[Angiographically marginally significant coronary stenoses--postponement of intervention based on measurement of myocardial fractional flow reserve].

M Mates, V Hrabos, J Vojácek, P Hájek, M Malý, D Horák, J Fiedler, V Durdil

Vnitr Lek 2002, 48(5):363-367

INTRODUCTION: When evaluating angiographically marginal coronary stenoses (i.e. 40-70% reduction of the diameter of the arterial lumen) it is under certain conditions difficult to decide on their actual functional impact. Assessment of the fractional flow reserve (FFR) is a simple method based on assessment of intracoronary pressures during pharmacologically induced hyperaemia. For the severity of stenosis according to previous studies the liminal values is FFR lower than 0.75; furthermore it was proved that intervention of angiographically marginal stenoses with FFR values of 0.75 or more can be safely postponed.OBJECTIVE: Test the safety of FFR...

[Echocardiographic quantification of changes in left ventricular kinetics in patients during hospitalization for a first myocardial infarct and treated with direct angioplasty].

J Krupicka, P Gregor, T Buděsínský, P Widimský, J Dvorák

Vnitr Lek 2002, 48(5):368-372

UNLABELLED: The authors quantified the changes of left ventricular kinetics during hospitalization after a first transmural myocardial infarction treated by direct percutaneous coronary angioplasty. For accurate quantification a group as close as possible to experimental conditions was selected. 64 patients (43 men), mean age 67.3 years (44-86) were investigated. The echocardiographic examination was made within 24 hours after admission and on discharge (9.8 days). A 16-segment of the left ventricle was used, the kinetics were evaluated by 4-grade score. The ejection fraction was calculated by Simpson's method from 4 cycles, the wall motion score index...

[Direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarct treated at the Cardiac Center of the General Medical School Hospital in Prague: a 1-year retrospective study].

F Holm, T Kovárník, M Aschermann, S Simek, A Linhart, J Humhal, R Skulec, V Reznícek

Vnitr Lek 2002, 48(5):373-379

UNLABELLED: Direct percutaneous transluminal coronary angioplasty (d-PTCA) in patients with acute myocardial infarctions (AIM) has become an alternative of thrombolytic treatment. If the involved department has adequate experience the success rate of the procedure is high and the immediate and long-term results are better than those of thrombolysis. Moreover contrary to thrombolytic treatment successful percutaneous coronary intervention in AIM is more beneficial for patients also later than 6 hours after the development of infarction pain. In the Cardiocentre of the General Faculty Hospital (GFH) patients with AIM are constantly attended, i.e. those...

[Occurrence of autoimmune complications in patients with chronic myelocytic leukemia during treatment with interferon alfa].

E Tóthová, N Stecová, A Kafková, M Fricová, E Svorcová

Vnitr Lek 2002, 48(5):380-383

UNLABELLED: Several prospective randomized studies have shown that the treatment of chronic myeloid leukemia with interferon alfa (IFN alpha) prolongs the survival by comparison with conventional chemotherapy. However, long-term treatment with Interferon alfa (IFN alpha) can produce or exacerbate immune-mediated complications (IMC). The purpose of this study was to analyze the experience with IMC in patients with chronic myelogenous leukemia (CML) undergoing IFN alpha treatment.PATIENTS AND METHODS: The occurrence of IMC was evaluated in 76 patients (47 male; 29 female) with Philadelphia chromosome (Ph)-positive CML. The median of age was 45 years...

[Therapeutic effectiveness of cladribine and cellular immunodeficiency--related effects in hairy-cell leukemia?].

L Raida, T Papajík, Z Pikalová, J Zapletalová, K Indrák

Vnitr Lek 2002, 48(5):384-389

The high therapeutic efficiency of lymphotoxic purine analogues, pentostatin and cladribine in hairy cell leukaemia which express the antigen CD25 (alpha chain interleukin-2 receptor) suggests the hypothesis whether protracted cellular immunodeficiency after treatment does not represent an important mechanism of control of this specific lymphoproliferation. The authors analyzed a group of 45 patients with CD25-positive hairy cell leukaemia treated with cladribine. In addition to the therapeutic response they evaluated also the state of cellular immunity during the subsequent months and years following cladribine administration. The regression lines...

[Hepatic encephalopathy after TIPS--retrospective study].

J Stefánková, T Fejfar, V Safka, P Hůlek, A Krajina, M Fendrichová

Vnitr Lek 2002, 48(5):390-395

UNLABELLED: Hepatic encephalopathy (HE) is the main neuropsychiatric complication in cirrhosis of the liver. It develops slowly, begins by alteration of sleep and proceeds via flapping tremor to sopor, coma. Among known factors which promote its development are age, high dietary protein intake, haemorrhage into the GIT and the use of sedatives. Transjugular portosystemic anastomosis (TIPS) as a therapeutic method in complications of portal hypertension is associated with a higher incidence of HE. The objective of the work was to assess by retrospective investigations of patients with cirrhosis of the liver after TIPS the incidence of clinically significant...

[Are we underestimating the nephrotoxicity of drugs?].

J Tisonová, B Biss, P Tison, M Kriska

Vnitr Lek 2002, 48(5):396-402

In the submitted review the authors discuss the nephrotoxicity of drugs which is a serious danger of pharmacotherapy. Clinically it may be manifested in different ways from acute deterioration of renal functions to the picture of chronic renal insufficiency. It is particularly important to know the nephrotoxic potential of different drug groups and to ensure a careful stratification of patients. The most frequent drug groups which lead to affection of the kidneys are radiocontrasting substances, aminoglycoside antibiotics, non-steroid analgesics-antiphlogistics and ACE inhibitors. With the increasing number of transplantations the problem of nephrotoxicity...

[Specific inhibitors of cyclooxygenase type 2] ].

J Tomasová-Studýnková

Vnitr Lek 2002, 48(5):403-408

In the submitted review the author analyzes the ratio, function and role of two different forms of cyclooxygenases--cyclooxygenase type 1 and cyclooxygenase type 2--in the human organism. Special attention is devoted to specific inhibitors of cyclooxygenase type 2. Specific inhibition of COX-2 is associated with a lower incidence of undesirable reactions while the antiinflammatory and analgetic effect is preserved. Celecoxib and rofecoxib--the oldest representatives of drugs from this group were used in a number of clinical studies. The results of some of these studies are presented and commented.

[Differential diagnosis of adrenal incidentalomas and the role of imaging methods].

M Krsek, H Matějovská

Vnitr Lek 2002, 48(5):409-415

In the last fifteen years the development of imaging techniques, especially the routine use of computed tomography (CT) and magnetic resonance imaging (MRI) lead to increased number of incidentally discovered adrenal masses. Facing the incidentalomas, it is necessary to make decisions about further management of the patient. This paper gives a review of diagnostic and therapeutic approaches to the adrenal incidentaloma, with available imaging tools and with the stress on the importance of particular imaging techniques.

[Beta-blockers in the treatment of chronic heart failure].

M Knazeje, M Belicová, J Kerný, M Mokán

Vnitr Lek 2002, 48(5):416-421

The authors discuss in the submitted review the problem of therapeutic use of beta-blockers in the treatment of cardiac failure. n the introduction they emphasize the medical and societal consequences of this disease with emphasis on necessary prevention. In the subsequent part they present a review of the most important clinical studies (completed and under way) focused on the mentioned problem. In the discussion they analyze the role of the sympathetic nervous system in the pathogenesis of cardiac failure and the theoretical basis of the use of beta-blockers in its treatment. In the conclusion they present a summary of practical principles for the...

[Anemia of chronic disease--standards for diagnosis and therapy. Recommendations of the Hematologic Section of the J.E. Purkyne Czech Medical Society].

V Scudla,

Vnitr Lek 2002, 48(5):422-426

[The preoperative examination. Recommendations of the Czech Internal Medicine Section of the J.E. Purkyne Czech Medical Society].

L Kotík,

Vnitr Lek 2002, 48(5):427-431

[Arteriovenous fistula as a complication of renal biopsy].

V Horcicka, K Krejcí, J Zadrazil, P Vrublovský, S al Jabry, M Köcher, P Bachleda

Vnitr Lek 2002, 48(5):432-437

Renal biopsy is nowadays considered a relatively safe and routine examination method in nephrology. Its development was made possible by extension of sonography and introduction of modern automatic bioptic sets. Relatively frequent complications of biopsy include macrohaematuria, perirenal haematomas and AV fistulae. The majority of complications is unimportant from the clinical aspect. Some 30% fistulae do not recede spontaneously and gradual remodelling of the circulation near the fistula may lead to the development of complications. In the submitted paper the authors inform on the case of a 55-year-old woman where 24 hours after biopsy of a renal...