Vnitřní lékařství, 2016 (vol. 62), issue 5

Editorial

Cystická fibróza - editorial

Veronika Skalická

Vnitr Lek 2016, 62(5):347

Imunitní systém a zpracování informací - editorial

Pavel Žampach

Vnitr Lek 2016, 62(5):348-350

Original articles

Hepatic transit times and liver elasticity compared with meld in predicting a 1 year adverse clinical outcome of a clinically diagnosed cirrhosis

Tomáš Koller, Zuzana Piešťanská, Tibor Hlavatý, Jozef Holomáň, Jozef Glasa, Juraj Payer

Vnitr Lek 2016, 62(5):351-359

Introduction and objectives:Hepatic transit times measured by the contrast enhanced ultrasonography and liver elasticity were found to predict a clinically significant portal hypertension. However, these modalities we not yet sufficiently evaluated in predicting adverse clinical outcome in patients with clinically diagnosed cirrhosis (D'Amico stages > 1), having a clinically significant portal hypertension. The aim of our study was to assess the predictive power of the liver transit times and the liver elasticity on an adverse clinical outcome of clinically diagnosed cirrhosis compared with the MELD score. Methods:The study...

Diagnostics of cystic fibrosis in adults

Libor Fila, Alžběta Grandcourtová, Lucie Valentová Bartáková, Zuzana Antušová, Eva Pokojová, Vladimír Herout, Petr Jakubec, Radka Bittenglová, Miloslav Marel

Vnitr Lek 2016, 62(5):360-364

Introduction:There is an increasing number of cystic fibrosis (CF) patients with the diagnosis established in adulthood worldwide. Aim:To give an overview of our experience with the diagnostics of CF in adulthood in the Czech Republic. Methods:CF patients with the diagnosis determined at the age ≥ 18 years during 2000-2014 period were selected from the Czech Registry of CF (www.cfregistr.cz). Demographic and clinical data were reported from medi-cal records at the time of diagnosis and as of 31^st December 2014. Only those with two CF causing mutation or with one CF causing mutation together with...

The efficacy of treatment of local residual neoplasia under standardized conditions

Ondřej Urban, Barbora Pipek, Ivana Mikoviny Kajzrlíková, Přemysl Falt, Petr Fojtík, Petr Vítek

Vnitr Lek 2016, 62(5):365-369

Objectives:Piecemeal endoscopic mucosal resection (EMR) is frequently used for the treatment of non-polypoid colorectal lesions larger than 20 mm. Nevertheless, local residual neoplasia occurs (LRN) in as much as 15 % of cases. The aim of our prospective interventional study was to evaluate the efficacy of treatment of LRN under standardized conditions. Methods:In two high volume non-university endoscopy centers, LRN has been treated according to the newly proposed classification based on endoscopic appearance by argon plasma coagulation (APC), endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Primary...

Reviews

Hypercalcemia, symptoms, differential diagnostics and treatment, or importance of calcium investigation

Zdeněk Adam, Karel Starý, Jozef Kubinyi, Kateřina Zajíčková, Zdeněk Řehák, Renata Koukalová, Miroslav Tomíška, Martina Doubková, Jiří Prášek, Eva Pourová, Zdeňka Čermáková, Luděk Pour, Marta Krejčí, Viera Sandecká, Eva Ševčíková, Sabina Ševčíková, Zdeněk Král, Aleš Čermák

Vnitr Lek 2016, 62(5):370-383

The concentration of calcium is carefully maintained under physiological conditions with parathormone, calcitonin and 1,25-dihydroxyvitamin D at appropriate levels. There are multiple causes that may bring about increased concentrations of calcium which exceed physiological values. Increased production of parathormone in parathyroid glands is only one of the possible causes. Malignant diseases are a very frequent cause of hypercalcemia, due to their creating mediators which stimulate osteoclasts and thereby osteolysis. A less frequent cause is represented by granulomatous processes, a typical example of which is sarcoidosis, whose cells increasingly...

Idiopathic inflammatory bowel disease as a prothrombotic state

David Kamenář, Julius Špičák

Vnitr Lek 2016, 62(5):384-391

Prothrombotic states related to idiopathic bowel disease (IBD) are typically caused by abnormalities of hemostasis associated with inflammatory processes. The risk of thromboembolic complications in patients with IBD is approximately three times as high as in the general population. A critical role is played by the acquired risk factors including medication, while the proportion of inherited thrombophilia in patients with IBD is the same as in the general population. Many abnormalities can be identified through laboratory testing at the level of coagulation factors, fibrinolysis, thrombocytes and endothelium. Although there are no systematic guidelines...

Clinical implications of polycystic ovary syndrome

Ingrid Dravecká

Vnitr Lek 2016, 62(5):392-397

Polycystic ovary syndrome (PCOS) is a heterogeneous and complex endocrine disease which among the female population belongs to the most widespread endocrinopathies and it is the most frequent cause of hyperthyroidism, anticoagulation and infertility. Insulin resistance is one of the important diabetology factors impacting hyperglycaemia in a majority of women with PCOS (60-80 %). Clinical expressions of PCOS include reproduction disorders, metabolic characteristics and psychological implications. Reproduction disorders include hyperthyroidism, menstruation cycle disorders, infertility and pregnancy complications as well as early abortions, gestational...

Treatment with rituximab as an opportunity for the prevention of infectious complications

Pavel Polák, Miroslav Penka, Petr Smejkal, Gabriela Chlupová

Vnitr Lek 2016, 62(5):398-405

Rituximab, a monoclonal antibody against the surface antigen of B-lymphocytes CD20 is beeing used in the treatment of numerous hematological, hematooncological and autoimmune disorders. After administration of rituximab, quick and almost complete depletion of B-lymphocytes with the exception of pre-B-lymphocytes and plasma cells occur. Neutropenia and low serum antibody levels in classes IgA, IgM and IgG may also develop. These changes usually persist for 6-12 months, rarely for several years. In the consequence, patients with the rituximab treatment are more prone to infections - usually of bacterial and viral origin. Concomitantly, rituximab treatment...

Can fish oil improve wound healing in surgery?

Jana Neuwirthová, Břetislav Gál, Pavla Urbánková, Pavel Smilek

Vnitr Lek 2016, 62(5):406-412

A surgical insult induces both local and systemic inflammatory responses which, if inappropriate, could impair wound healing. According to many studies ω-3 polyunsaturated fatty acids from fish oil improve the process of wound healing by their immunomodulatory effect. In contrast to current anti-inflammatory drugs, which could alter immune defence and impair the resolution of inflammation, ω-3 fatty acids have a simultaneous anti-inflammatory pro-resolution effect which is not immunosuppressive. Besides that they improve cicatrix quality. With regard to this effect they prevent excessive or prolonged inflammation and wound complications.

Use of new drugs within primary therapy of multiple myeloma

Martin Štork, Marta Krejčí, Viera Sandecká, Zdeněk Král, Luděk Pour

Vnitr Lek 2016, 62(5):413-422

In the last decades big changes were achieved in a field of multiple myeloma treatment. Cardinal change came with introduction of so-called novel agents - bortezomib, thalidomide and lenalidomide. Their benefit for effectivity of treatment and improvement of prognosis in patients with multiple myeloma was proven by many large clinical trials. To achieve best treatment outcome, the choice of frontline therapy is probably crucial, with aim to achieve best possible treatment response. The best choice in Czech health care system is bortezomib-based induction followed by an autologous stem-cell transplant as a consolidation. For old patients, unable to...