More than 1,000 species of seed plants and fungi are active in hypoglycemic tests. The potential of their effective molecules is considerable; it could be also expected, that the mechanism of their activity will be very varied. Even though the majority of information is only screening of hypoglycemic effect, there occur the results of valid essays, which report on the possible mechanisms of the activity. This paper represents the attempt at the categorisation of plant drugs, their fractions and isolated substances according to their pharmacological activity and mechanism of the effect.

Background:
Due to limitations of the Friedewald formula, alternative methods for calculating low-density lipoprotein cholesterol (LDL-C) were suggested. We evaluated utility of these methods. Methods: Ninety three subjects free of coronary heart disease were considered. LDL-C was measured by the homogeneous method, and calculated by the Friedewald formula LDL-C = TC - HDL - (TG/2.2) (LDL1) and alternative formulas LDL-C = 0.41 TC - 0.32 TG + 1.70 apoB - 0.27 (LDL2) and LDL-C = 0.94 TC - 0.94 HDL - 0.435 TG (LDL3).
Results:
All three formulas underestimated the measured LDL-C, both in the whole group and in subgroups according to TG levels (TG < 1.7 and in a range of 1.7-4.5 mmol/l, p < 0.001 for all). We found significantly higher bias for all three formulas in subjects with 1.7 ≤ TG < 4.5 mmol/l levels. The Friedewald formula showed the lowest assay bias in all the groups investigated. The mean absolute bias for LDL1 was 7.6 %, 18.3 % for LDL2 and 13.6 % for LDL3, respectively. Linear regression analysis showed correlation of calculated LDL-C values with the direct method in the range of r = 0.82 - 0.90 (p < 0.0001 for all, except of LDL2 in 1.7 ≤ TG < 4.5 mmol/l group where p = 0.0011).
Conclusions:
The Friedewald formula seems to be a better estimator of LDL-C in our study than the other two alternative formulas; however, it underestimated the LDL-C levels.

In the review article, the authors present current knowledge of biomarkers of myocardial ischemia and necrosis. They comment new definition of myocardial infarction resulted as consensus of European Society of Cardiology and American Heart Association. They added clinically interested data about routinely used cardiomarkers (cardiac troponins and creatinkinase). At the second part, the authors focused on new biomarkers (fatty acids binding proteins, ischemia-modified albumin, glycogen phosphorylase isoenzyme BB) and its significance in diagnosis of myocardial ischemia/necrosis and their prognostic significance. Some of new promising molecules are discussed in the last part of the article.

The authors examined indicators of the effect of free radicals (MDA, SOD, GSHPx, selenium) in 38 workers exposed to styrene. They revealed a statistically significant (p < 0.01) correlation of SOD activity and the period of exposure to styrene and also a statistically significant correlation (p < 0.05) between urinary selenium excretion and the period of exposure to styrene as well as a statistically significant correlation (p < 0.01) between the MDA serum concentration and urinary selenium excretion. There is no statistically significant difference between the MDA plasma concentration among smokers and non-smokers, the SOD activity is significantly higher in non-smokers (p < 0.05). Based on the revealed findings the authors assume that free radicals may also play a part in the action of styrene on the organism.

The authors assessed in blood some indicators of the reaction of the organism to the formation and action of free radicals in patients with rheumatoid arthritis, with other inflammatory articular diseases selected at random and with degenerative diseases of the joints and spine. From the results ensues that subjects with inflammations of the synovial membrane respond relatively frequently by a rise of indicators of the antioxidant system such as the activity of superoxide dismutase, glutathione peroxidase or the antioxidant capacity of plasma. Obviously a defence reaction of the organism is involved to the increased formation and action of free oxygen radicals in the inflamed articular lining. The authors conclude that the mentioned laboratory indicators of the action of free radicals could be used when checking the progress of treatment in rheumatic diseases.

The authors examined indicators of the effect of free radicals (MDA, SOD, GSHPx, selenium) in 20 patients with notified simple silicosis or miner's pneumoconiosis, in 11 patients with complicated silicosis or miner's pneumoconiosis and in 10 patients exposed to fibrogenic dust without an X-ray finding of pneumoconiosis. No statistically significant differences between individual groups were found. Subsequent investigations should be focused on subjects with incipient pneumoconiosis who are not yet entitled to damages.

Iron overload may result as a consequence of increased iron income or deffective iron utilization. The most common reason in our region is hereditary hemochromatosis or red blood cell transfusions dependent anemias with a high rate of ineffective erythropoiesis (eg. myelodysplastic syndrome). A key moment for the development of the toxicity caused by iron overload is increased iron release into circulation. An exceeded transferrin saturation leads to increased amount of non-transferrin bound iron in circulation and one of its components, so called labile plasmatic iron may initiate lipid peroxidation resulting in cellular destruction. Basic laboratory investigations for the diagnosis of iron overload are serum ferritin and transferrin saturation. NMR of liver or myocardium serves as a useful tool for non-invasive quantification of tissue iron. The treatment of hereditary hemochromatosis is based on combination of erythrocytopheresis and chelation therapy. Administration of iron chelators represents the treatment of choice in iron loaded anemias. Desferioxamine, deferiprone and deferasirox are the three currently available iron chelators. The aim of chelation therapy should be not only removal of increased body iron stores but also a prevention of development of iron overload and toxic effect of "free" iron.

The prevalence of 2 type diabetes in the world as a consequence of modern urban lifestyle is convincingly growing. Diabetes together with other risk factors for cardiovascular disease creates a part of metabolic syndrome. Diabetic cardiomyopathy is defined as heart failure in diabetic patient without any other known reason and an impairment of myocardial metabolism with preference of less efficient free fatty acids beta oxidation in generating ATP is typical for it. The main goal in the management of diabetic patient with CAD is to prevent macro- and microvascular complications and improve the prognosis of the patient. To achieve this we need a multifactorial approach concerning lifestyle modification, medical therapy and strict control of glycaemia.

Dabigatrane is the first new generation antiacoagulant that at a dose of 150 mg twice daily was, in the RE-LY study, more effective in cerebrovascular event and systemic embolisation prevention than well-controlled warfarin and had comparable or better safety profile than well-controlled warfarin. The 110 mg twice daily dose showed comparable efficacy and superior safety against warfarin. Crucial and unique among modern anticoagulants is its ability to significantly reduce ischemic as well as hemorrhagic CVEs at a dose of 150 mg twice daily. In addition, dabigatran significantly facilitates management of patients with atrial fibrillation as it does not require laboratory monitoring, has predictable pharmacokinetics, simple dosing regimen that does not require complicated dose adjustments, and does not interact with food. However, it is important to remember that it is an anticoagulant. Care should, therefore, be exercised when the treatment is indicated, renal function has to be known and it needs to be kept in mind that, as with any anticoagulant, the treatment may be associated with bleeding. However, when indication criteria are observed, the above listed advantages considered and careful patient monitoring put in place, the bleeding will be, compared to standard warfarin treatment, minimized.

Sodium ion with its accompanying anions plays the major role in osmolality of body fluids changes of which determine overall fluid balance in health given on one side by water intake and on the other side by its excretion via kidneys. In renal failure, control of the excess fluid removal is taken over by dialysis but control of water intake via thirst induced by changes in osmolality remains functional. Sodium balance is thus of utmost importance. It consists of two components - dietary salt intake and sodium balance during haemodialysis (HD). Choice of sodium concentration in dialysis solution (CD_Na) and its difference from plasma sodium (CP_Na) may thus significantly influence water intake during the interdialytic period. And despite of rather wide interindividual scatter in CP_Na, majority of dialysis centres still uses the same CD_Na value for all patients and their dietary counselling stresses the need of restriction in fluid intake only. The article analyzes possible impact (benefits) of the two principal approaches to CD_Na manipulation - its individualisation with the value being kept constant during the whole HD session and use of sodium profiling (changing CD_Na during the course of HD). Based on literary data and on own measurements, CD_Na individualisation appears far more beneficial in the long-term perspective. Contemporary off-line sodium profiling, regardless of how sophisticated control algorithm is used brings in the risk of positive sodium balance with all negative effects associated with it. Restriction of salt intake should be stressed in dietary counselling instead of mere fluid restriction.

Pancreatic cancer is a disease with exceptionally poor prognosis. This is mainly due to late diagnosis; surgical resection, as the only currently available curative method, cannot be performed if diagnosed late. It is known that 5-year survival does not exceed 5.0% and, similarly, the number of new diagnoses worldwide per calendar year equals the number of deaths per calendar year, i.e. 300,000 people. So far, no effective screening for pancreatic cancer is available in asymptomatic people. Therefore, identification of risk factors with respect to possible induction of cancerous growth, and their bearers, provides some hope. These factors include hereditary diseases such as Peutz-Jeghers syndrome, familial intestinal polyposis, melanoma mole, hereditary pancreatitis or family history of pancreatic cancer. In addition to the genetic factors, a number of initially benign diseases, such as chronic pancreatitis, diabetes mellitus or obesity, are also among risk factors. An international consortium of representatives from 15 countries has recently developed this screening alternative with the aim to actively identify people who are at risk of pancreatic cancer, examine their family members and provide subsequent regular follow-up using mainly the CECT and endosonography.

We present an overview of current opinions on combination therapy and the role of fixed combinations in the treatment of hypertension as per the ESH/ESC and CSH guidelines of 2007 and the revised European guidelines of 2009. A renin-angiotensin system blocker (ACE-I or sartan) combined with a calcium channel blocker is the most frequently recommended combination, followed by renin-angiotensin system blocker and a diuretic and a calcium channel blocker and a diuretic. A fixed combination of a calcium channel blocker and a beta-blocker has now been also recommended. Higher patient compliance and thus better control of hypertension is the main advantage of fixed combinations. We present an overview of fixed combinations registered in the Czech Republic until May 2012.

Alemtuzumab, the humanized monoclonal anti-CD52 antibody, is an effective agent in the treatment of fludarabine-refractory chronic lymphocytic leukemia (CLL). Due to many specific issues associated with alemtuzumab treatment, the Working Committee of Czech CLL Study Group developed these guidelines. Summary of recommendations: (1) The main indication of alemtuzumab is fludarabine-refractory CLL. (2) Further possible indications include first-line treatment (in patients who cannot be treated by fludarabine-containing regimens), therapy of patients with del 17p, treatment of refractory autoimmune cytopenias and management of patients with severe cytopenias due to bone marrow infiltration. (3) The treatment should last 12 weeks and should not be terminated prematurely if there are no signs of CLL progression; bone marrow aspirate/biopsy can be performed after 12 weeks of treatment. (4) Subcutaneous administration of alemtuzumab seems to be equally effective with advantageous reduction of infusion-related adverse events. (5) Patients treated with alemtuzumab must receive combined antimicrobial prophylaxis against Pneumocystis jiroveci and herpetic viruses. Cytomegalovirus viremia should be monitored using weekly PCR from peripheral blood. (6) Use of alemtuzumab in combinations and consolidation/maintenance protocols must be considered experimental and needs optimization within prospective clinical trials. (7) Alemtuzumab treatment should be conducted by an experienced hematologist within a center of intensive hematology care.

Helicobacter pylori (Hp) is the most common chronic bacterial infection in humans worldwide. The prevalence of Hp infection is high in developing countries (80-90%) and lower in developed countries (10-30%). In vast majority of infected individuals, the infection is acquired early in life. The risk of Hp infection is related to low socio-economic status and living conditions at early childhood (density of housing, overcrowding, number of siblings, sharing a bed, and lack of running water, low education of parents). Smoking is a risk factor of Hp infection in adults. In developed countries including the Czech Republic, the overall prevalence of Hp infection has fallen dramatically over recent decades. This decrease can be explained mostly by the relatively favourable and improving socio-economic conditions. However, it is necessary to consider also the fundamental determinants of "modern times" that could cause gradual disappearing of Hp from the human "microbiome".

This overview discusses an importance of molecular diagnostics of chronic myeloid leukemia, molecular monitoring of treatment efficacy, residual disease and resistance to therapy and the role of the National reference laboratory ÚHKT in these issues. The qualitative detection based on the multiplex reverse transcriptase PCR confirms the presence of mRNA of the fusion gene BCR-ABL in the examined sample, thus a diagnosis of chronic myeloid leukemia. Characterization of the type of BCR-ABL rearrangement is also important for the subsequent monitoring based on the quantification of BCR-ABL transcripts. The quantitative determination of BCR-ABL transcripts at regular intervals monitors the kinetics of the disease during the treatment at the molecular level. A milestone in the successful management of chronic myeloid leukemia by tyrosine kinase inhibitors is the achievement of the major molecular response, which corresponds to the levels of BCR-ABL transcripts ≤ 0.1%^IS. Thus, a fundamental aim is national and international harmonization of BCR-ABL transcripts quantification among laboratories. Currently, definition and monitoring of the complete molecular remission or deep molecular response rates is currently intensively studied worldwide, because of a higher number of patients achieving complete molecular response under 2nd generation TKI. The most studied and proved mechanism of the resistance to TKI therapy are mutations in the kinase domain of BCR-ABL. Sanger sequencing is the gold standard for the routine detection and characterization of BCR-ABL mutations. At present, mutation studies starting with using of the second-generation sequencing, which is expected to help in understanding of mutation development and clonal evolution under the pressure of TK inhibitors and the potential impact of this extremely sensitive technology for the prognosis.

Introduction:
Borderline between upper and lower respiratory tract pathology is probably artificial (bronchial asthma). Also inflammation of bronchial mucosa during chronic obstructive pulmonary disease (COPD) is likely combined with inflammatory involvement of nasal mucosa. Ciliary edge of respiratory epithelium is very important part of mucosa layer.
Aim:
To investigate and compare nasal and bronchial ciliary beat frequency (CBF), degree of nasal and bronchial ciliary dyskinesia, presence of ciliary akinesia and incidence of spinocellular metaplasia in the both mucosa localities among of stable COPD patients (pts).
Method:
Nasal and bronchial mucosa were obtained in the course of bronchoscopy examination of COPD pts in general intravenous anesthesia. Native samples of mucosa tissue were assessed by digital high-speed video microscopy (1,000× magnification). Paired t-test was used to evaluate differences in average frequencies. Significance level was α = 0.05. Mode was used to describe "index of dyskinesia", as a measure of association was used κ coefficient.
Material:
Seventeen COPD pts (6 weeks free of exacerbation) at the age 47-80 (average 64.2 years ± 9,7) were examined (13 male), average FEV₁ 61% predic. value (21-81, ± 15). All patients were active smokers (average 42 pack years ± 22.8) and all suffered from bronchitic (daily sputum production) phenotype of COPD.
Results:
We did not find any difference in average ciliary beat frequencies between nose (6,0 Hz ± 1.3) and bronchus (5.9 ± 1.3) locality (p = 0.427). We find weak association between nose and bronchus in "ciliary akinesia" (κ = 0.282) but medium association in "metaplasia" (κ = 0.485), in index of dyskinesia (κ = 0.733).
Conclusion:
We did not find in our data any difference in nasal and bronchial ciliary beat frequencies and we found medium association between nasal and bronchial spinocellular metaplasia and index of ciliary dyskinesia. Possible generalization of these results would require further investigation and analysis.

Light chain deposition disease (LCDD) damages most frequently kidneys, and less frequently other organs. The incidence of LCDD is lower than the incidence of AL-amyloidosis. Symmetric swelling of both legs was the first sign of nephrotic syndrome with renal insufficiency in our female patient. Renal biopsy specimen revealed the diagnosis of LCDD. Bone marrow biopsy contained 40% of plasma cells. Bone survey showed no osteolytic changes. These findings confirmed the diagnosis of multiple myeloma (MM) Durie Salmon stage IB with LCDD. The patient was initially treated with 4 cycles of VAD (vinkristine, adriamycine, dexamethasone) chemotherapy with no response. Followed collection of peripheral haematopoietic stem cells and later high dose chemotherapy with reduced dose of melphalan 140 mg/sqm and autologous peripheral haematopoietic stem cells transplantation. Melphalan dose was reduced because of renal insufficiency (serum creatinine 290 μmol/l) before application of conditioning regimen. High dose therapy was complicated by with deterioration of renal function, creatinine increased to 600 μmol/l. Worsening of renal function was most likely caused by nephrotoxicity of melphalan in nephrotic syndrome. This has been previously described in patients with AL-amyloidosis, and nephrotic syndrome who were treated with high dose melphalan. This phenomenon was entitled "post conditioning renal insufficiency". Hypoalbuminemia hypoproteinemia and reduced intravascular volume and renal damage caused by amyloid deposits as well as probably, amorphous non-amyloid deposits of monoclonal immunoglobulin are likely to have contributed to nephrotoxicity of the high dose of melphalan. However, worsening of renal insufficiency was facilitated by the mucositis-associated sepsis. Follow-up examination one month after high dose chemotherapy showed complete remission, that was confirmed by further examinations. In the course of the first year after high dose chemotherapy renal function gradually improved and nephrotic syndrome completely disappeared (complete kidney remission). Proteinuria declined to 2-3 g/24 hours and glomerular filtration slowly improved. Three years after high dose chemotherapy the patient is still in complete remission of multiple myeloma and free of nephrotic syndrome, with slightly increased creatinine (160 μmol/l) that, nevertheless, has had an improving tendency over last 3 years. The present case study illustrates accomplishment of complete haematological remission with high dose chemotherapy followed by autologous haematopoietic stem cells transplantation despite complete resistance of the disease to the standard chemotherapy VAD in a patient with MM and LCDD. We draw the reader's attention to the possibility of nephrotoxic effects of high dose melphalan (post conditioning renal insufficiency) in patients with nephrotic syndrome caused by light chain deposits as AL-amyloid or amorphous light chains deposits (LCDD)and we document the importance of plasma free light chain detection.

Introduction:
The Atractiv project assessing the efficacy of a complex approach to cardiovascular risk reduction in primary care was conducted by 464 physicians in the entire Czech Republic between 2006 and 2007.
Aim:
The primary goals of the Atractiv project were description of prevalence of risk factors for cardiovascular disease (CVD) in high-risk patients and attempt to maximize the risk reduction by optimalization of treatment. Within five visits the patients were carefully followed and their risk factors were intervened using lifestyle and pharmacological measures.
Methods:
The main focus of the project was management of dyslipidemia and arterial hypertension. Basic anthropometric and laboratory data were collected including serum lipids, glycemia, kidney liver function tests, CVD risk was assessed using SCORE charts. 4,427 patients were included in the project (2,372 men), average age 62.9 ± 10 years.
Results:
Optimalization of treatment of dyslipidemia resulted in a significant decrease of both total and LDL-cholesterol levels by 23 and 28%, respectively, HDL-cholesterol concentrations increased by 4.5% and levels of triglycerides declined by 22%. Improved management of arterial hypertension was accompanied by a decrease of average blood pressure from 152.5/90.5 mm Hg to 132.5/80.2 mm Hg. Average fasting glycemia was lowered by 0,4 mmol/l while body mass index and waist circumference decreased by 0.6 kg/m² and 2,5 cm, respectively. All differences between baseline and the last visit were statistically significant (p < 0.001). Pharmacotherapy indicated during the project was well tolerated and occurrence of side effects was minimal.
Conclusion:
The Atractiv project documents the complex approach to patients at high-risk of CVD including lifestyle intervention with effective combination of lipid-lowering drugs and antihypertensive drugs brings additional significant lowering of CVD risk. Application of modern, evidence-based approaches to treatment of dyslipidemia and arterial hypertension in everyday practice is possible, effective and feasible.

Schnitzler syndrome is a rare disease characterised by chronic urticaria and the presence of monoclonal IgM immunoglobulin, and by other symptoms. We report our experience with 14-year treatment of a patient. The first medical examination in our workplace was at the beginning of 1995 and the patient was diagnosed with the disease in 1996 (at the age of 52). Antihistaminics, the first medication used to relieve the symptoms of urticaria, had no subjective or objective effect. After the detection of osteolytic-osteosclerotic changes in the pelvic region, in areas with intense pain, we started treatment with pamidronate (90 mg at 28-day intervals), and the pain disappeared completely within 3 months of application of the drug. When the bisphosphonate therapy was interrupted, the pain recurred and receded completely after renewal of bisphosphonate administration. After the diagnosis, we gave the patient high doses of dexametazone (40 mg day 1-4, 10-13 and 20-23, at 28-day cycles). However, the therapy suppressed urticaria only on the days dexametasone was administered and the effect did not last when the drug was discontinued. Therefore we moved to continuous daily doses of prednisone (10-30 mg, depending on the intensity of problems), which was the only therapy with a long-term effect which was relatively well tolerated at the same time. Based on the excellent effect of 2-chlordeoxyadenosine in Waldenström's macroglobulinaemia, three cycles of this therapy were administered to the patient in 1996 (0.1 mg/kg/day, 7 days, at 28-day intervals). After the first infusion, urticarious lesions disappeared, but the positive effect on skin eruptions was limited in time and lasted only 14 days after the last infusion, i.e. the medication proved ineffective from a long-term point of view. The first improvement lasting for a longer period of time (partial remission) was achieved by regular application of interferon α (3 QU 3 times a week). However, adverse effects of interferon α prevailed after two years and the therapy was discontinued. Similarly phototherapy using the PUVA method resulted in partial regression of urticarious symptoms. Subsequently tested cyclosporine A (5 mg/kg/day) brought no benefit. Thalidomide (100 mg in the evening) administered on a continuous basis relieved pruritus and improved sleep disturbed by pruritus. However, adverse effects prevailed after 4 months and the therapy had to be discontinued, too. In 2005, we were hoping to achieve positive results with the most effective treatment for multiple myeloma of the time, a combination of bortezomib (1.3 mg/m² i.v. on day 1, 4, 8 and 11, thalidomide 100 mg daily and dexametazon 20 mg p.o. on days 1-4 and 8-11 in 21-day cycles - VTD). A total of 4 complete cycles and 4 cycles with bortezomib reduced by 50% were applied. Urticarious eruptions were reduced by at least 50% in the course of the therapy, and also the concentration of monoclonal immunoglobin decreased temporarily by more than 50%. However, after the therapy was discontinued, the symptoms returned with their original intensity, which means that VTD regime did not provide a long-term therapeutic response. In 2007, we started the anakinra (Kineret) therapy. Skin symptoms disappeared after the first injection and a dose of 100 mg/day ha

The registry of patients treated with Thromboreductine® (anagrelid) in the contributing centres in the Czech Republic has been updated with data on the patients receiving this medication since 2004. The original purpose of the registry was to record responses to Thromboreductine® therapy and adverse drug reactions in patients with essential thrombocytopenia. However, data on additional Ph negative myeloproliferations, as well as data on cytoreductive therapies other than exclusively that using Thromboreductine® has also been recorded in the course of its compilation, including data on combined regimes. At present, the database contains data on 421 patients, and valid conclusions can be drawn if the level of data filling is enhanced. Evaluation has been currently focused on the analysis of the risk of development of clinical symptoms of thrombosis and on the standards of treatment from the viewpoint of the achieved treatment response. Analyses of data from the registry corroborate the special importance of the proof of JAK2 mutation, and of the test for factor V Leiden mutation, and of protein of S for the assessment of the risk of thromboembolic complications. The output of the analysis confirms that anagrelid is a very efficient thromboreductive agent the administration of which is associated with a low incidence of non-serious adverse effects (10.9%). However, in spite of a fast response to therapy, the therapeutic goal consisting in the reduction of the platelet count below 400 (or below 600) × 10⁹/l, i.e. the complete (or partial) treatment response, is relatively slow to achieve. This is likely to be due to lack of radical corrections in the dosage of the drug for different reasons.

Aim:
Response to the therapy is one of the most valuable prognostic factors. The response evaluation is performed by computer tomography as a standard tool. The introduction of FDG-PET whole body imaging allows to discriminate viable tumor and fibrotic changes in structural abnormalities.
Methods:
We have performed retrospective analysis of 96 patients with diagnosis of diffuse large B-cell lymphoma (1999-2004) who were treated by anthracyclin based chemotherapy and FDG-PET was performed as a part of intermediate restaging (after 2nd-4th cycle, 69 patients) or/and at the end of standard chemotherapy (68 patients).
Results:
The progression free survival (PFS) and overall survival (OS) at 3 years were the endpoints. Median follow up was 30 months. The PFS and OS resp. for PET negative pts at intermediate restaging was 80.7 % and 97.6 % compared to the 50.5 % and 71.5 % resp. for PET positive patients. The relapse risk and death risk for PET positive patients was 4.8 and 6.4 resp. The PFS and OS resp. for PET negative pts at the end of chemotherapy was 81.7 % and 94.7 % resp. compared to the 29.4 % (p < 0.0001) and 57.5 % (p < 0.0001) resp. for PET positive patients. The relapse risk and death risk for PET positive patients was 7.0 and 12.9 resp. Predictive value of PET at intermediate as well at the end restaging was observed in IPI low group as well IPI high risk subgroups for both PFS and OS, except OS in high risk subgroup at intermediate restaging.
Conslusion:
The current analysis confirms predictive PET value for patients with DLBCL at intermediate as well at the end restaging. The question if and how to use the PET findings for tailoreing of therapy remains to be answered in prospective trials.

The aim of presented communication is summary of actual knowledge in pathogenesis, diagnosis and treatment of primary systemic AL-amyloidosis. Great attention is devoted to contribution of assessment of serum levels of free light chains including κ/λ ratio, measurement of cardiac biomarkers NT-proBNP and troponin, and also ¹³²I-SAP immunoscintigraphy for treatment response monitoring. The necessity of standardized evaluation of treatment results according to International Society for Amyloidosis recommended criteria are discussed. And also current possibilities of conventional chemotherapy, contribution of high-dose chemotherapy with autologous stem cell transplantation support (HDT-ASCT), inclusively individual "risk adapted" HDT-ASCT considering prognostic factors of the disease were discussed. Present possibility of immunomodulatory therapy with incorporation of thalidomide, bortezomib and lenalidomide, used in case of treatment failure or disease progression, and also supporting care, including organ transplantation are mentioned. The important role of general practitioners and expert internists in diagnosis of early stages of the disease is highlighted - circumstances chiefly determining treatment strategy and prognosis of this severe, formerly difficult to treat and devastating disease.

For the primary prophylaxis of variceal bleeding endoscopic band ligation has been shown to be as effective as non-selective beta-blockers (carvedilol), but variceal injection sclerotherapy is not generaly recommended in this setting because of higher rate of complications and lower effect in reducing either bleeding or mortality. Endoscopic management of acutely bleeding gastroesophageal varices includes injection sclerotherapy, rubber band ligation, and variceal obturation with tissue adhesives. Variceal injection sclerotherapy remains a quick, simple and cheap technique for the control of active bleeding from esophageal varices, but is associated with more re-bleeding than variceal band ligation, which is now preferred also for lower rate of complications. Endoscopic sclerotherapy has increasingly been replaced by ligation also in secondary prophylaxis of variceal bleeding. The studies showed that band ligation can eradicate varices in fewer sessions, re-bleeding and complications were fewer in comparison with variceal injection sclerotherapy. Because of the reduced efficacy, severe complications, and the high mortality associated with using conventional sclerosants in acute bleeding gastric varices, the technique of injecting tissue adhesives has been studied, described and used despite numerous complications. Endoscopic injection sclerotherapy of esophageal varices remains usable as an oldest method in arresting of this hemorrhage only in rare cases when the band ligation is not available.

Thyroid gland disorders, as the core of all endocrinopathies, affect 5-7% of the population of the Czech Republic, with women being affected 6-8 times more often than men. Clinically, thyreopathies are divided into hormonal production disorders and morphology disorders. Thyroid hormones fT₃, fT₄ and TSH serum levels determine the diagnosis of a thyroid gland disorder. Primary hypothyreosis is characterized by reduced fT₄ and increased TSH. Low T₃ syndrome is a protective reaction of the organism and is associated with conversion of T₄ into hormonally inactive triiodothyronine (rT₃). Primary hyperthyreosis is characterized by higher fT₄ and low TSH levels. Acute thyreoiditis: Inflammatory signs and normal thyroid function, anti-TPO as well as anti-TG are not elevated. Subacute thyreoiditis is manifested as an inflammation, normal anti-TPO and anti-TG, sometimes also hyperthyreosis. Chronic thyreoiditis, Hashimoto's struma is among the most frequent causes of hypothyreosis in the Czech Republic and it is diagnosed through high anti-TPO and anti-TG levels and higher TSH. Thyreoidal adenomas and carcinomas are clinically usually euthyroid. Determination of tumour markers - thyreoglobulines in papillary and follicular carcinomas and calcitonin in medullar carcinoma that requires genetic assessment (determination of germinal mutations, usually with PCR) - is essential.

Even though guidelines for diagnosing celiac disease have been compiled and accepted by a number of expert associations, this disease continues to be under-diagnosed in children and, particularly, in adults. This is even though numerous scientific papers, short case studies and review papers have been published highlighting this issue and consensually supporting screening methods. In addition, research results by reputable Czech and Slovak authors suggest that, at present, only a small proportion of all cases of celiac disease are correctly diagnosed. Considering this, methods to diagnose the disease in its initial stage are continuously being sought. Biopsy of the mucosa of the small intestine remains the gold standard when diagnosing celiac disease. Within the targeted diagnostic algorithm, less invasive techniques should precede biopsy. These are applied mainly in cases of atypical forms of the disease and are based on an examination of serum autoantibodies. Their application and use is advantageous from many perspectives. However, practical clinical experience showed that they are not always sufficiently specific and sensitive. Using their own experience and published literature, the authors discuss the issues of screening and diagnosing celiac disease. It is obvious that targeted screening will undoubtedly uncover new, mainly atypical forms of celiac disease, while some cases shall remain undiagnosed. The diagnosis of celiac disease can be made on the basis of clinical, laboratory and histopathological correlation, respecting possible difficulties.

NATO Advanced Training Course on Best Way of Training for Mass Casualty Situations was held in Haifa, Israel in November 16-18, 2009. In total, 22 participants from 8 countries of the Partnership for Peace and Mediterranean Dialogue Programmes attended the course. The participants, divided within three groups, discussed and practised the training methods for the preshospital aspect, the hospital aspect and the non-conventional aspect of the mass casualty management. An international team of experts, among others, used following teaching methods: general lectures, guided discussions, utilization of advanced multimedia tools, tabletop drills, and large scale drill as training tools. The trainees also learned about medical and clinical simulation as a training tool, and subsequently practiced it. A mass casualty drill was held in Rambam Health Care Campus at the end of the Course. The trainees of the course participated as observers and reviewers in the drill, and debriefed it together with Rambam medical staff. Realisation of the successful course was made possible by utilizing a grant of the NATO Science for Peace and Security Programme.

The authors present the result of their work where they provide evidence that in inflammatory and degenerative diseases the break-down on superoxide in inadequate. This oxygen radicals and its metabolites play a significant role in the pathogenesis of these diseases. The authors revealed a severe defect in superoxide degeneration in particular in articular exudates of patients with active synovitis. Administration of the preparation Selzink-Plus of PRO.MED.CS Co. Prague which contains selenium, zinc, beta-cyrotene, vitamin C and E along with antirheumatic treatment improves according to the authors the breakdown of superoxide and its metabolites and improves thus the patient's prognosis. Long-term administration of the preparation seems to produce even better results.

Osteoporosis is a disease causing higher bone fragility and bone ruptures occurring even in minimal traumas. Good patient compliance is the prerequisite for long-term efficacy of osteoporosis treatment. Compliance data from randomised clinical studies may not provide reliable information about compliance in clinical practice which is usually lower. CORAL (COmpliance with RALoxifene therapy) is a local, Slovak, non-interventional, open, prospective, uncontrolled and multicentre study of woman patients on raloxifen therapy in current clinical practice. Raloxifen is a selective estrogen receptor modulator (SERM) indicated for the treatment and prevention of postmenopausal osteoporosis.
Objectives:
The primary objective of the study was to assess compliance with raloxifen therapy in the conditions of current clinical practice. The secondary objectives were the assessment of the impact of therapy on the quality of life, of treatment satisfaction and treatment safety.
Patients and methods:
A total of 1497 patients with proven postmenopausal osteoporosis were enrolled in the 18-month study performed in 40 centres. Compliance was evaluated on the basis of the number of omissions in the use of the evaluated drug. Treatment satisfaction was evaluated by the patients who used a 0-100 visual analogue scale (VAS). Quality of life was evaluated by means of an EQ-5D quality of life questionnaire. In order to measure treatment safety, all adverse events were recorded by the supervising physician in a dedicated questionnaire at every visit.
Statistical methods used:
The non-parametrical Mann-Whitney test was used to assess the relation between raloxifen treatment compliance and the selected parametres (quality of life, treatment satisfaction, changes in health condition, premature discontinuation of therapy). The maximum likelihood ratio χ2 test and Fisher's exact test (for 2 × 2 tables) were used to analyse the ratio between compliance and reasons for enrolment in the study. Changes in treatment satisfaction in the course of the study were analysed using the Wilcoxon test. All the used tests were bilateral and data was assessed at a 5 % level of significance.
Results:
The mean age of the patients enrolled in the study was 63.4 ± 8.0 years. 58 % of patients were enrolled on the basis of densitometric evidence of osteoporosis, 74 % of patients were enrolled for proven osteoporosis which had been manifested by a fracture, and osteoporotic fracture as such was the reason to start therapy in 10 % of patients. The majority of patients enrolled in the study (77 %) had natural menopause. The mean period from menopause to the study was 15 years. Acceptable cooperation (≥ 80 % of medication used) was recorded for more than 90 % of patients during the study, and total dosing adherence was recorded more than 58 % of patients. A significantly higher satisfaction with pharmacotherapy was observed in the patients who adhered to the prescribed dosing schedule. Adherence to the prescribed dosing schedule was also associated with a considerable better health condition and a higher quality of life. In a total of 1,497 evaluated patients, treatment was prematurely discontinued in 87 (5.8 %) women. The attending physician's decision, advers

Aims:
The aim is a description of the recurrent arrhythmias after previous ablation of paroxysmal atrial fibrillation (AF), and the results of a repeat catheter ablation.
Methods:
A repeat ablation was performed in 76 patients (18 females, 54 ± 11 years) in 96 procedures, which was 21 % out of 362 patients, who had undergone the first ablation for a paroxysmal AF. The endpoints of the repeat ablation were re-isolation of the pulmonary veins (PV) and termination of a spontaneous or induced arrhythmia and restoration of a stable sinus rhythm (SR), and possibly achievement of noninducibility of any arrhythmia.
Results:
Clinical left atrial tachycardia (LAT) was present in 10 (13 %) patients before the first, and in 5 (25 %) patients before the second repeat ablation. Arrhythmia arising from an arrhythmogenic PV due to the conduction recovery into the left atrium (LA) was found in 50 (66 %) patients during the first, and in 7 (35 %) patients during the second repeat ablation. Arrhythmias, predominantly of the reentry mechanism and originating in the LA free wall, were found in 26 (34 %), respectively 13 (65 %) during the first or the second repeat ablation. All arrhythmias from PVs were terminated by a PV encircling ablation. Substrate-related arrhythmias were terminated by ablation except for 2 (3 %) patients during the first and 3 (15 %) patients during the second repeat ablation. Persistent AF was mainly terminated via conversion into a LAT. In these cases, the ablation sites leading to the SR restoration were, similarly to the primary LATs, located predominantly in the LA anterior wall. During the 22 ± 13 months follow-up, 68 (89 %) patients were free of AF, 54 (71 %) patients off the antiarrhythmic drugs and 14 (18 %) patients with the class I or III antiarrhythmic drugs.
Conclusion:
AF associated with PV-LA re-connection dominated prior to the first repeat ablation, then the proportion of the substrate-related arrhythmias from the LA free wall increased. Clinical efficacy of the repeat ablation is high.