Hlavní téma – Digestivní endoskopie

doc. MUDr. Ondřej Urban, Ph.D.

Vnitr Lek 2022, 68(6):351  

Endoscopic treatment of early colorectal cancer

Přemysl Falt

Vnitr Lek 2022, 68(6):355-362 | DOI: 10.36290/vnl.2022.075  

Early colorectal neoplasia is a localized precancerous lesion of the large intestine associated with negligible risk of lymphatic or systemic dissemination. Early neoplasia consists of adenoma with low- and high-grade dysplasia, intramucosal carcinoma and superficially invasive cancer without other high-risk features. In the majority of cases, early neoplastic lesions are detected by colonoscopy and treated by means of endoscopy resection replacing surgical treatment. Risk of invasive cancer should be stratified during diagnostic colonoscopy using morphological classifications and then, appropriate resection technique (endoscopic polypectomy, endoscopic...

Current trends in the diagnosis of pancreatic cancer

Petr Vanek, Michal Eid, Robert Psar, Vincent Zoundjiekpon, Ondrej Urban, Lumir Kunovsky

Vnitr Lek 2022, 68(6):363-370 | DOI: 10.36290/vnl.2022.076  

Pancreatic ductal adenocarcinoma (PDAC) is a dreaded malignancy with a dismal 5-year survival rate despite maximal efforts on optimizing treatment strategies. Currently, early detection is considered to be the most effective way to improve survival as radical resection is the only potential cure. PDAC is often divided into four categories based on the extent of disease: resectable, borderline resectable, locally advanced, and metastatic. Unfortunately, the majority of patients are diagnosed with locally advanced or metastatic disease, which renders them ineligible for curative resection. This is mainly due to the lack of or vague symptoms while the...

Early gastric cancer

Ladislav Douda, Jiří Cyrany, Ilja Tachecí

Vnitr Lek 2022, 68(6):371-375 | DOI: 10.36290/vnl.2022.077  

Early gastric cancer is defined histopathologically as a tumour with limited local progression to the mucosa and submucosa. The concept of early cancer was developed in the 1960s in Japan and is now widely accepted. The term of early gastric cancer included cases with/without metastatic lymph node involvement. However, a common characteristic is a favourable prognosis of the disease. The task of the endoscopist is primarily to diagnose (identify) the tumour (precancerous lesions) and to verify it by biopsy. Successful identification must be followed by its correct classification, leading to the choice of an adequate approach, which includes surveillance,...

Comprehensive approach to a patient with arterial hypertension and dyslipidemia

Zdeněk Ramík, Jan Václavík, Pavla Jadrníčková, Jana Obrová, Janula Stromská

Vnitr Lek 2022, 68(6):376-386 | DOI: 10.36290/vnl.2022.078  

Arterial hypertension together with dyslipidemia, diabetes and smoking are the most severe risk factors for cardiovascular (CV) disease. The Czech Republic is among the countries with a high risk of cardiovascular disease. To reduce cardiovascular mortality and morbidity in our patients, a comprehensive approach to treatment and, in most cases, aggressive control of all risk factors is needed. This article summarizes current diagnostic and therapeutic procedures for arterial hypertension and dyslipidaemia, as well as the concept of vascular age, which can help us to communicate CV risk with patients.

What is a risk heart rate at various stages of the cardiovascular continuum?

Anna Vachulová

Vnitr Lek 2022, 68(6):387-392 | DOI: 10.36290/vnl.2022.079  

Prevention, detection, and treatment of high blood pressure remain an important public health challenge. There is convincing evidence that heart rate is an important risk factor for cardiovascular disease. Recommendations for the resting heart rate measurement are roughly the same as those used for blood pressure measurement which is usually made during the same session. Across different parts of the cardiovascular disease continuum, different heart rate thresholds are identified. Elevated heart rate identifies patients with hypertension at high cardiovascular risk. One of the important causes of inadequate blood pressure control and at the same time...

SGLT-2 inhibition a useful tool in the treatment of heart failure with reduced and preserved ejection fraction

Jiří Slíva

Vnitr Lek 2022, 68(6):393-397 | DOI: 10.36290/vnl.2022.080  

Heart failure is highly prevalent in the population and, from a long-term point of view, a disease that is still difficult to treat. Although a number of medicinal solutions are offered in its treatment, there are still large reserves. The drug portfolio has recently been expanded to include the use of SGLT-2 inhibitors, initially for failure with reduced and now also with preserved ejection fraction. The question of the possibility of using these substances is discussed in the text, focusing on a possible explanation of their therapeutic benefit.

Chronic lung diseases and sleep

Samuel Genzor, Jan Mizera, Jakub Kiml, Petr Jakubec, Milan Sova

Vnitr Lek 2022, 68(6):398-401 | DOI: 10.36290/vnl.2022.081  

Sleep is vitally important part of our life. Its quality and quantity influence all physiological processes in our organism. The relationship between the lung diseases and sleep is bidirectional - the lack of quality sleep worsens the compensation and the course of the diseases and in the same time chronic lung diseases are negatively affecting sleep quality. The coexistence of the sleep disordered breathing and lung disorders is another important issue to discuss. In case of chronic obstructive pulmonary disease the overlap with sleep disordered breathing is characterized by higher prevalence of hypercapnia and overall worse prognosis. Moreover, there...

Clinical experience with the use of newer antibiotics in internal medicine

Pavla Paterová, Martina Novosadová

Vnitr Lek 2022, 68(6):E10-E14 | DOI: 10.36290/vnl.2022.085  

The alarming rise in antibiotic resistance between Gram-positive and Gram-negative bacteria makes maximum use of known and available antibiotics necessary. The aim of this work is to highlight some advantages and disadvantages of antibiotics that have appeared on the market in recent years, and share clinical experience with their use in internal medicine. Flucloxacillin is an antibiotic with a significant antistaphylococcal effect, the most significant indications of the oral form are infections of the skin and soft tissues with the causative agent of Staphylococcus aureus and streptococci. The intravenous variant of flucloxacillin is an noninferior...

Evaluation of medication errors in the hospital environment

Iva Brabcová, Valérie Tóthová, Hana Hajduchová, Ivana Chloubová, Martin Červený, Radka Prokešová, Josef Malý, Martin Doseděl

Vnitr Lek 2022, 68(6):E03-E09 | DOI: 10.36290/vnl.2022.084  

Introduction: Healthcare is inherently associated with a risk to patient health. One risk is associated with medication-related errors, which are commonly reported adverse events. By analyzing the root causes of medication errors, effective preventive measures can be proposed to reduce their likelihood. This study aimed to identify the reasons of medication administration errors, determine the number of medication administration errors reported, and describe the barriers hindering reporting. Methodology: The study used a standardized Questionnaire Medication Administration Error Survey (MAE survey) that was quantitatively analyzed. The study involved...

Spontaneous coronary artery dissection, two case reports of men

Adam Koudelka, Petr Lokaj, Jiří Pařenica, Jan Kaňovský, Petr Kala

Vnitr Lek 2022, 68(6):402-407 | DOI: 10.36290/vnl.2022.082  

Spontaneous coronary dissection (SCAD) is one of the less common causes of acute coronary syndrome. It mainly affects younger patients without typical risk factors for ischemic heart disease. SCAD usually arises suddenly in otherwise healthy individuals with a previously full quality of life, and given the potential urgency of the condition, it is an important nosological unit in the differential diagnosis of chest pain. With the improving availability of comprehensive diagnostic methods we could see an increase in number of reported cases, and thus the potential for early intervention or active prevention of complications including malignant arrhythmias...

Therapy of immunoglonuline IgG4 related disease (IgG4-RD)

Zdeněk Adam, Milan Dastych, Aleš Čermák, Martina Doubková, Šárka Skorkovská, Luděk Pour, Zdeněk Řehák, Renata Koukalová, Zuzana Adamová, Martin Štork, Marta Krejčí, Ivanna Boichuk, Zdeněk Král

Vnitr Lek 2022, 68(6):E15-E22 | DOI: 10.36290/vnl.2022.086  

Immunoglobulin IgG4 related disease (IgG4-RD) is a heterogeneous disorder with multi-organ involvement recognised as a separate entity at the beginning of this century only. Evolving therapy is reviewed in this paper. Glucocorticoids are first choice drug but long administration of glucocorticoids is connected with many adverse effects. In case of combination glucocorticoids and immunosuppressive agents lower doses of glucocorticoids are needed, the response rate is higher and therapy is better tolerated. Rituximab is drug, that is possible use as monotherapy or in combination with glucocorticoids and immunosuppressive drugs. Only one study compared...

New onset of diabetes mellitus and weight loss as a manifestation of pancreatic cancer

Aleš Dvořák, Miroslav Souček

Vnitr Lek 2022, 68(6):E23-E27 | DOI: 10.36290/vnl.2022.087  

The case report is about a 68-years-old man who developed a weight loss and diabetes mellitus as early symptoms of pancreatic cancer several months before the diagnosis. Unfortunately, the diagnosis was made too late, at the stage of generalized disease, when symptomatic treatment was the only possible way. The aim of the article is to warn about this possible way of pancreatic cancer manifestation, because only the diagnosis determined in time, when the tumor is localized, allows its resection - the only curative treatment method. For this reason, it is necessary to consider the presence of pancreatic cancer in the case of an atypical manifestation...

What is the goal blood pressure in kidney transplant recipients?

Tomáš Roháľ

Vnitr Lek 2022, 68(6):408-409 | DOI: 10.36290/vnl.2022.083  

Arterial hypertension is a frequent condition after kidney transplantation and its treatment is a common agenda of the follow-up care. Retrospective data show that treatment of arterial hypertension decreases the risk of kidney graft loss. While randomized controlled trials for target blood pressures in kidney transplant recipients are not available, < 130/80 mm Hg is the most frequently mentioned value. Generally, all classes of antihypertensive drugs can be used, but it is important to consider timing after transplantation and possible interactions with immunosuppressive drugs.

Opustil nás MUDr. Tomáš Klíma

Michael Aschermann, Jan Starý

Vnitr Lek 2022, 68(6):410  

European Summer School of Internal Medicine (12.-18. 6. 2022, El Escorial, Madrid, Španělsko)

Viktor Klementa

Vnitr Lek 2022, 68(6):E29  

EFIM Academy

MUDr. Zdeněk Monhart, Ph.D., FEFIM

Vnitr Lek 2022, 68(6):E28