Viskoelastické metody jako standard monitorování hemostázy? - editorial

Roman Hájek

Vnitr Lek 2018, 64(4):339-340 | DOI: 10.36290/vnl.2018.049  

Raritní kombinace Turnerova syndromu a kongenitální adrenální hyperplazie s deficitem 21-hydroxylázy - editorial

Karola Balšíková

Vnitr Lek 2018, 64(4):341-342  

Epicardial fat and osteoprotegerin - does a mutual relation exist? Pilot study

Markéta Sovová, Eliška Sovová, Jana Zapletalová, Markéta Kaletová, David Stejskal, Milan Sova, Michal Konečný, Vlastimil Procházka, Drahomíra Vrzalová, Lea Zarivnijová

Vnitr Lek 2018, 64(4):343-346 | DOI: 10.36290/vnl.2018.051  

Introduction:Epicardial fat (EPI) plays important role in development of metabolic and cardiovascular diseases. According to population studies EPI represents independent risk factor of cardiovascular diseases (CVD) and also for neoplasms. Osteoprotegerin (OPG) is a glycoprotein which have role in regulation of immune and cardiovascular systems. High serum levels of OPG are connected with high cardiovascular risk. The aim of our study was to evaluate possible correlation between EPI and OPG level in asymptomatic relatives of patients with CVD. Material and methods:53 asymptomatic relatives (37 male) (median age...

Impact of surgery on quality of life in Crohn's disease patients: final results of Czech cohort

Lumir Kunovsky, Ladislav Mitas, Filip Marek, Jiri Dolina, Karolina Poredska, Lenka Kucerova, Klara Benesova, Zdenek Kala

Vnitr Lek 2018, 64(4):347-354 | DOI: 10.36290/vnl.2018.052  

Introduction:Crohn's disease (CD) belongs to chronic diseases that highly affect the patient's quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients' QoL and determine factors that can affect postoperative QoL. Methods and patients:We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a...

Effectiveness and safety of lixisenatide for treatment of diabetes in the real world: data from the Monitoring Registry in a Real-Life Cohort in the Czech and Slovak Republic

Martin Haluzík, Alena Adamíková, Milan Běhunčík, Marek Macko, Radka Štěpánová

Vnitr Lek 2018, 64(4):357-366 | DOI: 10.36290/vnl.2018.053  

Introduction:GLP1 receptor agonist lixisenatide has demonstrated its efficacy in numerous clinical trials, nevertheless its real-life effectiveness data is limited. Aim:To describe effectiveness and safety of lixisenatide in routine clinical practice in the Czech Republic and the Slovak Republic, as recorded by the Registry-Based Observational Study. Methods:Multinational, multicenter, observational, non-interventional, 6-month prospective product registry of patients with type 2 diabetes mellitus aged > 18 years who were initiating therapy with lixisenatide. Patients were enrolled into this registry, provided...

A consensual therapeutic recommendation for type 2 diabetes mellitus by the Slovak Diabetes Society (2018)

Emil Martinka, Vladimír Uličiansky, Marián Mokáň, Ivan Tkáč, Peter Galajda, Silvia Dókušová, Zbynek Schroner

Vnitr Lek 2018, 64(4):405-426 | DOI: 10.36290/vnl.2018.059  

Type 2 diabetes mellitus is a heterogeneous medical condition involving multiple pathophysiological mechanisms. Its successful treatment requires an individualized approach and frequently combined therapy with utilizing its effect on multiple levels. Current possibilities enable the employment of such procedures to an incomparably greater extent than before. The effects of different classes of oral antidiabetic drugs on the reduction of glycemia and HbA_1c is mutually comparable. However differences are observed in the proportions of patients who met the required criteria, regarding the increase in weight, incidence of hypoglycemia as well...

Diagnosis of MODY - brief overview for clinical practice

Jana Urbanová, Ludmila Brunerová, Jan Brož

Vnitr Lek 2018, 64(4):367-374 | DOI: 10.36290/vnl.2018.054  

Maturity Onset Diabetes of the Young (MODY) comprises inherited forms of diabetes mellitus caused by the mutations in the genes involved in the development, differentiation and function of beta-cells. The majority of patients with MODY remains misdiagnosed and erroneously classified as type 1 or type 2 diabetic patients. Correct MODY diagnosis is, however, essential since it enables individualization of treatment, assessment of the prognosis and identification of diabetes among patient's relatives. Clinical presentation of MODY is highly variable and it could resemble other types of diabetes, thus identification of MODY patients might be difficult....

Current treatment options in Maturity-Onset Diabetes of the Young

Ludmila Brunerová, Jana Urbanová, Jan Brož

Vnitr Lek 2018, 64(4):375-379 | DOI: 10.36290/vnl.2018.055  

The discovery of MODY (Maturity-Onset Diabetes of the Young) and the elucidation of its heritability enabled more precise clinical characteristics of different MODY subtypes and led to understanding that glucokinase MODY (GCK-MODY) is not associated with vascular complications in long term follow-up, whereas MODY of transcription factors (e.g. HNF1A-MODY) is in case of bad metabolic control connected with the acceleration of particularly microvascular complications. There is a strong evidence of the needlessness of any specific antidiabetic treatment in prognosticaly favourable GCK-MODY (except for the pregnancy). On the contrary,...

Rotational thromboelastometry in therapy of life threatening bleeding

Miroslav Durila

Vnitr Lek 2018, 64(4):380-383 | DOI: 10.36290/vnl.2018.056  

Bleeding and coagulopathy is a common problem in the fields of internal medicine. In case of life-threatening bleeding, rotational thromboelastometry (ROTEM) has critical role in diagnosis and therapy of coagulopathy. In contrast to commonly used tests such as prothrombin time and activated partial thromboplastin time, ROTEM evaluates coagulation of the whole blood as a bedside method. The use of ROTEM for rapid diagnosis and targeted therapy of coagulopathy leads to reduction in bleeding and thus to reduction in administration of blood transfusion products. ROTEM is a viscoelastic method incorporated in current European and Czech-Slovak guidelines...

Drug and herbal hepatotoxicity: an overview of clinical classifications

Mária Szántová, Jozef Sedlačko, Martina Jakabovičová

Vnitr Lek 2018, 64(4):384-393 | DOI: 10.36290/vnl.2018.057  

Drug induced liver injury (DILI) is often underdiagnosed disease with increasing incidence. In developed countries it belongs to the leading causes of acute liver failure. Risk groups are women and persons older than 60 years. The work summarizes the up to date information on diagnosis and mostly used classifications on DILI. It is quite often and serious complication of medicament therapy. DILI belongs to the most often cause of acute hepatic failure in the old age in developed countries. Diagnostic procedure includes medical history (time correlation with drug intake), clinical symptoms and blood tests. Laboratory tests may be helpful to specify...

Dyslipidemia and hypertension - what to worry about more?

Jan Václavík

Vnitr Lek 2018, 64(4):395-401 | DOI: 10.36290/vnl.2018.058  

Dyslipidemia is present in every other patient with arterial hypertension. With increasing blood pressure and cholesterol levels, the risk of cardiovascular events increases proportionally. Treatment of dyslipidemia appears to lower cardiovascular mortality to a greater extent than treatment of hypertension. A significant proportion of patients with dyslipidemia indicated for drug therapy are not treated at all or treated insufficiently and do not reach the target values. Concurrent treatment of hypertension and dyslipidemia reduces the incidence of cardiovascular events significantly more than treating only one of these diseases. An even better efficacy...

Acquired hemophilia A: case report

Štefan Sotak, Miriam Mitníková

Vnitr Lek 2018, 64(4):427-431 | DOI: 10.36290/vnl.2018.060  

Case report of a 74-year-old male with acquired hemophilia A, whose etiology was not found, confirmed by hemocoagulation examinations, with clinical manifestation of protracted macroscopic hematuria, spontaneous skin and intramuscular bleedings. Treatment comprised conservative therapy administration of hemostyptics, red blood cells transfusions application of recombinant human factor VII (rFVII) and immunosuppression. Finally, patient died due to nosocomial infection caused by multidrug-resistant pulmonary pathogen.

Rare combination of Turner syndrome and congenital adrenal hyperplasia with 21-hydroxylase deficiency: case report

Ivana Ságová, Matej Stančík, Dušan Pávai, Daniela Kantárová, Anton Vaňuga, Peter Vaňuga

Vnitr Lek 2018, 64(4):432-436 | DOI: 10.36290/vnl.2018.061  

Combination of Turner syndrome (TS) and classic congenital adrenal hyperplasia (CAH) is rare. Globally, the incidence of CAH, autosomal recessive disorder caused by enzyme defect of steroidogenic pathway, is very low (1 : 10 000-16 000). 90 % of CAH cases are caused by 21-hydroxylase gene mutation (CYP21A2). Globally, the incidencie of Turner syndrome reaches 1 : 2 500. Phenotypically, females with TS may render wide spectrum of clinical features. Dominant symptoms are lowered terminal height and gonadal dysgenesia, ultimately leading to absence of puberty and infertility. Virilisation may be evident among TS women with chromosome Y 45, X/46,...

Virilization as demonstration of hypertestosteronism by ovarian tumor: case report

Michal Mokáň, František Nehaj, Juraj Sokol, Peter Vaňuga, Marián Mokáň

Vnitr Lek 2018, 64(4):437-440 | DOI: 10.36290/vnl.2018.062  

Hypertestosteronism as part of hyperandrogenic states in women is generally defined as abundance of male hormones (in this case abundance of testosterone). Spectrum of clinical symptoms include menstrual disorders, amenorrhoea, different range of hirsutism and virilization. Statistically, most androgen secreting tumors are ovarian aetiology (testosterone secreting tumors located in suprarenal gland are very rare). This rare tumor may produce excess amounts of testosterone, as well as its precursor androstenedione. The highest incidence is between 20-40 years and in postmenopausal period. The treatment is essentially surgical; with gradual adjustment...

Heart transplantation and follow-up treatment with AL-amyloidosis in 5 patients

Zdeněk Adam, Eva Ozábalová, Petr Němec, Helena Bedáňová, Milan Kuman, Jan Krejčí, Lenka Špinarová, Víta Žampachová, Zdeňka Čermáková, Luděk Pour, Marta Krejčí, Viera Sanecká, Martin Štork, Tomáš Pika, Jan Straub, Dagmar Adamová, Yvetta Stavařová, Zdeněk Král, Jiří Mayer

Vnitr Lek 2018, 64(4):441-449 | DOI: 10.36290/vnl.2018.063  

The prognosis for patients with cardiac impairment due to AL-amyloid deposition and severe cardiac insufficiency is poor, with a survival median in the order of months. The classical treatment of AL-amyloidosis in combination with cardiac insufficiency is very poorly tolerated and the treatment of such patients is associated with considerably higher mortality than among other patients with AL-amyloidosis. If, however, patients with an isolated or another dominating cardiac impairment, without severe damage to other organs and tissues, have a heart transplant performed, their cardiovascular condition will significantly improve as a result, along with...

Cyclic Cushing's syndrome: a case study and overview

Jana Kollerová, Ján Malina, Andrej Šteňo, Pavol Povinec, Juraj Payer

Vnitr Lek 2018, 64(4):450-456 | DOI: 10.36290/vnl.2018.064  

Cushing's syndrome and especially Cushing's disease represent diagnostically and therapeutically complicated medical situations. In some patients, cyclic changes in cortisol production additionally hamper the diagnosis in terms of source identification and management of hormone overproduction. It may not be clear, whether the patient is cured or not even years after the treatment. It is a rare disorder variant, but we assume that it is underdiagnosed and it's incidence is actually higher. The article deals with a complicated course of diagnosis and treatment in a patient with cyclic Cushing's syndrome.

Přínos nové fixní kombinace rosuvastatinu s ezetimibem k léčbě dyslipidemií a ke snížení celkového kardiovaskulárního rizika

Hana Rosolová

Vnitr Lek 2018, 64(4):457-460 | DOI: 10.36290/vnl.2018.065