Editorial

Alena Šmahelová

Vnitr Lek 2007, 53(5):475  

Z odborné literatury

Vnitr Lek 2007, 53(5):573  

Za prof. MUDr. Janem Němcem, DrSc. (11. 8. 1932 - 21. 4. 2007)

Václav Zamrazil

Vnitr Lek 2007, 53(5):574-575  

Outline of the physiology and pathophysiology of the senses

O. Kittnar

Vnitr Lek 2007, 53(5):477-482  

Sense organs are considered as systems that detect information from the outer and inner environment and transfer it to the central nervous system where it is processed by a series of brain structures which make it the basis for the conscious interpretation of the surrounding world. The work discusses sense receptors as nerve structures recording specific forms of energy in our surroundings and their key function, so-called transduction, i.e. the conversion of energy of a given modality to electrical energy of the action potentials of afferent nerves. The information encoded in this form is then brought together in subcortical (thalamic) centres for...

Olfaction and gustation in diabetes

Š. Svačina

Vnitr Lek 2007, 53(5):483-485  

Dysfunction of olfactory and gustatory functions can occur in diabetes. Gustatory dysfunction correlates with specific complications of diabetes. Olfactory dysfunction correlates with diabetic macronagiopathy. Gustatory sweating is the most important olfactory and gustatory dysfunction in diabetes. Pathology of olfaction and gustation can play a role in the pathogenesis of diabetes and its complications. Olfaction and gustation could be also a target of diabetes therapy in the future.

Diabetes mellitus and cognitive impairments

I. Tůma

Vnitr Lek 2007, 53(5):486-488  

Patients with diabetes have an at increased risk of developing cognitive impairment in comparison with the general population. Cognitive dysfunction comprises impairments of executive functions, memory, attention, and psychomotor efficiency. The question of whether recurrent exposure to severe hypoglycaemia promotes long-term cognitive dysfunction is unresolved. The main risk factors for cognitive impairment in diabetes are considered to be chronological age, duration of diabetes, and coexistent microvascular and macrovascular complications. Diabetes should be treated as a risk factor for cognitive impairment. Cognitive dysfunction is associated with...

Examination of tactile disorders in diabetic patients and cooperation with a neurologist

A. Jirkovská, P. Bouček

Vnitr Lek 2007, 53(5):489-494  

Examining sensorial dysfunction may be difficult for both the doctor and the patient because subjective feelings are misleading and do not reflect the actual severity of a neurological disorder. Sensorial tests provide objective results of measurements, which can be checked against normal values and which allow for determining the severity of neuropathy. Examining sensorial function on feet is necessary in diabetic patients because its loss is the principal risk factor for ulceration. The examination comprises vibration perception tests using a tuner or a biothesiometer, and evaluating surface sensation with the use of monofilaments. A more detailed...

Diabetic ophthalmopathy

E. Rencová

Vnitr Lek 2007, 53(5):495-497  

Diabetic ophthalmopathy implicates complications of diabetes mellitus such as diabetic retinopathy, diabetic maculopathy, rubeosis of the iris, secondary glaucoma, complicated cataract, diabetic neuropathy of cerebral nerves supporting ocular muscles, diabetic neuropathy of optic nerves. We present the complications and the options for treating them.

Pathogenesis of diabetic retinopathy

T. Pelikánová

Vnitr Lek 2007, 53(5):498-505  

Diabetic retinopathy (DR) develops in patients with both type 1 and type 2 diabetes and is the major cause of vision loss and blindness in the working population. The main risk factor of DR is hyperglycemia accompanied by enhanced mitochondrial production of reactive oxygen species and oxidative stress, formation of advanced glycation end products (AGE) and hexosamines, increased polyol metabolism of glucose. The severity of vascular injury depends on the individual genetic background and is modified by other metabolic and haemodynamic factors influencing numbers of intracellular signalling molecules such as PKC, MAPK or NF-κB. In diabetes, damage...

Cataracts, glaucoma and diabetes mellitus

N. Jirásková

Vnitr Lek 2007, 53(5):506-508  

Provides a brief overview of current knowledge in the literature and the author's own experience of the diagnosis, treatment and possible complications of cataracts and glaucoma for patients with diabetes.

Surgical treatment of diabetic retinopathy

V. Korda

Vnitr Lek 2007, 53(5):509-511  

Laser treatment is effective for diabetic macular oedema and proliferative diabetic retinopathy. In focal diabetic macular oedema, laser coagulation of the microaneurisms prevents the leakage of liquid through their walls. In diffuse macular oedema, laser photocoagulation not only destroys the microaneurisms but probably also hereby causes stimulation of proliferation activity of endothelial cells in retinal capillaries and veins. For some patients with diabetic retinopathy there is a progression of retinal findings and complications arise that require surgery within the eye - pars plana vitrectomy (PPV). In general PPV is indicated in diabetic retinopathy...

Pharmacological treatment of diabetic retinopathy

A. Šmahelová

Vnitr Lek 2007, 53(5):512-520  

Diabetic retinopathy is the most serious diabetic complication. Modern pharmacotherapy offers a wide range of potential treatments (ACE inhibitors, sartans, hypolipidemic drugs, drugs influencing proteinkinase C and vascular endotelial growth factor etc.). Diabetic retinopathy was previously treated surgically but today pharmacotherapy is becoming increasingly important. Undoubtly basic strategy for preventing diabetic retinopathy is antihyperglycemic therapy and normoglycemia.

Inflammatory diseases of the eye

A. Feuermannová

Vnitr Lek 2007, 53(5):521-523  

Inflammatory diseases of the eye represent a non-homogenous group of diseases that can lead to impaired vision or even the loss of the eye. In her work the author gives a brief and self-contained overview of the most frequent diseases, including their symptoms and clinical image.

Thyroid orbitopathy and diabetes

J. Čáp

Vnitr Lek 2007, 53(5):524-527  

Thyroid-associated ophthalmopathy (TAO) is an inflammatory process associated with autoimmune thyroid diseases (AITD), most commonly Graves disease. It is clinically present in up to one half of patients suffering with AITD and 3-5 % of patients suffer from intense pain and inflammation with double vision or even loss of vision. Because diabetes mellitus type 1 and AITD have similar pathogenesis and shared genetic background it is not surprising that up to 30 % of patients with type 1 diabetes develop AITD during long term follow-up. It is important to consider the activity and severity of TAO separately. Treatment is effective at the beginning of...

Sensorineural hearing loss in diabetes. Prosthetic care in hearing impaired patients

O. Dlouhá

Vnitr Lek 2007, 53(5):528-533  

Sensorineural hearing loss is more common in patients with diabetes than in the control nondiabetic patients, and severity of hearing loss seemed to correlate with progression of disease. This may be due to microangiopathic disease in the inner ear. References for diabetic microangiopathy are presented. Sensorineural hearing loss can often be helped by hearing aids. During the last decade there have been significant developments in hearing aid technology. Progress began with the presentation of programmable hearing aids in the late 1980-ies. The first hearing aids with fully digital signal processing became commercially available in 1995. The hearing...

Tinnitus and diabetes

M. Holcát

Vnitr Lek 2007, 53(5):534-536  

Tinnitus is the perception of sound in the absence of corresponding external sound(s). Tinnitus can be perceived in one or both ears or in the head. It is usually described as an unpleasant noise, but in some patients it takes the form of a ringing, buzzing, hissing, humming, or whistling sound, or as ticking, clicking, roaring, tunes, songs, or beeping. It is estimated that 1 out of every 5 people experience some degree of tinnitus. Tinnitus is not itself a disease but an unwelcome symptom. It can be accompanied by audiometric evidence of deafness which occurs in association with both conductive and sensorineural hearing loss resulting from a range...

Development of opinions on physical exercise for diabetics

J. Rybka

Vnitr Lek 2007, 53(5):537-539  

Physical activity is an integral part of treatment for type 1 diabetes mellitus (DM1T) and type 2 diabetes mellitus (DM2T). A programme of regular physical activity adapted to the complications in effect is recommended for all diabetics. Diabetes mellitus has become a problem and an entirely distinct illness for modern cardiology, especially because of the exceptional development of accelerated atherosclerosis. Long term training brings has long term positive effects on blood sugar and insulin sensitivity. There is no doubt that physical activity plays a key role in the regulation of body weight and the reduction in fat deposits for diabetics, with...

Exercise therapy for patients with metabolic syndrome

H. Svačinová

Vnitr Lek 2007, 53(5):540-544  

The author presents a list of physical activity effects in metabolic and cardiovascular adaptation and current knowledge of the molecular mechanism of the effect of exercise on insulin resistance. The main principles for the prescription of exercise therapy for patients with metabolic syndrome are presented. The role of patient motivation and compliance is emphasised as part of a complex approach to the treatment of metabolic syndrome; it has a substantial influence on the results of treatment.

Metabolic importance of muscles and the role of sports in diabetic patients

Š. Svačina

Vnitr Lek 2007, 53(5):545-547  

Muscle is a very important tissue in pathogenesis of diabetes and its complications. In future muscle will become a target of novel farmacotherapy of diabetes. Sport in diabetes has important cardiovascular effects and limited metabolic effects. Physical activity in diabetes can induce hypo- and hyperglyceaemia. Dosing scheme for insulin and diet was published for sporting in diabetes. Most important is individual selfmonitoring and adjustment of therapy during sporting activities.

Nutrition for diabetics in relation to physical exertion

Z. Zadák

Vnitr Lek 2007, 53(5):548-549  

Metabolic disorders for sugars, fats and amino-acids have a significant influence on the physical performance of type 1 and 2 diabetics. Recent studies have given a great deal of attention to the influence of the entry of fatty acids into muscles and steatosis in skeletal muscles during the onset and development of insulin resistance. Another important mechanism that influences the maintenance of muscle mass and its performance is the transport of magnesium and its availability in muscle tissue. There is a lack of magnesium in the populations of the industrially developed world and its depletion leads to disorders of muscular function, especially in...

Therapeutic regimes accompanying physical exercise for diabetics

J. Olšovský

Vnitr Lek 2007, 53(5):551-553  

The author explains the need for an individual approach to education on physical activity. The individual approach relates to suitable physical exercise and the intensity and length of exercise, but also therapeutic regimes. The author presents general recommendations for dietary regimes and regimes for insulin dosage as they are submitted, in the process of education, to patients with diabetes mellitus in his workplace.

Increased activity of the sympathetic nervous system and the possibilities for therapeutic influence

M. Souček, J. Nevrlka, I. Řiháček, P. Fráňa, M. Plachý

Vnitr Lek 2007, 53(5):554-559  

Breakdown in the function of the autonomic nervous system (ANS) due to chronic stress is very probably one of the main pathophysiological mechanisms in the onset and development of essential hypertension, especially in younger hypertonic patients. The degree of dysfunction can be assessed by means of simple tests such as measurement of resting heart rate. Beta-blockers are the most effective group for chronic treatment of excessive activity of the sympathetic nervous system.

Defining the level of physical activity for a diabetic who is obese

M. Matoulek

Vnitr Lek 2007, 53(5):560-562  

Physical activity plays an important role in the treatment of metabolic syndrome and/or type 2 diabetes or obesity. Less than 20 % of the adult population does physical exercise at least twice a week. The effectiveness of physical exercise depends on paying attention to the following parameters: the frequency, the intensity and the duration. The most difficult parameter to set for patients with obesity or metabolic syndrome is the optimum intensity of exercise. The most common means of measuring the intensity of physical activity is heart rate or pulse rate. With patients who take medicines that affect their heart rate, the Borg scale is used to give...

Physical activity centre VŠTJ MEDICINA Prague - rehabilitation for diabetics

P. Fábin, M. Matoulek

Vnitr Lek 2007, 53(5):563-565  

Physical activity is the basic non-pharmacological instrument in the treatment of type 2 diabetes. Nevertheless, only a small number of diabetics take regular physical exercise. One of the reasons why diabetics "do not exercise" is that they have little opportunity to try physical stress under expert supervision and to get to know its effects on, for example, sugar levels. It is a very complex matter to define the optimal intensity of physical activity of, for example, a diabetic who suffers from obesity. In 2001 VŠTJ MEDICINA Prague opened its first physical activity centre at the First Faculty of Medicine, Charles University in Prague, in cooperation...

Rehabilitation and prosthetic care for diabetic patients after the extremity amputation

I. Pejšková, A. Mareček

Vnitr Lek 2007, 53(5):566-572  

Extremity amputation is a treatment for disease complications, sequelae traumas congenital predispositions that brings many patients to the orthopaedic-prosthetic department of the Teaching Hospital in HK. The professional team in the department help patients to come to terms with their physical alteration and fully or partially return to their ordinary daily routine through prosthetic aids and physiotherapy

XXVI. dny mladých internistů. Olomouc, 31. 5.-1. 6. 2007. Sborník abstrakt

Vnitr Lek 2007, 53(5):577-621