Vnitřní lékařství, 2020 (vol. 66), issue 5
Review articles
Dyslipidemia in patients with chronic kidney disease: etiology and management
Magdaléna Dušejovská, Marek Vecka, Ivan Rychlík, Aleš Žák
Vnitr Lek 2020, 66(5):275-281 | DOI: 10.36290/vnl.2020.082 
The worldwide population is burdened with chronic kidney disease (CKD) from 10-13 %. Patients with CKD subsequently die to cardiovascular disease (CVD) and their complications. In the Czech population, in 2016, the number of patients with end stage renal disease (ESRD) on regular dialytic treatment was 6 739, or 674/1 000 000 inhabitants. Overall mortality in regular dialysis treatment patients was 18.4 % in 2016, of which 43 % died of cardiovascular complications. In view of this fact, a number of expert groups are concerned, among other things, with the problems of lipid metabolism disorders, with the aim of finding a common predictive marker (preferably...
Transcatheter aortic valve implantation - what do we know in 2020
Petr Toušek, Viktor Kočka, Petr Mašek
Vnitr Lek 2020, 66(5):282-286 | DOI: 10.36290/vnl.2020.083
Aortic stenosis is the most common acquired valve disease in adults and the prevalence of this disease is increasing with the aging population. Transcatheter aortic valve implantation (TAVI) became fully established method for treating this disease. The aim of this review is to present the current view of the performance technique, to summarize the data on the outcome of patients from recently published randomized studies and registries and to simply describe patient care after the procedure.
Chronic cholestatic liver diseases - Primary biliary cholangitis and Primary sclerosing cholangitis
Tomáš Fejfar, Tomáš Vaňásek, Petr Hůlek
Vnitr Lek 2020, 66(5):287-300 | DOI: 10.36290/vnl.2020.084
Cholestasis is defined as hepatocyte and cholangiocyte bile excretion failure or failure of bile transport to the duodenum. Primary biliary cholangitis (PBC) and primary sclerosing cholangitis as chronic progressive cholestatic diseases are the common reasons of chronic cholestasis. Altogether with cholestatic laboratory picture the pruritus, liver osteodystrophy and fatigue are associated symptoms in both diseases. All associated symptoms and complications are needed to be diagnosed and treated early. In case of liver cirrhosis complicatons of accompanied portal hypertension should be treated and liver transplantation must be considered in all those...
Vaccines recommended for diabetic patients
Petra Macounová, Rastislav Maďar
Vnitr Lek 2020, 66(5):301-307 | DOI: 10.36290/vnl.2020.085
Diabetes mellitus is the name of a group of chronic diseases in which absolute or relative lack of insulin causes hyperglycemia. The hyperglycemic environment causes disorders of the cells of innate immunity, which leads to reduced function of the immune system, and therefore diabetics are more susceptible to infections. Due to immune dysfunction, infections are not only more common, but also more severe and with higher mortality than in people without diabetes. Nevertheless, in diabetics, an adequate immune response to the vaccine is maintained, so it is possible to use one of the most effective options for preventing infections, which is vaccination....
Ropeginterferon alfa-2 b for the therapy of polycythemia vera
Libor Červinek
Vnitr Lek 2020, 66(5):309-313 | DOI: 10.36290/vnl.2020.086
Interferon alfa (IFN‑α) has been used in the treatment of myeloproliferative disorders for more than 30 years. IFN‑α has been shown to induce clinical, hematological, molecular, and histopathological remission, but its toxicity has remained a limitation of its more widespread use. The development of pegylated forms with a better tolerance has brought new options for patients. Phase III clinical trials, ropeginterferon‑α versus hydroxyurea: PROUD-PV and CONTINUATION-PV, have shown long-term superiority in the efficacy and safety when comparing ropeginterferon alfa-2 b with hydroxyurea. Therapeutic use of interferons...
E-publication
Alcohol-related liver diseases (ALD)
Jiří Ehrmann, Květoslava Aiglová, Ondřej Urban, Silvia Cveková, Pavol Dvoran
Vnitr Lek 2020, 66(5):e3-e15 | DOI: 10.36290/vnl.2020.091
The main aim of this educational article ( narrative review ) is to reflect clinical practice guidelines of the European Association for the Study of the Liver (EASL) published in J Hepatol 2018, contrasting with the 2012 guidelines especialy in the new terminology of alcohol-related liver diseases (ALD). The strong emphasis on prevention of alcohol use disorders (AUD) may be exert at all stages of public health care. Another aim of the article are ALD history, epidemiology, metabolism of alcohol and clinical pictures of ALD.
Diabetes mellitus and illicit drugs
Jana Malinovská, Jana Urbanová, Michala Lustigová, Kristýna Kučera, Jan Brož
Vnitr Lek 2020, 66(5):e16-e19 | DOI: 10.36290/vnl.2020.092
Lifetime prevalence of illicit drug use is high in the Czech Republic (CR) - it reached 31.2 % of the population in the age group 15-64 years in 2017. Diabetes mellitus (DM) applies to 8.8 % of the Czech population. Risks of illicit drug use in diabetic patients are related both to their effect on glucose metabolism and to the lifestyle associated with illicit drug use, which might lead to worsened glycemic control and increased morbidity and mortality of the patients. Cannabis use, being the most common illicit drug use in the CR, presumably does not have a direct effect on glucose metabolism. However, it increases appetite and decreases self-control....
Pulmonary‑renal syndrome
Zdenka Hrušková, Vladimír Tesař
Vnitr Lek 2020, 66(5):e20-e25 | DOI: 10.36290/vnl.2020.093
Pulmonary syndrome is defined by occurrence of lung involvement (alveolar haemorrhage) in association with renal failure (with a typical crescentic necrotizing rapidly progressive glomerulonephritis). It is caused by an autoimmune disease, most frequently ANCA-associated vasculitides and anti-GBM (glomerular basement membrane) disease. Early establishment of the right diagnosis and immediate treatment are crucial for favourable prognosis of the patients. First choice therapy includes high-dose corticosteroids and cyclophosphamide, usually with plasma exchange added. Newer therapeutic possibilities include especially rituximab even though there is limited...
Original articles
Confocal laser endomicroscopy in the diagnostics of esophageal diseases: a pilot study
Lumír Kunovský, Zdeněk Kala, Radek Kroupa, Tomáš Grolich, Jiří Dolina, Milan Dastych, Jitka Vaculová, Jakub Vlažný, Petr Moravčík, Lydie Izakovičová Hollá, Petra Bořilová Linhartová, Petr Jabandžiev, Vladimir Procházka
Vnitr Lek 2020, 66(5):e26-e32 | DOI: 10.36290/vnl.2020.094
Background: Probe‑based confocal laser endomicroscopy (pCLE) is a novel diagnostic technique for endoscopy which enables a microscopic view at a cellular resolution in real‑time. Endoscopic detection of early neoplasia in the distal esophagus is difficult and often these lesions can be missed. The aim of the pilot study was to obtain characteristic pCLE figures in esophageal diseases for following studies, and to evaluate the possible future role of pCLE in the diagnostics of dysplastic Barrett's esophagus (BE) or early esophageal adenocarcinoma (EAC). Methods: A review of the current literature was performed and previously published pCLE...
Comparison of different approaches for estimation of prevalence of type 2 diabetes mellitus in the Czech Republic
MUDr. Pavel Hroboň, M.S., Magdalena Škodová, Petra Kučová, Jana Votápková
Vnitr Lek 2020, 66(5):e33-e37 | DOI: 10.36290/vnl.2020.095
Prevalence of type 2 diabetes in the Czech Republic can be estimated from data reported by health care providers either to the statistical office or to health insurers. The latter include both diagnosis and prescribed drugs. Patient classification to a certain chronic condition based on consumption of drugs (Pharmacy-based Cost Groups classification) has been used in the Czech Republic for the purpose of redistribution of collected funds among health insurers since the beginning of 2018. This article compares prevalence of diabetes estimated from statistical data and from data reported to health insurers, and discusses current and future advantages...
Case reports
Treatement of dyspnea: the cause of troublesome diagnostic process of neurological illness
MUDr. Michal Scheinost, MUDr. Michaela Martincová, MUDr. Zuzana Podhrázská, MUDr. Andrej Mokeev, MUDr. Martin Forgáč
Vnitr Lek 2020, 66(5):314-315 | DOI: 10.36290/vnl.2020.087
This casuistic talks about the patient who was admitted to hospital for acute bronchitis. Treatment of respiratory illness led to exacerbation of latent myasthenia gravis (MG). Difficulties in diagnostics of MG were caused by atypical form of illness and also by treatment of bronchitis which modified classical symptoms.
Case reporty
E-publication
Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis
Veronika Pokorna, Svetlana Bodikova, Jozef Kaluzay, Zuzana Liskova, Olga Jurkovicova
Vnitr Lek 2020, 66(5):e48-e51 | DOI: 10.36290/vnl.2020.090
We present a case report of a patient with acute upper and lower limb ischemia due to paradoxical embolism. A 67-year old woman without history of venous thromboembolism suffered dislocated patellar fracture requiring surgery in November 2017. Two months after surgery she presented to the emergency room with bilateral pulmonary embolism, occlusion of the left subclavian artery, left common femoral artery and superior mesenteric artery. Transesophageal echocardiography detected patent foramen ovale. Vascular surgeon decided against embolectomy, interventional radiologist against pharmacomechanical thrombolysis due to the extent of the occlusions. Systemic...
An incidental finding of pheochromocytoma in a 33-year-old patient with Lynch syndrome
Emília Mojtová, Jana Hanajíková, Olívia Hamidová, Gabriel Bognár, Daniel Dyttert, Marianna Grigerová, Štefan Kečkéš, Ján Podoba
Vnitr Lek 2020, 66(5):e38-e42 | DOI: 10.36290/vnl.2020.096
Pheochromocytoma is a catecholamine-producing neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. The detection of these tumors is extremely important because they are associated with high cardiovascular morbidity and mortality. Progress in molecular genetics has revealed that up to 35% of pheochromocytomas are inhereted. Lynch syndrome (hereditary nonpolypous colorectal cancer - HNPCC) is an autosomal dominant genetic condition that is associated with a high risk of colorectal cancer or other extracolonic tumors (adenocarcinoma of endometrium, stomach, ovarian carcinoma, carcinoma of urinary tract, small intestine, brain tumors...
Liver transplantation as potential curative method in severe hemophilia A: case report and literature review
Pavel Polák, Petr Smejkal, Gabriela Romanová, Jiřina Zavřelová, Radomíra Hrdličková, Šárka Blahutová, Libuše Husová, Marta Zvarová, Miroslav Penka
Vnitr Lek 2020, 66(5):e43-e47 | DOI: 10.36290/vnl.2020.097
The authors present clinical case of orthotopic liver transplantation for cirhosis due to chronic viral hepatitis C in a subject with severe hemophilia A. Preoperatively performed pharmacokinetic study with recombinant F VIII confirmed satisfactory in vivo recovery of 2.1 %. A bolus application of 52 units F VIII/kg body weight with target F VIII activity over 100.0 % was administred shortly before the transplantation started. Totally, 30 000 units of recombinant F VIII, 3 thrombocyte concentrates, 2 erythrocyte concentrates, 5 units of virally inactivated plasma, 1 unit of fresh frozen plasma and 3 500 antithrombin units were used. There were no perioperative...
Differential Diagnosis Column or What you can be asked at a postgraduate certification exam
Osteolytic bone lesions, hypercalcemia and paraprotein, but not a myeloma: case report and review of literature
Katarína Hradská, Tomáš Jelínek, Juraj Ďuraš, Jana Mihályová, Tereza Popková, Jakub Cvek, Kamil Bukovanský, Martin Havel, Veronika Spáčilová, Roman Hájek
Vnitr Lek 2020, 66(5):316-321 | DOI: 10.36290/vnl.2020.088
In June 2018, 77-year-old man was referred to The Department of Haematooncology, University Hospital Ostrava, for suspicion of multiple myeloma. This was supported by laboratory findings of hypercalcemia, paraprotein IgA κ in serum and by the presence of multiple osteolytic skeletal lesions. Low number of plasma cells in bone marrow sample - cytologically (3.6 %) as well as in flow cytometry (less than 95 % clonal plasma cells out of total bone marrow plasma cells) - pointed at the direction of monoclonal gammopathy of undetermined significance (MGUS). In the course of differential diagnosis of hypercalcemia, elevated level of parathormone had...
Pharmacological profile
Praluent (alirokumab)
Tomáš Král
Vnitr Lek 2020, 66(5):322-326 | DOI: 10.36290/vnl.2020.089
PCSK9 inhibitors (inhibitors of proprotein convertase subtilisin/kexin type 9) offer a promising treatment strategy decreasing the concentrations of both atherogenic low density lipoprotein (LDL) and cholesterol contained within LDL. Alirocumab is one of two PCSK9 inhibitors that entered clinical practice so far. Alirocumab is a specific antibody against PCSK9, manufactured using recombinant technique. When the antibody binds to the PCSK9 isoenzyme, no complex encompassing PCSK9 and LDL receptor can be formed, thus enabling further recirculation of the LDL receptor. Increasing the amount of LDL receptors available on the cell membranes leads to higher...