[The effect of clodronate on bone density in patients with multiple myeloma--a 2-year follow-up of therapeutic effects].

Z Adam, B Prokes, V Znojil, J Vorlícek, N Hejlová, D Hájek, M Krejcí

Vnitr Lek 1996, 42(6):379-385

Biphosphonates are used for the treatment of hypercalcaemia as well as in normocalcaemic patients for the long-term inhibition of malignant osteolytic bone processes. In patients with multiple myelomas treated with biphosphonates in randomized studies a reduction of the number of new osteolytic foci was proved and improvement of the quality of life. The objective of the present study was to evaluate the effect of clodronat on the development of bone density in patients with multiple myeloma. In the study since 1993 27 patients were included. In August 1995 22 patients were evaluated who were treated for more than 12 months with clodronat (Bonefos Leiras)....

[New trends in ECG Holter monitoring].

E Sovová, V Doupal, J Lukl

Vnitr Lek 1996, 42(6):386-389

The authors review contemporary possibilities of Holter ECG monitoring. In the first group of patients they emphasize possibilities and the yield of long-term ambulatory ECG monitoring by means of an apparatus started by the patient. The second group of patients was examined by Holter monitoring, using an oesophageal lead. It is a method hitherto not used in the Czech Republic, which if properly indicated, improves the non-invasive diagnosis of cardiac arrhythmias.

[Diabetic ketoacidosis--personal experience with treatment using low (physiologic) doses of insulin].

D Baraniková, B Renker, J Konecná, E Slopková, I Viteková, J Vavrík

Vnitr Lek 1996, 42(6):390-393

The authors present an account on their experience with treatment of diabetic ketoacidosis with small (physiological) doses of insulin in a group of patients who were hospitalized in the course of four years at the intensive metabolic care unit. Diabetic ketoacidosis is in spite of therapeutic advances still a serious matter. It calls for monitoring of vital functions, intensive treatment and regular checks of laboratory indicators. Treatment of diabetic ketoacidosis with small (physiological) insulin doses proved effective and safe and the incidence of complications was minimal.

[Diabetic nephropathy and isolated hyporeninemic hypoaldosteronism].

J Hrnciar

Vnitr Lek 1996, 42(6):394-399

Isolated hypoaldosteronism is found in 75% diabetics where the disease has persisted for 10 or more years. Sporadically it is found in congenital autonomous neuropathy, in acute glomerulonephritis, in gouty kidney, tubulointerstitial nephritis, after transplantation of the kidney, on mytomycin etc. During dynamic testing of the response of plasma renin activity and aldosterone to the administration of furosemide and a vertical position in diabetics a significantly reduced response was recorded as compared with non-diabetic hypertonic subjects. In 18.3% no response was observed (decompensated form of IHH). Diabetic hypertonics behaved like control hypertonics...

[Clinical use of infusion pumps with rotors in occlusive tracts].

K Sevela, V Gajdůsková, V Havránková, F Havlát, P Krifta, A Jarosová

Vnitr Lek 1996, 42(6):400-403

The authors used in clinical practice an infusion pump driven by a rotation system with an occlusive pathway whereby the movement of the rotor is ensured by a stepper with reduction of the steps to 12,800 microsteps per revolution. As regards the degree of mechanical damage of the inserted tube of the infusion set this system did not differ from the keyboard system which is used by the majority of manufacturers as the driving unit of infusion pumps. Mechanical damage of the infusion set made from PVC was evaluated by the authors with regard to the amount of phthalic acid extracts which are added to PVC as softening agents and are not chemically linked....

[Phthalic acid esters in the peritoneal cavity of patients treated with continuous ambulatory peritoneal dialysis].

K Sevela, V Gajdůsková, F Havlát, V Havránková, A Jarosová

Vnitr Lek 1996, 42(6):404-407

A solution for peritoneal dialysis stored in bags made from material which does not contain diethylhexyl phthalate is significantly less contaminated with this plasticizer, as compared with a solution stored in bags made from PVC with diethylhexyl phthalate. The afferent tube which contains diethylhexyl phthalate in all sets investigated by the authors is not an important source of this plasticizer for the peritoneal solution. Contamination of the peritoneal solution with dibutyl phthalate added to colours used for print on the bags (inscription on the outside of the bag) was found in both types of bags (no significant differences were found). It may...

[Evaluation of factors affecting the formation of thrombi in hemoperfusion columns].

K Sevela, V Gajdůsková

Vnitr Lek 1996, 42(6):408-413

The formation of thrombi in the haemoperfusion column is undesirable as it deprives the patient of blood elements and reduces the eliminating capacity of the haemoperfusion column. This applies in particular to patients with acute intoxications treated by haemoperfusion. In experimental haemoperfusions in animals the authors provided evidence of a close correlation between thrombus formation in the haemoperfusion column and the number of stops of the blood flow in the course of individual experimental haemoperfusions. The period of stops was always 1.5 min. A further even closer correlation was found only between the formation of thrombi in the haemoperfusion...

[Incidence and current treatment of cytotoxic cyclopeptide (phalloidine) poisoning in pregnant women].

F Jaros, M Kascák

Vnitr Lek 1996, 42(6):414-417

The authors treated successfully a patient who ingested along with three members of the family the mushroom Amanita phalloides and was in the 24th week of gestation. She gave birth to a healthy infant. The authors discuss the incidence and contemporary treatment of cytotoxic, cyclopeptide (phalloid, hepatotoxic) intoxications, incl. those with Amanita phalloides during pregnancy. They present case-histories and an account on amatoxin intoxications in pregnant women published so far in the literature, and experience with the treatment of a 18-year-old pregnant woman. They reflect whether termination of pregnancy is indicated in pregnant women intoxicated...

[Choledochal cyst].

O Urban, J Chalupa

Vnitr Lek 1996, 42(6):418-419

Cysts of the choledochus are the most frequent type of cystic dilatation of the biliary pathways. The authors describe the case of a 24-year-old patient with a history of biliary complaints. A cyst of the choledochus was suspected after sonographic examination. The diagnosis was confirmed by infusion cholangiography and endoscopic retrograde cholangiography. The patient was indicated for surgery, i.e. resection of the cyst with hepaticojejunoanastomosis Roux-en-Y.

[Do beta-blockers have a role in the modern treatment of arterial hypertension?].

K Horký

Vnitr Lek 1996, 42(6):420-425

The submitted review draws attention to advantages and pitfalls of the use of betablockers in the treatment of arterial hypertension. Despite certain metabolically adverse effects which are reduced to a minimum in small doses and more recent betablockers, the latter are along with diuretics the only antihypertensive agents where unequivocally the the long-term favourable effect on the general and cardiovascular mortality was proved. In other hypertensive agents results are expected after completion of multicentric studies which are underway. Beta-blockers, as monotherapy or combined with other drugs, are the drug of choice in the treatment of essential...

[Treatment of hypertension in primary and secondary prevention of cerebrovascular stroke].

J Widimský

Vnitr Lek 1996, 42(6):426-431

Treatment of hypertension plays a key role in primary prevention of cerebrovascular attacks. Meta-analysis of 17 prospective studies of the treatment of hypertension proved that reduction of the systolic and diastolic blood pressure by 8-10/5-6 mmHg leads to a reduction of fatal and non-fatal cerebrovascular attacks by 40%. In the nineties a Swedish and British investigation of systolic-diastolic hypertension in elderly subjects-STOP and MRC-provided evidence of the great impact of treatment of hypertension in primary prevention of cerebrovascular attacks also in elderly hypertensive subjects (60-80 years). It is important to treat also in advanced...

[The role of endothelin in coronary circulation].

O Lisý, J Vojácek

Vnitr Lek 1996, 42(6):432-436

Endothelin, one of the most important vasoconstrictor substances produced by endothelial cells plays along with NO an important role in maintaining the vascular tonus and influencing the vasomotorics of coronary vessels and myocardial perfusion. Damage of the vascular endothelium upsets the dynamic balance between the action of vasoconstrictor and vasodilator substances. In the submitted review the authors discuss the influence of endothelin on cardiomyocytes, the cardiac conduction system and the coronary arteries. The authors emphasize the action of endothelin in atherosclerotically altered coronary arteries, in hypercholesterolaemia and arterial...

[Dyslipidemia in diabetes mellitus].

J Sobra, J Skrha, R Ceska

Vnitr Lek 1996, 42(6):440-441