Hlavní téma: Vaskulární medicína

doc. MUDr. Debora Karetová, CSc.

Vnitr Lek 2023, 69(7):411  

Chronic critical limb ischemia (CLTI)

Miroslav Chochola

Vnitr Lek 2023, 69(7):416-424 | DOI: 10.36290/vnl.2023.083  

Chronic critical limb ischemia (CLTI - chronic limb threatening ischemia) is considered the most serious type of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene, due to occlusion of peripheral arterial vessels. It is associated with a high risk of major amputations, cardiovascular events and death. Treatment of patients with CLTI places a significant economic burden on healthcare systems worldwide. An overview of the epidemiology, pathophysiology, diagnosis and treatment of CLTI is presented.

Non-traumatic lower limb compartment syndrome

David Ambrož

Vnitr Lek 2023, 69(7):426-429 | DOI: 10.36290/vnl.2023.084  

Non-traumatic compartment syndrome is a serious condition that affects muscle compartments typically in patients after ischemic insult during acute limb ischemia and can have serious consequences for the affected limb and the patient's overall health. This syndrome is characterized by increased pressure in the intrafascial space, leading to compression of muscles, blood vessels and nerves leading to worsening ischemia and even irreversible damage to these structures. Early diagnosis and treatment are crucial to reduce the risk of complications and preserve limb function. In this article, we review the definition, pathophysiology and important clinical...

Case­‑report: Paget­‑Schrötter syndrome as a cause of chronic thromboembolic pulmonary hypertension

Michaela Veselá, Pavel Jansa, Debora Karetová, Viktor Veselý, Aleš Linhart

Vnitr Lek 2023, 69(7):430-432 | DOI: 10.36290/vnl.2023.085  

Paget-Schrötter syndrome is a rare syndrome of idiopathic thrombosis of the upper extremity. This syndrome most often occurs in young men. The provocative factor can be work or sport with elevation of upper extremities above the head. There are several spaces in the cervical lateral region where compression of nerve vascular bundle can occur. The combination of the coincidence of Paget-Schrötter syndrome as a cause of chronic thromboembolic pulmonary hypertension is rare. Both diagnoses require specific therapy. For Paget-Schrötter syndrome it is a surgical approach or rehabilitation together with pharmacological treatment. However, for chronic thromboembolic...

Kommerell's diverticulum - rare developmental abnormality of aortic arch

Johana Horáková

Vnitr Lek 2023, 69(7):433-436 | DOI: 10.36290/vnl.2023.086  

Kommerell's diverticulum is an aneurysmal dilatation of the descending thoracic aorta at the site of the origin of subclavian artery. It is a remnant of the 4th dorsal aortic arch and tends to be associated with other developmental abnormalities. Dysphagia and dyspnea are main clinical symptoms, but the diverticulum is usually diagnosed incidentally when CT angiography is performed for another indication. The treatment is either endovascular or surgical depending on the anatomical conditions and comorbidities of the patient. We present a case report of a 62-year-old female patient with a right-sided aortic arch and Kommerell's diverticulum indicated...

Who treats the patients with diabetes in the Czech Republic?

Jan Škrha, Klára Benešová, Jiří Jarkovský, Ladislav Dušek

Vnitr Lek 2023, 69(7):452-459 | DOI: 10.36290/vnl.2023.088  

Data obtained from the National register of covered medical services (NHRZS) on provided care developed by diabetologists, general practitioners and internists since 2010 to 2021 confirm an increased number and percentage of diabetic patients treated especially by non-insulin antidiabetic drugs by general practitioners (an increase from 4.7 % to 22,8 % diabetic patients). At the same time data offer an information on stagnation of diabetic patients treated by insulin only. The trend registered in provided care stimulates a discussion on future way including the needs for high quality of structured and multidisciplinary approach offered to diabetic...

Neurological complications of diabetes mellitus

Eva Vlčková

Vnitr Lek 2023, 69(7):460-465 | DOI: 10.36290/vnl.2023.089  

The most important microvascular neurological complication of diabetes mellitus is diabetic neuropathy. In addition to the most common distal sensory or sensory-motor polyneuropathy, this term also includes autonomic neuropathy and a number of focal forms (mononeuropathy, plexopathy). Diagnosis is based on history and clinical examination; the choice of other diagnostic methods (nerve conduction studies and needle electromyography, autonomic nerve function tests, assessment of intraepidermal innervation from skin biopsy, etc.) depends on the type of nerve fibers affected. The basic intervention in the therapy and prevention of the development and progression...

Cancer after kidney transplantation

Anna Novotná, Silvie Rajnochová­ Bloudíčková

Vnitr Lek 2023, 69(7):E10-E14 | DOI: 10.36290/vnl.2023.093  

Cancer is the second cause of death in kidney transplant recipients. The incidence increases with the post-transplant period. The etiology is multifactorial; in addition to traditional risk factors, the effects of immunosuppressive treatment and impaired immunosurveillance play a decisive role. Posttransplant cancer can occur as a result of transmission from the donor, de novo or as a relapse. Both transplant candidates and donors must be carefully examined to rule out an active cancer. Eligibility of recipients and donors with a history of cancer depends on the cancer type, stage and current restaging. Along with conventional therapeutic approaches,...

Do we still need an exercise ECG?

Juraj Dúbrava

Vnitr Lek 2023, 69(7):E15-E20 | DOI: 10.36290/vnl.2023.094  

The importance of exercise ECG for the diagnosis of myocardial ischaemia has fundamentally decreased in the era of advanced cardiac imaging techniques. The biggest problem is suboptimal diagnostic accuracy, especially unsatisfactory sensitivity. A significant limitation is the high proportion of inconclusive tests and the lower diagnostic accuracy in women. The European Society of Cardiology prefers non-invasive functional imaging or coronary computed tomography angiography for diagnosing obstructive coronary artery disease (CAD). Exercise ECG may be considered as an alternative test to rule-in or rule-out CAD when other non-invasive or invasive imaging...

Malnutrition in chronic liver disease

Marie Ryšánková, Marek Šatný

Vnitr Lek 2023, 69(7):E21-E28 | DOI: 10.36290/vnl.2023.095  

Malnutrition is common in advanced chronic liver disease (ACLD) negatively affecting both patient morbidity and mortality. Etiopathogenesis is multifactorial and includes insufficient food intake, malabsorption, metabolism alteration towards catabolism and increased energy expenditure. The diagnostic process involves conscientious history taking, basic biometric measurements, functional muscle tests, and with increasing significance also core muscle mass assessment using CT scan. Therapy consists of sufficient nutrients, minerals and micronutrients intake which can be achieved by increased oral intake or using enteral or parenteral nutrition. The aim...

The potential use of laboratory monitoring during individualizing the dosage of direct oral anticoagulants - a literature review

Kateřina Zyková, Anna Rejman Patková, Miroslav Penka, Josef Malý

Vnitr Lek 2023, 69(7):438-451 | DOI: 10.36290/vnl.2023.087  

Introduction and Aim: Direct oral anticoagulants (DOACs) are administered in fixed daily doses without the need for routine monitoring. Despite significant inter-patient variability in systemic exposure, data regarding populations predisposed to abnormal concentrations are limited. The objective of this literature review was to analyse selected factors that may significantly influence DOAC concentrations within clinical settings, emphasising situations in which laboratory monitoring of DOACs might be applicable. Methods: Publications from Pubmed and Scopus databases assessing the effect of advanced age, altered renal function, sarcopenia, obesity,...

Association of Alzheimer disease and optical coherence tomography parameters - systematic review

Adam Ernest, Ludmila Brunerová

Vnitr Lek 2023, 69(7):E4-E9 | DOI: 10.36290/vnl.2023.092  

: Alzheimer disease (AD) as the most common cause of dementia, is affecting approximately 3-40 % of the elderly population and its incidence grows. It is a great burden for healthcare system. Standard diagnostic neurocognitive examination is time consuming and quite expensive. Therefore there is need for fast and accurate screening test. The retina of the eye is embryologically extension of the brain so it is assumed that there is correlation between status of the retina detected by optical coherence tomography and cognitive function. The aim of this study is to create a systematic review of studies which analysed correlation betwen retinal...

Differencial diagnosis of skin bleeding conditions

Eva Březinová

Vnitr Lek 2023, 69(7):E29-E38 | DOI: 10.36290/vnl.2023.096  

The article clearly deals with the issue of skin bleeding conditions. Skin bleeding occurs on the basis of disorders of blood platelets or blood vessels, due to coagulopathies or other causes. In particular, the differential diagnosis of purpura is given in detail. Cutaneous bleeding manifestations can help in the initial diagnosis of a hematological or other systemic disease. The differential diagnosis of skin bleeding conditions is very broad, however, based on the number of lesions, their distribution and morphology, it is possible to refine the diagnostic procedure and supplement the relevant laboratory and other examinations needed to establish...

Can measurements of arterial stiffness detect patients with hypertension at increased dementia risk?

Jitka Mlíková Seidlerová

Vnitr Lek 2023, 69(7):466-468 | DOI: 10.36290/vnl.2023.090  

Recent data suggest that we are on the verge of a dementia pandemic. Hypertension is a significant risk factor for this so far untreatable irreversible condition. The attention of researchers is now focused on identifying individuals at increased risk of cognitive decline or with early-stage cognitive deficit. Apart from cognitive function tests and imaging studies, no suitable biomarkers to identify these individuals have been available as yet. Haemodynamic parameters could be potentially useful biomarkers. At the ESH 2022 Congress, Professor Cunha presented the current knowledge suggesting that cognitive decline could be related to visit-to-visit...

What's new in endocrinology?

Michal Kršek

Vnitr Lek 2023, 69(7):469-472 | DOI: 10.36290/vnl.2023.091  

Present article informs about selected recent developments in clinical endocrinology. Neuroendocrinology section is devoted mainly to developments in medical therapy of pituitary disorders, namely Cushing's syndrome and acromegaly. Update of guidelines on management of Cushing' syndrome is also mentioned. Thyroid section informs about ETA consensus on indication for post-surgical radioiodine therapy in differentiated thyroid cancer and also about new therapy for thyroid-associated ophthalmopathy-monoclonal antibody against IGF-1R teprotumumab. Large section reviews major changes covered in recent clinical practice guidelines on the management of adrenal...