Diagnostics and therapy of gout - editorial

Petr Bradna

Vnitr Lek 2015, 61(6):507-508  

Alveolar echinococcosis - rare cystic disease of the liver - editorial

František Stejskal

Vnitr Lek 2015, 61(6):509-510  

PEGASUS - Ticagrelor in secondary prevention on patients after a myocardial infarction

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2015, 61(6):511-515  

Background:Ticagrelor is a P2Y₁₂ receptor antagonist that has been shown to reduce ischemic events for up to a year after an acute coronary syndrome. The efficacy and safety of long-term ticagrelor therapy beyond 1 year after a myocardial infarction is unknown. Methods:We randomized 21,162 patients with a history of myocardial infarction within the prior 1-3 years in a double-blind 1 : 1 : 1 fashion to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all with low-dose aspirin, and followed them for a median of 33 months. The primary efficacy endpoint was the composite of cardiovascular death,...

Guidelines of Czech Association for Thrombosis and Haemostasis of the Czech Medical Association of J. E. Purkyně for safety treatment with new oral anticoagulants (NOAC) - dabigatran etexilate, apixaban and rivaroxaban

Jan Kvasnička, Miroslav Penka, Tomáš Kvasnička, Jana Michalcová, Zuzana Kudrnová, Ivana Malíková

Vnitr Lek 2015, 61(6):537-546  

There are presently new oral anticoagulants (NOAC) for prevention and the treatment of thromboembolic diseases and they are registered in CZ. It concerns of orally direct inhibitors of thrombin (dabigatran etexilate), inhibitors of factor Xa (apixaban, rivaroxaban), respectively, with advantage of some properties not being seen in "classical" anticoagulants. In the use of new anticoagulants, however, are some problems - such as laboratory monitoring in urgent situations of effective treatment and the absence of specific antidote - resolved. The text below brings indications, dosage of the drugs, their elimination, follow-up of efficacy of the treatment...

Diagnosing and therapy of gout

Karel Pavelka

Vnitr Lek 2015, 61(6):517-526  

Gout is an inflammatory, metabolically conditioned crystal-induced disease. Prevalence of gout is on the increase. In clinical practice it is frequently wrongly diagnosed and the therapy of acute attacks in particular is not adequate. The first part of the publication discusses diagnostic possibilities of gouty arthritis. First of all the advantage of the analysis of synovial exudate and of direct evidence of crystals in the polarization microscope is emphasized. If the material for crystallographic analysis is not available, it is necessary to use a combination of clinical criteria as specified e.g. in the recommendations of the European League Against...

Rare case of cystic disease of the liver - alveolar echinococcosis of the liver

Tomáš Kupka, Peter Baľa, Lubomíra Hozáková, Jaroslav Havelka, Martina Bojková, Bohdana Břegová, Arnošt Martínek, Petr Dítě

Vnitr Lek 2015, 61(6):527-530  

Alveolar echinococcosis is a rare parasitic disease, especially of liver, caused by larval stage of tapeworm Echinococcus multilocularis. At the end of the last century France, Germany, Austria and Switzerland were the most often regions with this disease, these days is this infection diagnosed also in our territory. We describe the case of the disease of the twenty-five years old male with nonspecific signs and hepatomegaly, who was diagnosed on the basis of imaging and laboratory sampling. Due to inoperability the patient is now in infectologist follow-up on a long-term treatment with albendazole. He is clinically stable, included in waiting...

"Stressful holiday" - takotsubo cardiomyopathy

Lumír Koc, Marie Pavlušová, Jiří Pařenica, Jan Maňoušek, Jitka Vlašínová, Jindřich Špinar, Petr Kala

Vnitr Lek 2015, 61(6):531-534  

Takotsubo cardiomyopathy (TTC) is an acute syndrome characterized by rapid onset of transient systolic dysfunction of the left ventricle. Symptoms, ECG and laboratory findings resemble acute coronary syndrome, from which TTC differs by the absence of coronary artery disease. In typical cases, TTC is triggered by exposure to unexpected stress and the clinical course and prognosis are very good. We present a case of a 63-year-old woman, in whom the onset of the disease was complicated by ventricular fibrillation. The patient recovered without sequelae thanks to immediate cardiopulmonary resuscitation and following care in a specialized cardiocenter,...

Richard Češka, Tomáš Freiberger, Martina Vaclová, Vladimír Bláha, Zuzana Urbanová. Familiární hypercholesterolemie

Vladimír Soška

Vnitr Lek 2015, 61(6):549  

Eva Kašáková, Martin Vokurka, Jan Hugo. Výkladový slovník pro zdravotní sestry

Marie Malinková

Vnitr Lek 2015, 61(6):550  

Primář MUDr. Petr Svačina, šéfredaktor časopisu Vnitřní lékařství, sedmdesátiletý

Richard Češka

Vnitr Lek 2015, 61(6):501  

Niekoľko osobných spomienok

Ján Murín

Vnitr Lek 2015, 61(6):502  

Sedmdesátníkem? Neuvěřitelné. Zralý věk primáře Petra Svačiny

Milan Kvapil, Terezie Pelikánová

Vnitr Lek 2015, 61(6):502  

Petr Svačina jubilující

Miroslav Souček

Vnitr Lek 2015, 61(6):503  

Za profesorem Milošem Štejfou

Jiří Vítovec, Lenka Špinarová, Jindřich Špinar

Vnitr Lek 2015, 61(6):547-548  

Mezioborové sympozium s postgraduálním zaměřením Diabetik - společný pacient diabetologa a ortopeda

Vnitr Lek 2015, 61(6):551  

The imaging of musculoskeletal manifestations and complications in diabetes mellitus

Jindra Brtková

Vnitr Lek 2015, 61(6):552-558  

The musculoskeletal system is one of the major regions, where changes caused by diabetes mellitus (DM) are often encountered causing severe impairment of the quality of patients' lives. These changes have therefore become an important focus of diagnostic and therapeutic procedures, with imaging methods - both plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and to a lesser extent ultrasound (US), being their cornerstones. In the article the images of musculoskeletal (MSK) manifestations of diabetes mellitus are presented, structured into changes directly caused by DM, metabolic consequences of DM, syndromes with increased...

Continuing peripheral nerve blocks - benefit for orthopedic patients with diabetes mellitus?

David Doležal, Abdo Islam Saleh

Vnitr Lek 2015, 61(6):559-562  

There is increasing incidence of diabetes mellitus in population of developed countries. And there is also, together with this fact, an increasing frequency of surgical not only orthopedic procedures for diabetic complications or for other reasons. However, thanks to modern sophisticated perioperative approaches, diabetes itself is no longer main risk factor for worsening of perioperative morbidity and mortality. The organ complications of diabetes still remain the crucial for patients' outcome. The individual approach to each patient is important when we are planning anesthesiological perioperative strategy. Assessment of long term diabetes compensation...

Perioperative care and diabetes

Alena Šmahelová

Vnitr Lek 2015, 61(6):563-566  

The perioperative care of diabetic patients is specific due to the necessity of adequate glycaemic correction, as well as owing to the occurrence of complications not taking place in nondiabetic patients. The present antidiabetic treatment therefore mostly needs to be adjusted to the perioperative period, but this is largely not necessary in the case of small and short surgeries. The perioperative care of diabetic patients must be carefully organized and scheduled. The main rules include adequate monitoring of blood glucose and insulin therapy, provision of nutrition and surgery performance in the morning.

Complications associated with joint replacements in diabetic patients

Pavel Šponer, Tomáš Kučera, David Pellar

Vnitr Lek 2015, 61(6):567-570  

While a joint implant is the method of choice for numerous locomotor disorders and it is indicated for diabetic patients based on the same rules as for patients without diabetes mellitus, a joint implant in diabetic patients is associated with a high risk of perioperative complications. Considering a very difficult and demanding treatment of a deep infection of a joint replacement, the prevention of complications plays the key role. A precondition for adequate perioperative preparation and correctly managed perioperative and postoperative care of patients with diabetes mellitus is the close cooperation of the orthopedist, diabetologist and anesthesiologist,...

Obesity and orthopedic surgery, or else do mechanical complications of obesity exist?

Štěpán Svačina

Vnitr Lek 2015, 61(6):571-573  

Arthroses of weight-bearing joints and vertebrogenic problems are characteristic diseases of the obese. However the extreme risk is associated in particular with the combination with metabolic syndrome. Arthroses of bearing joints thus do not only present a mechanical complication of obesity, but also a metabolic complication. Similarly, the risk of venous thromboembolism which involves all orthopedic surgeries, is associated with both a rising BMI and hormonal condition (use of hormones and the like.). A joint replacement surgery can be typically performed on patients with a weight of up to 90 kg or BMI below 30. A preparation aimed at decreasing...

Acute and chronic anticoagulation therapy in relation to joint replacements

Jaroslav Malý

Vnitr Lek 2015, 61(6):574-581  

Thromboembolic disease (TED) is a considerable social and health problem. The solution evidently consists in the prevention of TED in clinical fields, not in the treatment itself. We can assume that effective prevention consequently reduces the cost of the following treatment. A lethal pulmonary embolism (PE) can be the first and the final clinical manifestation in patients with an asymptomatic deep venous thrombosis. This makes the systematic prevention of venous thromboembolism in higher risk patients necessary. Unfortunately, pharmacological prevention has been used less than would be needed. Inseparable from the TED prevention are physical methods....

Diabetic neuropathy

Jindřich Olšovský

Vnitr Lek 2015, 61(6):582-586  

The paper deals with one of microvascular complications of diabetes - diabetic polyneuropathy. It is discussed comprehensively from its causes, incidence, its classification and diagnostic possibilities to the risks it entails for patients and therapeutic possibilities.

Diabetic foot infections

Lenka Ryšková

Vnitr Lek 2015, 61(6):587-591  

Diabetic foot infections (DFIs) are serious problems in persons with diabetes, about 10 to 25 % of patients with diabetes develop a foot ulcer and 60 % of them are infected. DFIs cause morbidity, limit mobility, worsen patients' quality of life. Infections are classified as mild, moderate, or severe. Most DFIs are polymicrobial, with Gram-positive cocci (especially staphylococci), Gram-negative bacilli and obligate anaerobes. Successful therapy of DFI requires proper topical care and often includes surgical interventions but appropriate antibiotic treatment plays a key role. Initial antimicrobial therapy of these infections is usually empirical, the...

Selected skin involvement of necrobiosis lipoidica type and skin and mucous membrane fungal infections in diabetes mellitus

Miloslav Salavec, Marie Šimková

Vnitr Lek 2015, 61(6):592-596  

Article reviews some skin and mucosal lesions associated with diabetes mellitus with focus on skin fungal infections and necrobiosis lipoidica.

Application of stem cells in orthopedics

Pavel Žák

Vnitr Lek 2015, 61(6):597-598  

Regeneration of articular cartilage remains a major challenge in orthopaedics. Cell-based therapies (with chondrocyte and MSCs - mesenchymal stem cells) to augment cartilage repair have received considerable interest during recent years. Adipose MSCs have been used in the Czech Republic for osteoarthritis therapy, despite not being recommended by the Czech Orthopaedic Association. This lecture reviews the studies and their level of evidence for orthopaedic routine therapy of osteoarthritis.

Orthopedic surgical management of the diabetic foot

Tomáš Kučera, Jaromír Šrot, Josef Roubal, Pavel Šponer

Vnitr Lek 2015, 61(6):599-603  

The basic prerequisite for the successful treatment of the diabetic foot is a multidisciplinary approach. Ideally, the diagnosis and treatment is managed by a podiatrist, who is also responsible for a cost-effective and well-managed setting. General concern of diabetics is the fear of losing a limb. On the basis of multidisciplinary approach is possible to prevent major amputations in many cases, or in case of them to ensure the prosthetic and rehabilitation care. New possibilities of revascularization and cooperation with antibiotic centers increase the success of surgical treatment of diabetic foot syndrome. Surgical procedures could be divided into...

Basic principles and difficulties relating to rehabilitation in diabetic patients following amputation

Martin Jindra, Bohuslava Věchtová, Jana Bielmeierová

Vnitr Lek 2015, 61(6):604-608  

Vascular diseases as a result of diabetes mellitus are the most frequent indication for amputation in the Czech republic. Diabetic patients following amputation, unlike the other amputees, very frequently suffer multiple complications. These are both of general and local nature and pose a limitation to rehabilitation care as well as a prosthesis use. The main goal of therapeutic rehabilitation is the practice of locomotion with a prosthesis (artificial limb) and the patient's full return to normal life. A team of closely cooperating specialists is involved. The rehabilitation care of amputees is divided into acute and aftercare. Within preoperative...