20 let klinických zkušeností s léčbou chronické myeloidní leukemie inhibitory tyrosinové kinázy

Edgar Faber

Vnitr Lek 2020, 66(4):E4 | DOI: 10.36290/vnl.2020.072  

Léčba pacientů s chronickou myeloidní leukemií - nečekaný anebo očekávaný průnik onkologie a vnitřního lékařství?

Daniela Žáčková

Vnitr Lek 2020, 66(4):e5-e6 | DOI: 10.36290/vnl.2020.073  

Contemporary treatment methods of adult patients with BCR/ABL1 positive chronic myeloid leukemia

Katarína Slezáková, Martin Mistrík, Angelika Bátorová

Vnitr Lek 2020, 66(4):214-224 | DOI: 10.36290/vnl.2020.064  

Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasia that is characterised by Philadelphia chromosome (Ph1 chromosome) and/or fusion gene BCR-ABL1 in bone marrow. Interpheron α and bone marrow transplantation used to be the main treatment modalities for patients with CML 20 years ago. Due to the introduction of imatinib mesylate since the year 2000 the outcome of CML patients has dramatically improved. The survival of both younger and elderly patients in the case of an optimal response has been prolonged and currently is close to survival of healthy population. Although, one third of patients does not respond well to first line...

Anticoagulation therapy in cancer associated thromboembolism - new studies, new guidelines

Jana Hirmerová

Vnitr Lek 2020, 66(4):225-231 | DOI: 10.36290/vnl.2020.065  

Low molecular weight heparin (LMWH) has become a standard of treatment of cancer-associated thromboembolism (CAT). Until recently, direct oral anticoagulants (DOAC) have not had data about efficacy and safety in cancer patients. However, in the last two years, four randomized open-label studies comparing DOAC and LMWH in the treatment of CAT have been published. The first one was a large trial with edoxaban, followed by two smaller studies with rivaroxaban and apixaban, and, recently, by another large trial with apixaban. There are some differences among the studies concerning design, inclusion and exclusion criteria, length of treatment. In summary,...

Gastrointestinal and hepatic symptoms of tickborne diseases

Mária Budzáková, Jan Trna

Vnitr Lek 2020, 66(4):232-235 | DOI: 10.36290/vnl.2020.066  

While investigating patients with gastrointestinal (GI) and/or hepatic symptoms, tickborne diseases are only rarely considered to be the cause. However, the Czech Republic is an endemic region for several of tickborne diseases and, therefore, they should be a part of differential diagnosis of GI symptoms of unknown origin. This article describes GI and hepatic symptoms of several tickborne diseases - Lyme disease, ehrlichiosis, Rocky mountain spotted fever, tularemia, Colorado tick fever, tick-borne relapsing fever, Q fever and babesiosis. GI and hepatic symptoms are quite common in Lyme disease patients. The prognosis is generally favourable with...

Secondary prevention after acute coronary syndrome

Ján Murín, Jozef Bulas, Ľudovít Gašpar, Alexander Klabník, Martin Wawruch

Vnitr Lek 2020, 66(4):236-241 | DOI: 10.36290/vnl.2020.067  

Patients suffering acute coronary syndrome have a very high risk for a repeated syndrome. After stabilization of acute coronary syndrome and discharge of a patient it is important to educate the patient how to prevent it in the future (dietary and life style changes), but treatment of all cardiovascular risk factors/diseases, as hypertension, dyslipidemia, diabetes but stabilization of all cardiovascular diseases is also important. Important is also antithrombotic treatment (mostly double antiplatelet treatment when percutaneous coronary intervention was used with a coronary stents), RAAS blockers, betablockers and statins (strong as atorvastatin and...

Bleeding in portal hypertension

Tomáš Fejfar, Tomáš Vaňásek, Petr Hůlek

Vnitr Lek 2020, 66(4):e7-e16 | DOI: 10.36290/vnl.2020.074  

Liver cirrhosis is the most common reason of clinically significant portal hypertension in the western countries. Portal vein or hepatic veins thrombosis is less common. Variceal bleeding is the most severe life threatening complication of portal hypertension. Appropriate treatment includes initial general management, fluid replacement and hemosubstitution, antibiotic prophylaxis, vasoactive medication and endoscopic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) is standard option in case of first line treatment failure. Dedicated esophageal metal stent or balloon tamponade could be used as a bridge to the TIPS or in case of TIPS...

Patient after kidney transplantation in outpatient internal clinic

Tomáš Roháľ

Vnitr Lek 2020, 66(4):e17-e21 | DOI: 10.36290/vnl.2020.075  

Kidney transplantation is the first-choice treatment of the end-stage kidney disease. By increasing the number of kidney transplants and by improving the care for these patients, there is increasing number of patients with a functional graft, who need adequate follow-up and treatment. It is advisable to feasibly transfer some portion of the care to the doctors based outside transplant centres and so it is necessary to make them familiar with these issues. That is also the purpose of this article, which is focused on some of those frequent medical problems associated with kidney transplantations, which are in competence of internal medicine doctors....

Lung diseases and autoimmune hemolytic anemia associted with IgG4 disease

Martina Doubková, Radoslav Matěj, Zita Chovancová, Michael Doubek

Vnitr Lek 2020, 66(4):e22-e27 | DOI: 10.36290/vnl.2020.076  

IgG4 related disease (IgG4-RD) is a rare and relatively new group of systemic inflammatory diseases characterized by inflammatory, fibrotic or sclerotic involvement of one or more organs accompanied by increased IgG4 plasma cells tissue infiltration and usually elevated serum IgG4 (IgG4 > 1.35g/l, normal range 0.08-1.40 g/l) level. Histopathological findings are crucial for the diagnostics of this disease. The authors present a case report of a patient with IgG4 associated disease manifested by a rare combination of autoimmune hemolytic anemia and pulmonary involvement.

Witholding dialysis in elderly patients with chronic kidney disease

Zuzana Křemenová, Barbora Szonowská, Barbora Vráblová

Vnitr Lek 2020, 66(4):e28-e35 | DOI: 10.36290/vnl.2020.077  

Elderly patients with advanced chronic kidney disease have high symptom burden, despite the progress in renal replacement therapy. Dialysis is not a good option especially for frail elderly patients with higher comorbidity rate. Integration of palliative and supportive care to conservative management improves quality of life and prolongs survival of these patients. Conservative management of symptoms, prognostication, communication of advance care plans and shared-decision making should be a part of physician's skills. There are some recommended prognostication systems in nephrology, which can help to facilitate the physician-patient communication...

Liver fibrosis

Václav Šmíd

Vnitr Lek 2020, 66(4):e36-e41 | DOI: 10.36290/vnl.2020.078  

Liver fibrosis is the excessive deposition of extracellular matrix in liver tissue resulting in structural and functional liver changes. The basis for these changes is the imbalance between fibrogenesis and fibrolysis, which arises in response to chronic liver damage, regardless of its aetiology. Advanced liver fibrosis leads to cirrhosis with its possible complications - portal hypertension, hepatocellular carcinoma, and liver failure. For patients with chronic liver disease, the development of liver fibrosis as well as its severity is the most important prognostic factor. Early diagnosis is a key to avoid above mentioned complications. Understanding...

Are changes in the blood count clinically useful marker of azathioprine dose?

Vladimír Kojecký, Jan Matouš, Zdena Zádorová, Bohuslav Kianička, Aleš Hep

Vnitr Lek 2020, 66(4):e42-e45 | DOI: 10.36290/vnl.2020.079  

Introduction: The 6-thioguanine nucleotide (6-TGN) level, may be used to estimate dose-adequacy of azathioprine (AZA) therapy. 6-TGN test is not commercially available. The aim of the study was to determine whether a blood cell changes correlate also with the dose of AZA and may serve as a predictor of the dose adequacy (for MCV > 6 fl). Methods: Retrospective, multicentre study in subjects with IBD treated with azathioprine. Demographic data, leukocyte, platelet counts, erythrocyte (MCV) and thrombocyte (MPV) volume, azathioprine dose, inflammatory activity in the 3rd, 6th and 12^th months of treatment and presence of sideropenia were...

Heparin-induced thrombocytopenia: a case report and literature overview

Pavel Polák, Yvona Kaloudová, Hana Krupicová, Pavel Coufal, Břetislav Lipový, Jiřina Zavřelová, Marie Prudková, Andrea Štěpařová, Lucie Říhová, Renata Bezděková, Romana Králová, Lukáš Frola, Miroslav Penka

Vnitr Lek 2020, 66(4):242-248 | DOI: 10.36290/vnl.2020.068  

Heparin-induced thrombocytopenia (HIT) is an immunologically-mediated complication, which usually follows heparin exposition, less frequently exposition to other drugs or even occurs spontaneously. The type of heparin, its dose and mode of application as well as the exposition time, major trauma or operation, and obesity represent the main risk factors for HIT. The probability of HIT correlates with so-called 4T-score. A confirmatory laboratory diagnostic should be exclusively reserved for patients with a medium to a high probability of HIT development (more than 3 points in 4T-score). The screening method is based on serological detection of antibodies...

Microscopic polyangiitis

Daniel Tobiáš, Kristína Brázdilová, Zdenko Killinger, Juraj Payer

Vnitr Lek 2020, 66(4):249-252 | DOI: 10.36290/vnl.2020.069  

Microscopic polyangiitis is a rare, systemic, necrotizing, pauci-immune, ANCA associated small vessel vasculitis, with no evidence of granulomatous inflammation. Diagnosing microscopic polyangiitis is often difficult because of it´s presentation by a number of non-specific symptoms. We treated a 35-year old patient, who was admitted for migrating arthritis and fever with papulous rash. In this case, we want to point out the importance of considering the diagnosis of MPA and similar rare diseases in the process of differential diagnosis, mainly in patients presenting with non-specific symptoms, because the mortality of this disease without adequate...

Heart failure as a manifestation of acromegaly

Ivana Ságová, Milan Dragula, Daniela Kantárová, Anton Vaňuga, Peter Vaňuga

Vnitr Lek 2020, 66(4):e46-e50 | DOI: 10.36290/vnl.2020.080  

Acromegaly is a rare disease with incidence of 3-4 patients per 1 000000 per year, which is mainly caused by benign tumour of the pituitary gland. Long-term presence of elevated growth hormone (GH) and insulin like growth factor 1 (IGF-1) levels accompanying this disease is associated with rheumatologic, cardiovascular, pulmonary and metabolic complications. Cardiovascular complications of acromegaly include a cardiomyopathy, arterial hypertension, arrhytmias, valvulopathy as well as endothelial dysfunction. Cardiovascular diseases are the leading cause of mortality in patients with acromegaly. An early diagnosis of acromegaly significantly influences...

Long term use of the telemonitoring system Diani in the therapy of a patient with type 1 diabetes

Jan Brož, Anna Holubová, Jan Mužík, Martina Vlasáková, Miroslav Mužný, Alice Králová, Lucie Hoskovcová, Denisa Janíčková Žďárská, Eirik Arsand, Michaela Hronová, Jana Urbanová, Milan Kvapil

Vnitr Lek 2020, 66(4):e51-e55 | DOI: 10.36290/vnl.2020.081  

Mobile and wearable technologies offer patients with diabetes mellitus new possibilities for data collection and their more effective analysis. The Diabesdagboga smartphone application and the Diani web portal enable to collect and analyze glycaemia values, carbohydrates intake, insulin doses and the level of physical activity. The data are not only accessible in the corresponding smartphone but also automatically transferred to an Internet portal, where they may be completed by the records from an electronic pedometer and continuous glucose monitor. All these data may then be displayed in various types of graphical outputs and are available to both...

Hyperuricemia in renal disease patients

Štěpán Bandúr

Vnitr Lek 2020, 66(4):259-266 | DOI: 10.36290/vnl.2020.071  

Hyperuricemia is a common laboratory finding in different types of patients. Except of those with acute or chronic gout, it is frequently found in patients with metabolic syndrome, patients with malignancies or renal impairment - acute kidney injury (AKI) and chronic kidney disease (CKD). Hyperuricemia might cause renal dysfunction or might be a part of laboratory abnormalities associated with loss of renal function as well. There is also large body of evidence of hyperuricemia as a potential cardiovascular (CV) risk factor, which might even more increase CV risk in CKD patients. Association of asymptomatic hyperuricemia and progression of CKD remaines...

Evaluation of surgical risk in patients with liver cirrhosis

Eva Uchytilová, Eva Kieslichová

Vnitr Lek 2020, 66(4):253-257 | DOI: 10.36290/vnl.2020.070  

The prevalence of liver cirrhosis in population is increasing, as well as its prevalence among patients admitted to hospital for elective surgery. These patients are at risk of high postoperative morbidity and mortality. Perioperative risk assessment of patients with liver cirrhosis is a complex procedure. It consists of evaluation of general condition of the patient, including comorbidities and nutritional status, evaluation of the grade of liver disease, and urgency of the surgical procedure. There are no specific guidelines. Proper risk assessment before surgery, considering alternative ways of treatment, is a cornerstone of optimal postoperative...

Stanovisko Angiologickej sekcie Slovenskej lekárskej komory (AS SLK) k užívaniu antagonistov renín-angiotenzín- aldosterónového systému  (ACE inhibítorov; blokátorov receptora angiotenzínu II – ARB, sartanov; kombinácie ARB s inhibítorom neprilyzínu – ARNI) počas pandémie spôsobenej SARS­‑CoV-2 (Koronavírusová choroba 2019; Covid-19)

doc. MUDr. Peter Gavorník, PhD., mim. prof.

Vnitr Lek 2020, 66(4):e57  

K životnímu jubileu  prof. MUDr. Jindřicha Špinara, CSc., FESC

Jiří Vítovec

Vnitr Lek 2020, 66(4):56