Jistoty a nejistoty na křižovatkách současné medicíny

prof. MUDr. Richard Češka, CSc.

Vnitr Lek 2023, 69(1):3  

Isolated pulmonary embolism - a specific clinical entity?

Jana Hirmerová, Simona Bílková, Vlastimil Woznica

Vnitr Lek 2023, 69(1):8-13 | DOI: 10.36290/vnl.2023.001  

Pulmonary embolism in classical meaning is a complication of deep vein thrombosis (usually in the leg veins), developing after a part of the thrombus dislodged and got wedged in pulmonary arteries. However, in half of the patients with pulmonary embolism, deep vein thrombosis is not found. One potential explanation is a different, less common location of the thrombus or previous complete embolization of the whole thrombotic mass. Another possibility is pulmonary artery thrombosis in situ, which is a specific clinical entity associated with some typical risk factors. It develops in the place of vascular injury, as a consequence of hypoxia, inflammatory...

What is new in 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non‑cardiac surgery

Bronislav Čapek, Jan Václavík

Vnitr Lek 2023, 69(1):14-22 | DOI: 10.36290/vnl.2023.002  

In 2022, the European Society of Cardiology has published updated guidelines for the cardiovascular evaluation and management of patients undergoing non-cardiac surgery. In this article we briefly summarize the most important recommendations with an emphasis on their use in everyday clinical practice - from the complex assessment of cardiovascular risk and prediction of cardiovascular complications, through the indication of basic paraclinical examinations, the importance of biomarkers, adjustments to pharmacotherapy of heart failure, adjustments to anticoagulant and antiplatelet therapy, to other specifics of individual cardiovascular and other diseases...

Diabetic foot infection - diagnosis and treatment

Robert Bém

Vnitr Lek 2023, 69(1):25-30 | DOI: 10.36290/vnl.2023.003  

Diabetic foot (DF) is one of the most serious complications of diabetes, leading to high morbidity and mortality in patients with diabetes, significantly affecting their quality of life and placing a huge burden on the healthcare system. Diabetic foot infection (DFI) is a major factor in the non-healing of diabetic ulcerations of the lower limbs, increases the number of hospital admissions, prolongs their duration and is a frequent cause of increased number of amputations. The most serious form of foot infection is osteomyelitis. Management of infection in SDN includes proper diagnosis, including obtaining appropriate specimens for culture, indication...

Dental interventions in oral antithrombotic therapy

Juraj Deglovič, Anna Remková

Vnitr Lek 2023, 69(1):31-36 | DOI: 10.36290/vnl.2023.004  

Dentists commonly encounter patients taking oral antithrombotic agents who require invasive dental procedures. Although antithrombotics can cause an increase in bleeding, there is consensus that treatment regimens with antiplatelet agents, older anticoagulants (warfarin) and direct oral anticoagulants should not be altered before routine dental procedures when the risk of bleeding is low. Thromboembolic risk of their discontinuing likely outweighs potential bleeding complications associated with surgery. Therefore, the risks of stopping or reducing these medications must be weighed against the potential consequences of prolonged bleeding, which can...

Histamine intolerance

Roman Hakl, Jiří Litzman

Vnitr Lek 2023, 69(1):37-40 | DOI: 10.36290/vnl.2023.005  

Histamine intolerance (HIT) is a non-immunological disorder associated with an impaired ability to metabolize ingested histamine. Manifestation of HIT includes gastrointestinal and non-gastrointestinal symptoms. Clinical symptoms of HIT are non-specific and can imitate different diseases such as allergies, food intolerance, mastocytosis and other. The diagnosis of HIT is difficult. There are several candidate tests to detect DAO insufficiency, but their informative value is questionable. Currently, a positive clinical effect of a low-histamine diet is the most important for establishing the diagnosis. Equally in the treatment, a low-histamine diet...

Ethical aspects in oncology

Anetta Jedličková

Vnitr Lek 2023, 69(1):E03-E10 | DOI: 10.36290/vnl.2023.009  

Decisions related to the treatment of oncological diseases bring various ethical dilemmas to healthcare providers caring for cancer patients. Along with the development of medicine and new therapeutic methods, there are also increased demands on the appropriate selection of eligible patients for allocation to a particular treatment method, which causes a number of ethical connotations. The paper deals with ethical issues in the course of oncology treatment, with theoretical bases for ethical decision-making and with ethical aspects of communication with patients suffering from oncological diseases. The paper also contains results of studies that dealt...

Clinical microbiology and its role in current medicine

Milan Kolář

Vnitr Lek 2023, 69(1):E11-E14 | DOI: 10.36290/vnl.2023.010  

The characteristics of current clinical microbiology and its role in modern medicine are presented. The article defines the main objectives of microbiological examination, principles of antibiotic and diagnostic stewardship. The main emphasis is placed on the correct interpretation of microbiological results.

Optimal vascular access to hemodialysis, or what modern medicine offers us

Ondřej Hloch, Jan Brož, Jan Masopust, Dana Mokrá, Martin Souček, Sabina Pálová, Karel Vik, Ondřej Pátek, Jiří Charvát

Vnitr Lek 2023, 69(1):E15-E18 | DOI: 10.36290/vnl.2023.011  

Hemodialysis is a life-saving method for patients with acute and chronic kidney failure. This treatment requires sufficiently large and safe vascular access. Ensuring optimal vascular access is therefore a prerequisite and an integral part of the care of these patients. In addition to commonly known vascular approaches such as non-tunnelized or tunneled hemodialysis catheters and AV fistulas, less well-known methods are also available, such as a translumbar or directly surgically inserted hemodialysis catheter into the right atrium. However, these alternative approaches are the only, life-saving alternative for some patients. The ambition of this review...

Development of chronic venous disease

Jiří Spáčil, Jaroslava Svobodová

Vnitr Lek 2023, 69(1):E19-E22 | DOI: 10.36290/vnl.2023.012  

Introduction: Chronic venous disease is known to gradually worsen in the course of years. However, little clinical data is available. The patient group and methods: We used the set of our patients with completed clinical examination, duplex sonography and photoplethysmography and selected 160 patients examined at our office after 10 and more years. Females represented 79% in the group. The mean age was 54 years (range 18-82 years). Venous varices in lower limbs in the family were reported by 49% patients. Venous sclerotization had been undergone by 6.3% and venous surgery by 10.6% patients. The mean body mass index was 27. We used CEAP classification....

Gut microbiome and renal transplantation

Patrícia Kleinová, Monika Beliančinová, Matej Vnučák, Karol Graňák, Ivana Dedinská

Vnitr Lek 2023, 69(1):41-46 | DOI: 10.36290/vnl.2023.006  

Gut microbiome research has been a surge of interest in many branches of medicine in the last decade. Our main aim is to show ability of microbes to infuence the functions of human body, especially in the immune system, and on the other hand to clarify changes in composition of gut microbiome in the post-transplantation period and their function for the long-term survival of the graft and the patient in the context of the occurrence of a wide range of complications. Kidney transplantation with the subsequent use of immunosuppressants and antibiotics affects the composition of gut microbiome. The subsequent development of dysbiosis significantly increases...

Differential diagnosis of increased Erythrocyte Sedimentation rate

Vlastimil Ščudla, Pavel Horák

Vnitr Lek 2023, 69(1):48-56 | DOI: 10.36290/vnl.2023.007  

The paper is aimed at differential diagnosis of increased sedimentation rate (ESR) from the point of internal medicine. After the interpretation of the term we describe the technique of the examination and possible errors in pre-analytical as well as analytical phase. The paper includes ranges for conventional FW assessment (analysis of ESR based on Fahraeus-Westergren) and the characteristics of newer methods. We list the overview of the most common causes that affect faster or slower ESR. The stress is put on the assessment of the causes of increased ESR and its persistence from the perspective of clinical practice, we also describe diseases with...

News in cardiology

Jan Václavík

Vnitr Lek 2023, 69(1):57-63 | DOI: 10.36290/vnl.2023.008  

The article summarizes new advances in cardiology published in 2022, which have an impact to everyday practice of not only internists and cardiologists. The administration of polypill to patients after myocardial infarction (SECURE study), early pharmacotherapy of hypertension in pregnant women with blood pressure exceeding 140/90 mmHg (CHAP study), or the administration of dapagliflozin to patients with heart failure with preserved or mildly reduced ejection fraction (DELIVER study) have been shown to be effective. Patients with heart failure do not have to limit their sodium intake (SODIUM-HF study), on the contrary, they benefit from up-titration...

ESC 2022 a studie DELIVER

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2023, 69(1):64-65 | DOI: 10.36290/vnl.2023.013