis and steatohepatitis in diabetic patient

P. Hůlek, I. Dresslerová

Vnitr Lek 2011, 57(4):364-367  

Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized condition of excess fat deposition within the liver. NAFLD includes a spectrum of liver pathology ranging from bland hepatic steatosis to steatohepatitis and cirrhosis. Nonalcoholic steatohepatitis (NASH) is an inflammatory and fibrosing condition of the liver thought to be an intermediate stage of NAFLD that may progress to end-stage liver disease, liver-related death and hepatocellular carcinoma. Nonalcoholic steatohepatitis (NASH) is a common liver disease that is characterized histologically by hepatic steatosis, lobular inflammation, and hepatocellular ballooning, it can progress...

Diabetes mellitus and the liver cirrhosis

T. Fejfar, V. Šafka, V. Jirkovský, J. Štefánková, P. Hůlek

Vnitr Lek 2011, 57(4):368-371  

Patients with liver cirrhosis have increased risk of diabetes mellitus development, especially when the underlying disease is hereditary hemochromatosis, autoimune hepatitis, non-alcoholic steatohepatitis or chronic hepatitis C. Patients with associated diabetes according to liver cirrhosis complications have worse prognosis and the therapy is influenced by both diseases. The authors bring short review of particular diseases, diagnosis and treatment strategy.

Acute pancreatitis in diabetics

L. Sobotka

Vnitr Lek 2011, 57(4):372-374  

All diabetic patients with acute pancreatitis should be intensively treated and monitored in spite of the fact that 75-80% have mild-to-moderate disease. This is due to difficult diagnosis and problems with standard monitoring due to diabetes and its complications. Especially intensive rehydration and subsequent fluid mobilisation can be difficult. Also glucose control and impaired gut motility can cause difficulties in diabetic patients with acute pancreatitis. Nutrition support should be implemented according to severity of disease and insulin infused to control glycaemia.

Coeliac disease and diabetes

J. Škrha

Vnitr Lek 2011, 57(4):375-377  

Coeliac disease is associated with type 1 diabetes mellitus more than ten times more frequently than it is present in nondiabetic population. It often exists with minimal signs or without them. It may cause different complications if it would remain without treatment. Active screening of coeliac disease and similarly of autoimmune thyreopathy is therefore an integral part of examination in type 1 diabetic patients.

Colorectal cancer and diabetes

Š. Svačina

Vnitr Lek 2011, 57(4):378-380  

Colorectal carcinoma is a tumour with higher incidence in patients with type 2 diabetes and obesity. Recently, a slightly higher risk has also been shown in prediabetic states. The most important latest finding is that of a reduced risk in patients treated with metformin; there is a trend now to also prescribe metformin in patients with disturbed glucose tolerance or increased fasting glycaemia. Regular physical activity and reduced animal fat intake with increased intake of fruits and vegetables may help to prevent the disease. Pathogenesis may include changes to intestinal flora. The most important current preventive clinical measure is colonoscopy....

Analogues of amylin, α-glucosidase inhibitors and the digestive system in homeostasis regulation

J. Rybka

Vnitr Lek 2011, 57(4):381-387  

The digestive tract plays an important role in glucose homeostasis. The important fact is that cells of the digestive tract are also the place of production of numerous regulatory peptides. Their use in the treatment of diabetes has been subject to study for many years. The paper examines the synthetic analogue of the human hormone amylin, the secretion of which coincides with the secretion of insulin. The synthetic analogue pramlintide is used in treatment of DM1Tas well as DM2T. Likewise, a group of intestinal α-glukosidase inhibitors - acarbose in this country - was introduced into clinical practice some years ago. Both drugs share their glucose-lowering...

Autonomic neuropathy of the gastrointestinal tract

J. Olšovský

Vnitr Lek 2011, 57(4):388-390  

The paper focuses on the issues of diabetic autonomic neuropathy in the gastrointestinal tract. It describes the aethiopathogenesis of diabetic polyneuropathy. More detailed discussion is then provided with respect to gastrointestinal tract. The clinical picture and options available for the diagnosis and treatment when various parts of the gastrointestinal tract are involvement are examined.

Dyspeptic syndrome associated with antidiabetic therapy

A. Šmahelová

Vnitr Lek 2011, 57(4):391-395  

Dyspeptic syndrome is a common complication of treatment with antidiabetic drugs. This may be a trivial as well as a very serious complication. Nauzea, vomiting, diarrhoea, abdominal pain, loss of appetite and taste disturbances are the most common symptoms of dyspeptic problems in patients treated with metformin. They rarely are a reason for treatment discontinuation. Dyspeptic syndrome is a common complication in patients treated with acarbose, this may be prevented by reduced intake of sucrose. Pneumatosis cystoides intestinalis is a rare complication in acarbose-treated patients. Antiobesity agent orlistat is frequently associated with dyspeptic...

Metabolic surgery - the most effective diabetes treatment

P. Sucharda

Vnitr Lek 2011, 57(4):396-401  

Bariatric operations resulting in a favourable metabolic effect - not only due to a reduction of excessive body weight - are known as metabolic surgery. Interventions into the digestive tract, especially the prevented contact of food with the duodenal and proximal jejunal lining and/or the effect of an insufficiently digested food on the jejunum, favourably affect incretin mechanisms. Thus, "resolution" of type 2 diabetes and discontinuation of antidiabetic medication can be achieved in as many as 95 percent of patients. Today, combined procedures (gastric bypass, biliopancreatic diversion) are indicated for diabetic subjects with severe obesity. The...

Metabolic surgery - a new approach to the management of selected diseases

M. Fried, K. Doležalová

Vnitr Lek 2011, 57(4):402-404  

Treatment options for type 2 diabetes have changed dramatically in the past few years. Experimental works followed by evidence based studies proved long-term efficacy of metabolic surgery in type 2 diabetes treatment. Moreover diabetes resolution is not directly correlated with weight loss and occurs independently to it. Large literature metaanalyses showed that type 2 diabetes can be subtantially improved with metabolic surgery in about 85 % of all diabetic patients, out of which can be resolved in more than 75%. Metabolic surgery affects hormonal secretion on multiple levels namely in the small intestine. Restrictive as well as combined and malabsorptive...

Incretin hormones

J. Čáp

Vnitr Lek 2011, 57(4):405-410  

Incretin hormones are peptides that are secreted from endocrine cell of gastrointestinal tract after nutrient ingestion and stimulate insulin secretion. Glucosodependent Insulinotropic Peptide - GIP is released from K-cells of duodenum and proximal jejunum, recently GIP synthesis has been proved in pancreatic α cells. Besides the incretin effect causes GIP increased lipogenesis and decreased lipolysis in fat tissue, increased bone formation and decreased resorption and has protective and proliferative effect on CNS neurons. Both GIP agonists (to treat diabetes) and antagonist (to treat obesity) are being studied. Another incretin hormone is derived...

Treatment of type 2 diabetes mellitus with GLP-1 antagonists

M. Haluzík, M. Urbanová, P. Trachta

Vnitr Lek 2011, 57(4):411-415  

Increased prevalence of type 2 diabetes mellitus and its close clustering with obesity, arterial hypertension, dyslipidemia and other pathologies commonly referred to as metabolic or insulin resistance syndrome, represents one of the major health problem worldwide. The side effects of most of oral antidiabetics and insulin include increase in body weight and/or hypoglycemia that may limit its use in some patients. GLP-1 agonists are medicaments stimulating GLP-1 receptor similarly as endogenous GLP-1. These substances are in contrast to endogenous GLP-1 resistant to inactivation by ubiquitous enzyme dipeptidyl-peptidase 4 which enables its administration...

Incretin therapy and the metabolic syndrome

Š. Svačina

Vnitr Lek 2011, 57(4):417-421  

Incretin therapy includes treatment with incretin analogues (exenatid and liraglutid) and so called incretin enhancers (gliptins and DPP-4 inhibitors respectively - sitagliptin, vildagliptin, saxagliptin, linagliptin). In patients with type 2 diabetes, this novel antidiabetic treatment usually leads to successful reduction in fasting as well as postprandial glycaemia and glycosylated haemoglobin. At the same time, it importantly improves all components of metabolic syndrome (dyslipidemia, hypertension, systemic inflammation). Incretin analogues also reduce body weight while DPP-4 inhibitors are weight-neutral. Both groups of drugs are expected to have...