[The Czech Diabetology Society presents a Diabetology Seminar, "Quo vadis diabetologia?", on 22 November 2001 in Zlin].

Vnitr Lek 2002, 48(6):458-548

[Cardiac surgery--present possibilities].

Jan Cerny

Vnitr Lek 2002, 48(6):460

[Interventional cardiology--present possibilities].

L Groch

Vnitr Lek 2002, 48(6):461-463

[Surgical myocardial revascularization--present status] ].

P Nĕmec

Vnitr Lek 2002, 48(6):464-468

The number of operations increased and except of classical revascularisation with cardiopulmonary bypass and ischaemic heart arrest several new methods were introduced. Less invasive approach, especially without cardiopulmonary bypass is used more frequently due to technical development in stabilizing systems. The use of arterial grafts became a standard. Due to the improvements in surgical technique and postoperative care the significance of traditional risk factors decreased. The early results improve in spite of older patients with more risk factors are operated on every year.

[Contribution of an experimental animal diabetologist to the diagnosis and therapy of human diabetes mellitus].

R Korec

Vnitr Lek 2002, 48(6):469-476

[Hypoglycemia, an acute complication or a syndrome?] ].

J Skrha

Vnitr Lek 2002, 48(6):479-482

[Prediction of type 1 diabetes mellitus in first degree Czech relatives of diabetic patients].

J Vavrinec, O Cinek, Z Sumník, S Kolousková, H Malcová, P Drevínek, M Snajderová

Vnitr Lek 2002, 48(6):483-489

Diagnosis of autoimmune beta cell destruction by genetic risk analysis, autoantibody evaluation and the test of stimulated insulin secretion performance in first-degree relatives of diabetic patients. 208 Czech children and adults (101 boys and 107 girls, 186 siblings, 22 offspring of diabetic parents, aged 1-22 years, mean age 11.5 +/- 5.4 years) were enrolled in the study. Complete DQB1, DQA1 typing and DRB1*04 subtyping were performed by the PCR in 202 subjects. Sera of all children were investigated for anti-GAD65, anti-IA2 and insulin antibodies using RIA methods. The cut-off normal levels were determined as the 99th percentile of 105 non-diabetic...

[C-peptide as the decisive factor for classification of type 1 diabetes mellitus and type 2 diabetes mellitus].

J Perusicová, H Bárová, M Hill, Z Masek

Vnitr Lek 2002, 48(6):490-499

OBJECTIVE: The main objective was to seek, based on defined groups of diabetics, C-peptide levels on fasting and after stimulation which would help to differentiate diabetes mellitus type 1 from diabetes mellitus type 2 in patients with manifestation of diabetes in adult age. GROUPS: Group A comprised 65 non-obese diabetics type 2 with failure of PAD treatment. Group B included 304 newly manifested diabetics type 1 and 2 aged 31-65 years. Group C was formed by 424 patients with diabetes mellitus type 1 and type 2 with different duration of diabetes.RESULTS: Group A: mean C-peptide levels on fasting 0.32 and after stimulation with a standard breakfast...

[Obesity, type 2 diabetes and their quantitative relation].

S Svacina, K Owen

Vnitr Lek 2002, 48(6):500-506

Diabetes type 2 and obesity are diseases which have marked mutual relations. The pathogenesis of these relations is in many respects obscure. Also the molecular biological knowledge of the two diseases is inadequate so far. In the submitted brief paper the authors present only a review of some quantitative aspects of the relationship of obesity and diabetes supplemented by some of their own results. The authors summarize the epidemiological relations of diabetes and obesity, possible prediction of the development of diabetes in obese subjects, possible prevention of diabetes in obese subjects and possible treatment of obese diabetics. Slight weight...

[Nutritional support of elderly diabetics with acute diseases from the viewpoint of the diabetologist].

A Smahelová, Z Zadák

Vnitr Lek 2002, 48(6):507-511

Acute diseases in seniors suffering from diabetes significantly influence their nutritional status which is one of the factors participating in the development of acute hyperglycaemic decompensation of diabetes or hypoglycaemia. Inadequately compensated diabetes in seniors is conversely associated with nutritional disorders and the patient is at greater risk of an acute intercurrent disease. Ensuring optimal nutrition in old diabetics is one of the basic provisions in the treatment of intercurrent acute disease.

[Changes in the concept of the diabetic diet].

M Anděl, P Kraml, P Dlouhý, F Duska, V Smejkalová

Vnitr Lek 2002, 48(6):512-514

[New oral antidiabetic agents and current strategies of peroral antidiabetic therapy (PAD)].

J Rybka, M Kvapil

Vnitr Lek 2002, 48(6):517-522

Optimal compensation in patients with type 2 diabetes is individualization of therapy according to the stage of the disease and ratio of the main pathophysiological disorders. Because of the hitherto inadequate effectiveness of known procedures attention is focused on seeking new more effective procedures either based on the use of known molecules of oral antidiabetics or introduction of new substances.

[Current trends in insulin therapy].

T Pelikánová

Vnitr Lek 2002, 48(6):523-528

More than 80 years have elapsed since the discovery of insulin. The submitted paper analyzes the main contemporary trends of the development of insulin therapy which comprise the development of new insulin analogues and their use in modified insulin regimes, the development of preparations for inhalatory or oral administration, new techniques of administration and new ways of self-monitoring. The author mentions also non-traditional forms of insulin therapy such as transplantation of insulin producing tissue and in the conclusion she discusses trends of insulin administration in subjects without diabetes.

[Atherosclerosis, alcohol and diabetes].

V Bartos

Vnitr Lek 2002, 48(6):529-533

Diabetes is a known risk factor of atherosclerosis, moderate consumption of alcohol was reported to reduce the cardiovascular morbidity and mortality. This review presents information on the possible mechanisms of the antiatherogenic effect of alcohol and data of the effect of moderate alcohol drinking on the prevention of cardiovascular diseases. Red wine contains polyphenols with an antioxidant effect, alcohol is metabolized to acetaldehyde which was proved to inhibit the formation of advanced glycation endproducts (AGE) and lipoprotein oxidation. Diabetic patients may benefit from moderate consumption of alcohol beverages only if the risk of hypoglycemia...

[Autonomic neuropathy in diabetics, treatment possibilities].

S Lacigová, Z Rusavý, D Cechurová, Z Jankovec, M Zourek

Vnitr Lek 2002, 48(6):534-541

Diabetic neuropathy is a chronic complication of diabetes. It involves non-inflammatory damage of the function and structure of peripheral nerves by metabolic vascular pathogenic processes. In case of affection of vegetative nerves (small non-myelinated C fibres) autonomic neuropathy develops. It is a relatively frequent form of neuropathy which remains for a long time without clinical symptoms and therefore is rarely diagnosed and treated. Manifestations of the affection are encountered in all organs which are supplied by vegetative nerves. The presence of this complication of diabetes is signalized by tachycardia at rest, deterioration of gastric...

[Basic questions in therapy of the diabetic foot].

A Jirkovská

Vnitr Lek 2002, 48(6):542-548

The diabetic foot syndrome including foot tissue impairment distally from the ankle associated with neuropathy and angiopathy in diabetic patients is the main cause of amputations. However, amputations are not inevitable and the provision of rapid and intensive treatment of foot complications in multidisciplinary foot clinics can reduce the number of amputations in diabetic patients. The fundamental principle in the therapy is comprehensive approach; the omitting of any of the principle of the therapy may contribute to its failure. The most frequent case in the praxis is the omitting of the of-loading of the ulcers e.g. by the therapeutic shoes (half-shoes)...

[5th Mikulas Symposium dedicated to Dr. Petr Dite on an important birthday and held in Brno, 7 December 2001].

Vnitr Lek 2002, 48(6):549-590

[Diagnosis of familial adenomatous polyposis].

V Jirásek

Vnitr Lek 2002, 48(6):552-555

Familial adenomatous polyposis (FAP) is a hereditary disease with autosomal dominant transmission, it is a practically 100% precancerosis. For detection of further patients in the family careful examination of the patient and all subjects at risk, i.e. above all grade 1 relatives, is decisive. The presented paper summarizes the author's own experience with the follow up and examination of a group of 96 patients from 42 families. The group of patients has been assembled gradually since 1967. The basis of the examination is preparation of a pedigree, somatic examination, endoscopic examination of the large intestine and the oral portion of the digestive...

[Screening programs for sporadic colorectal carcinoma].

P Fric

Vnitr Lek 2002, 48(6):556-559

In developed countries colorectal cancer (CRC) is the second most frequent organ malignancy of both genders. According to the world statistics Czech Republic occupies the top position in incidence of this disease. Approximately 75% of all CRC are the sporadic CRC in subjects with negative family or personal history of the disease. The low (average) risk factor in these subjects is age over 50 years, from which the incidence of CRC nearly doubles in each decade. The following options of screening are available for these subjects: 1. faecal occult blood test (FOBT), 2. flexible sigmoidoscopy, 3. combination of both previous procedures, 4. colonoscopy,...

[Gastrointestinal surgery and its perspectives].

M Duda, J Herman

Vnitr Lek 2002, 48(6):560-562

[Etiopathogenesis of diarrhea and basic principles of diagnosis and therapy].

J Ehrmann

Vnitr Lek 2002, 48(6):563-566

Acute diarrhoea is worldwide the second most frequent disease after acute inflammations of the airways. Chronic diarrhoea is a less frequent disease, nevertheless the GP, specialist in internal medicine or gastroenterologist encounters it very frequently. For correct understanding of basic diagnostic and therapeutic principles of diarrhoea knowledge of its etiopathogenesis is necessary. In the submitted review the author mentions the functions of the small and large intestine and their part in the development of diarrhoea. He gives also the definition and classification of diarrhoea. The author presents the basic characteristics of osmotic, secretory,...

[Diagnosis of the Zollinger-Ellison syndrome. I: Significance of anamnestic, clinical and laboratory examinations].

R Hyrdel, J Bozíková, M Demeter, I Reznák, O Kovácik, A Beseda, V Straka

Vnitr Lek 2002, 48(6):567-572

The authors describe the diagnostic algorithm of Zollinger-Ellison's syndrome which proved useful in the diagnosis of 73 patients with a confirmed diagnosis. They evaluate the diagnostic validity of anamnestic and clinical data, of different examination methods and compare them with experience assembled abroad. For the diagnosis of sporadic gastrinomas the onset of the disease after the age of 40 years is important, the development of serious peptic complications (haemorrhage F-70%, M-59%, perforation M-54%, F-47%) and the presence of watery diarrhoea (41%). As to laboratory parameters they rely on high BAO values (96% > 15 mmol H+/hour and 100%...

[Problems in portal hypertension].

P Hůlek

Vnitr Lek 2002, 48(6):573-574

[A new indication for transcutaneous cholangioscopy].

J Cernoch

Vnitr Lek 2002, 48(6):575-577

UNLABELLED: The main indication for transcutaneous cholangioscopy through a channel of percutaneous transhepatic drainage are choledocholithiasis, hepatolithiasis and non-malignant or malignant stenosis of the bile ducts. In our department we were able to treat thus repeatedly also complete severing of the biliary pathways.GROUP: Twelve patients with complete severing of the right hepatic ducts (4x) or common bile duct (8x) after cholecystectomy could not be operated on account of great surgical risk or adhesions after operation. On account of cholangitis they had percutaneous transhepatic drainage. After three weeks transcutaneous cholangioscopy...

[Rifaximin in the treatment of hepatic encephalopathy].

J Lata, P Hůlek, T Fejfar, J Spicák, P Drastich, Z Marecek, R Brůha, L Husová, M Senkyrík

Vnitr Lek 2002, 48(6):578-582

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis. Usually it is treated by non-absorbable disaccharides or antibiotics and its treatment is often difficult and associated with undesirable effects. The objective of our investigation was to evaluate the safety and effectiveness of a new antibiotic used in this indication--rifaximine. With rifaximine, 400 mg three times per day, a total of 25 patients were treated for a 10-day period. Significant improvement of the manifestations of encephalopathy occurred (evaluated by the grade of encephalopathy, test of combining numerals, the degree of flapping tremor and the arterial...

[Anti-cytokines in the treatment of idiopathic intestinal inflammations--theory and practice].

V Zboril

Vnitr Lek 2002, 48(6):583-586

Into treatment of idiopathic inflammations of the gut cytokines or their antagonists entered less than 5 years ago and they extended the range of classical medicamentous treatment with aminosalicylates, corticosteroids and immunosuppressives. The theoretical models of their therapeutic application pertained to the blocking of anti-inflammatory cytokines (IL-1, IL-6, IL-8, TNF alpha), the use of immunomodulating cytokines (IL-2, IL-6, IL-8, IL-9) similarly as the therapeutic administration of cytokines with a predominant growth and regulating activity (CSF, TGFalpha, TGFbeta, ODGF, IL-10, IL-11, IL-12). The range is supplemented by ICAM, VCAM antibody...

[Barrett's esophagus].

J Dolina, A Hep, P Dítě, H Münzová, M Kunovská, L Husová, Z Plottová

Vnitr Lek 2002, 48(6):587-590

Barrett's oesophagus is a premalignant metaplastic change of the oesophageal mucosa. Due to its relationship with oesophageal reflux disease and the development of adenoma-carcinoma of the oesophagus the problem arouses increasing interest. In the wide pathogenesis of the disease most probably the composite effect of the refluxed HCl content and duodenal juices play a part. In the diagnosis in addition to fundamental methods--endoscopy and histology--increasingly chromoendoscopy and fluorescent endoscopy are involved. Dispensarization of patients is essential and depends on the degree of pathohistological epithelial changes. Treatment of Barrett's...