Alergie a imunopatologie – hlavní téma

Petr Panzner

Vnitr Lek 2020, 66(6):331  

Anaphylaxis - acute and long-term management

Martina Vachová

Vnitr Lek 2020, 66(6):335-339 | DOI: 10.36290/vnl.2020.098  

Anaphylaxis is a serious, potentially life-threatening condition, and all healthcare professionals should be aware of it. Prompt recognition of anaphylaxis signs and early initiation of adequate treatment are essential for successful acute management. The first-line treatment is the administration of intramuscular adrenalin, followed by other interventions. Patients should be monitored after recovery for possible biphasic reaction. Before discharge, the individual risk of further reaction should be assessed and where appropriate an adrenalin auto-injector should be prescribed. Allergy specialist follow-up is essential for the identification of possible...

Food allergy and intolerance

Ivana Šetinová

Vnitr Lek 2020, 66(6):340-344 | DOI: 10.36290/vnl.2020.099  

The arcticleprovides general information about current knowledges of pathogenesis in development of food allergy, including diagnostic posibilities and pitfalls of IgE and non-IgE mediated food allergy and their treatment. Further, the most common cause of food intolerance is commented and the diet recommendation.

Complement deficiencies

Marta Sobotková

Vnitr Lek 2020, 66(6):346-352 | DOI: 10.36290/vnl.2020.100  

Complement system plays a crucial role in innate imunity. Complement deficiencies are often associated with severe infections, usually meningoccocal, pneumococcal or caused by Haemophilus influenzae, or with autoimmune diseases, especially systemic lupus erythematodes. Inherited complement deficiencies are very rare although their prevalence in population may be underestimated due to lower availability of adequate laboratory testing. Acquired complement deficiencies accompany other underlying diseases and often are caused by increased consumption and only partial.

Immunosenescence - the sunset over the immune system

Zita Chovancová

Vnitr Lek 2020, 66(6):353-358 | DOI: 10.36290/vnl.2020.101  

Immunosenescence is characterized by remodeling and dysregulation of immune system due to aging process. These changes affect innate as well as adaptive immunity. Due to the complexity of the physiological processes, in which the mechanisms of the immune system interfere, also other systems of the organism are affected by these changes. Thymus involution as well as chronic antigenic stimulation are the main causes of immunosenescence and lead to a proinflammatory setting of the organism. In addition to impaired immune response against infections or reactivation of latent infections, reduced response to vaccination or decreased antitumor immune surveillance,...

Influenza and its complications

Adam Vitouš, František Stejskal

Vnitr Lek 2020, 66(6):360-362 | DOI: 10.36290/vnl.2020.102  

Influenza is viral acute respiratory illness. During winter season flu occurs in local epidemics of various magnitude. Influenza causes substantial loss of workdays, human suffering, and significant mortality rate in population, despite the existing treatment and effective vaccination.

Familial pulmonary fibrosis - guidelines for diagnostics and treatment

Martina Šterclová, Michael Doubek, Martina Doubková

Vnitr Lek 2020, 66(6):365-369 | DOI: 10.36290/vnl.2020.103  

Familial pulmonary fibrosis (FPF) is defined as interstitial lung involvement in at least two members of the same biological family. Pathogenesis of FPF involves background of genetic risk factors further modified by environmental exposures and aging. Manifestation of FPF mirrors manifestation of interstitial lung diseases generally. Patients may present also with involvement of other organs, as seen usually in those affected by complex syndromes or telomeropaties. Described mutations concern telomeres homeostasis genes (TERT, TERC, RTEL1, PARN, DKC1, TINF, NAF1), surfactant genes (SFTPC, ABCA3, NFKX2-1) or genes associated with complex syndromes (COPA,...

Crystalopathy - underestimated entity in nephrology

Petra Bachroňová, Ivan Rychlík

Vnitr Lek 2020, 66(6):371-377 | DOI: 10.36290/vnl.2020.104  

Crystal is a solid particle with a geometric shape because its atoms, ions, or molecules are arranged in a regular ordered structure. However, in case of accidental order of the particles, we are talking about the amorphous substances which can also form crystal-like particles. Crystallopathy is a disease that involves crystals of crystal-like particulate matter in the pathogenesis of tissue injury. Generally, several predominant pathophysiological mechanisms are involved in the formation of crystallopathies: necroinflammation, chronic remodeling of tissues leading to their atrophy and scarring, and obstruction of ducts, cavities or vessels by larger...

Percutaneous left atrial appendage closure

Marek Hozman, Pavel Osmančík

Vnitr Lek 2020, 66(6):e3-e9 | DOI: 10.36290/vnl.2020.109  

Stroke is one of the most severe complications of atrial fibrillation. Oral anticoagulation is the first choice therapy in prevention of cardiac embolic events. Particularly in patients with the history of serious bleeding, oral anticoagulation may be contraindicated. Percutaneous left atrial appendage closure represents an alternative in prophylaxis of cardiac embolic events. This review article describes physiology and pathophysiology of the left auricle, the most frequently used devices and their indications and scientific rationale.

Current status of dietary measures in patients with advanced-stage chronic renal failure

Anna Maršáková, Karolína Krátká, Petra Bachroňová, Ivan Rychlík

Vnitr Lek 2020, 66(6):e10-e13 | DOI: 10.36290/vnl.2020.110  

For patients with advanced chronic kidney disease (CKD) appropriately chosen and timely initiated dietary measures, as a complement to drug therapy, may slow the progression of the disease and delay the need for dialysis treatment. According to the results, dietary protein restriction may play a very important in management of such a patient. The effect of low protein diet is given by the early initiation and well cooperation of patients. The low protein diet with supplementation of ketoanalogues of amino acids is an attractive intervention to help maintain good nutritional status of patients and also have a positive role in calcium phosphate metabolism....

Hemodialysis vascular access dysfunction and its endovascular treatment

Martin Vorčák, Kamil Zeleňák, Ján Sýkora, Alena Ježíková, Marián Mokáň

Vnitr Lek 2020, 66(6):e14-e18 | DOI: 10.36290/vnl.2020.111  

Hemodialysed patients with end stage renal disease are reliant to proper function of vascular access - mostly arterio-venous fistula (AVF). AVF patency is jeopardized by stenosis formation, which needs to be treated before thrombosis. Angioplasty is primarily indicated and prolongs vascular access patency. High pressure balloons and cutting balloons aid to high technical success rate. Angioplasty needs to be repeated in order to maintain long term patency. Drug-eluting balloons prolong long term patency. Stents and stentgrafts are seldom used in inoperable patients and in selected locations. Technical advances allowed endovascular treatment in AVF...

Histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Comparison of recent WHO classification published 2017 and classification of Histiocyte Society published 2016

Zdeněk Král, Zdeněk Adam, Marta Ježová, Luděk Pour, Marta Krejčí

Vnitr Lek 2020, 66(6):e19-e27 | DOI: 10.36290/vnl.2020.112  

The histiocytoses are rare disorders characterized by the accumulation of cells thought to be derived from dendritic cells or macrophages. Their clinical behaviour ranges from mild to disseminated and, sometimes, life-threatening forms. The incidence of this diseases is much smaller, then the incidence of diseases derived from lymphocytic or myeloid lineage. Langerhans cell histiocytosis is most frequent disease from this group. The last version of WHO classification from 2017 and last version of classification published by Histiocyte Society is summarised in this paper.

Glycated haemoglobin as a marker of elevated LDL and TAG: a cohort study

Linda Buková, Peter Galajda, Martin Javorský, Marián Mokáň

Vnitr Lek 2020, 66(6):e28-e34 | DOI: 10.36290/vnl.2020.113  

Sulfonylurea derivatives and risk of hypoglycaemia in type 2 diabetic patients

Jakub Svěcený, Jana Jirušková, Karel Hrach, Lucie Radovnická, Jiří Laštůvka

Vnitr Lek 2020, 66(6):e35-e42 | DOI: 10.36290/vnl.2020.114  

Hypoglycemia related to treatment of type 2 diabetes mellitus patients constantly represents a substantial problem. It is connected with higher mortality and lower quality of life, mostly displayed with elder patients. Therefore it is vital to revise the antidiabetic therapy regularly and to inquire for the associated risks. Nevertheless, elder patiens are often following the inadvisable treatment by sulphonylureas derivates, which represent the second most risky medication causing hypoglycemia after insulin. In our retrospective study we analysed the occurence of serious hypoglycemia, caused by any factor, with severe diabetics urgently hospitalised...

Endoscopic diagnostics and therapy of pancreatobiliary diseases in persons after gastric resection according to Billroth I.

Bohuslav Kianička, Lumír Kunovský, Martin Blaho, Vladimír Kojecký, Alena Ondrejková, Hana Nechutová, Miroslav Souček, Filip Šustr, Markéta Musilová, Jan Novák, Petr Piskač, Petr Dítě

Vnitr Lek 2020, 66(6):e43-e45 | DOI: 10.36290/vnl.2020.115  

The stomach resection according to Billroth I (B I) is very rarely done. The aim of this retrospective study is to evaluate our experience with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients after stomach resection according to Billroth I. In patients with a condition after stomach resection according to B I, a study of the group of 20 years (November 1994 - December 2014) took place. Three patients were evaluated retrospectively after B I stomach resection with biliary obstruction. For the ERCP was used the Olympus therapeutic videotheroscop in all cases with the standard (as in normal anatomical situation)....

Myocardial infarction or broken heart syndrome?

Vojtěch Brázdil, Martin Hudec, Martin Poloczek, Jan Kaňovský, Roman Štípal, Petr Jeřábek, Otakar Boček, Petr Kala

Vnitr Lek 2020, 66(6):378-380 | DOI: 10.36290/vnl.2020.105  

Takotsubo or broken heart syndrome represents a rare type of cardiomyopathy, often imitating acute myocardial infarction. It is a sudden transient cardiac syndrome that typically involves left ventricular apical akinesis with preserved motility of basal heart segments. In contrast to acute myocardial infarction, the pathology is fully reversible in the majority of patients. In the present case-report, we discuss 78-years-old female referred to our department for typical symptomatology of acute myocardial infarction. Coronary angiography revealed significant stenosis on the left anterior descending coronary artery, but ventriculography disclosed apical...

Dieulafoy's jejunal lesion as a source of lifethreating bleeding

Lenka Dvorská, Jiří Janoušek, Ilja Tachecí, Tomáš Rozkoš

Vnitr Lek 2020, 66(6):381-385 | DOI: 10.36290/vnl.2020.106  

Dieulafoy`s lesion is a rare condition characterized by bleeding into gastrointestinal tract from minimaly eroded submucous artery. Mostly is localized in stomach in elderly polymorbid men, but can occure in entire gastrointestinal tract, in both sexes, in every age. It should be thought off as one of possible causes of obscure bleeding. It is often massive, requiring fast diagnostics, treatment and multidisciplinary approach. The case report discusses patient with recurrent hemodynamicaly significant bleeding into jejunum. It pointed to combined diagnostic approach using both endoscopy and angiography. After failing endoscopically and angiografically...

Hospital-acquired methemoglobinemia

Jan Táborský, Martin Střelka, Marcela Káňová, Zdeněk Kořístek, Šárka Blahutová, Roman Černohorský, Tomáš Mičkal

Vnitr Lek 2020, 66(6):e46-e52 | DOI: 10.36290/vnl.2020.116  

Methemoglobinemia is rare condition of hem iron. Ferrous form iron (Fe²⁺) is oxidised to Ferric form (Fe³⁺). Methemoglobin has reduced ability to release oxygen to tissues and thereby leads to tissue hypoxia. We present case of patient with methemoglobinemia of unknown etiology. Methemoglobinemia developed during hospitalization. Diferent causes of methemoglobinemia and also a treatment possibilities are discussed.

Gastrointestinal tract involvement in mixed connective tissue disease (Sharp syndrome)

Lenka Nosáková, Martin Schnierer, Peter Bánovčin, Katarína Stašková, Martin Ďuríček, Rudolf Hyrdel

Vnitr Lek 2020, 66(6):e53-e57 | DOI: 10.36290/vnl.2020.117  

Mixed connective tissue diseases (MCTD) is a very rare autoimmune disease connecting clinical signs of systemic lupus, systemic sclerosis, polymyositis and rheumatoid arthritis. Clinical manifestations are very diverse. In some patients, the digestive tract is affected in varying degrees. The esophagus is affected most often, and patients are complaining of dysphagia. Morphologically, this disorder is similar to the injure in systemic scleroderma. In this case, we describe a unique case of a severe damage of digestive tract manifested by esophageal motility disorders, cachectization, ascites, and repeated ileus conditions.

What is new for internists in the updated guidelines on the diagnosis and management of pulmonary embolism 2019?

Zdeněk Monhart

Vnitr Lek 2020, 66(6):386-390 | DOI: 10.36290/vnl.2020.107  

The new guidelines on the diagnosis and management of pulmonary embolism developed in collaboration with the European Respiratory Society were presented on the congress od European society of cardiology in 2019. Are internists concerned, when these guidelines were presented at the congress of cardiologic society? Management of acute pulmonary embolism is less "cathlab dependent"than management of acute coronary syndromes - and pulmonary embolism patients are often treated by internists. Moreover, differential diagnosis of dyspnoea is a everyday problem solved by internists. What is new in the updated guidelines? Refinements in interpretation of D-dimer...