[The concept of internal medicine and specialization in internal medicine].

K Horký

Vnitr Lek 1993, 39(2):108-110

[New developments in the treatment of non-specific intestinal inflammation].

Z Maratka

Vnitr Lek 1993, 39(2):111-113

This term comprises idiopathic proctocolitis (IPC) and regional enteritis (RE, Crohn's disease). Despite a number of similarities (similar age, symptoms, immunology, drugs), the two conditions differ substantially (site, pathology, surgery) and thus from a practical aspect it is essential to differentiate them. The term "ulcerative colitis" comprises also other inflammations, e.g. recently identified infections with causal agents which are difficult to diagnose. There are also several types of regional enteritis which differ as to their course and sequelae. As regards medical treatment, in both conditions in particular corticosteroids are used and...

[Early diagnosis of gastric cancer].

I Duris

Vnitr Lek 1993, 39(2):114-117

Endoscopic diagnosis completed by biopsy achieved remarkable accuracy. New trends--endoscopy with the use of ultrasound orange red porphyrin fluorescence elicited by blue light e. g. krypton laser and strip biopsy not only greater accuracy of endoscopic methods but also open up new therapeutic possibilities. Histochemical and histoenzymatic methods allow to classify histological findings of the norm (presence of pepsinogen and neutral glycoprotein) of atrophic gastritis with intestinal metaplasia (acid glycoprotein, activity of sucrose, alkaline phosphatase-AP, leucin-aminopeptidase-LAP) and of dysplasia (presence of sulfomucin, decrease of AF, LAP,...

[Therapy of peptic ulcer].

V Jirásek

Vnitr Lek 1993, 39(2):118-124

After a historical review of therapeutic methods of peptic ulcer the author discusses contemporary views on therapy. As a basis he uses the idea that Helicobacter pylori is the decisive factor for the development of peptic ulcers. Therefore the basis of treatment should be its eradication by bismuth salts. Despite this at present the basis of treatment are antagonists of H2 receptors. Economic aspects are important. In repeatedly relapsing ulcers with evidence of Helicobacter pylori the author recommends eradication by a combination of drugs.

[Secondary osteopenia in gastrointestinal diseases].

J Kocián

Vnitr Lek 1993, 39(2):125-131

Of 2557 patients with osteopenia examined during the past 17 years 1707 were classified as secondary osteoporosis and 406 as osteomalacia. Diseases of the gastrointestinal tract participate as the cause of osteoporosis in 635 patients (37.19%) and osteomalacia was the cause in 210 patients (51.72%). The highest ratio in osteoporoses are lactose intolerance--256 cases (14.99%); maldigestion was recorded in 305 patients (17.86%). This category comprises gastrectomies of both types, severe affections of the gallbladder and biliary pathways, insufficiency of the external pancreatic secretion, patients with frequent exacerbations of ulcerative colitis....

[Diagnosis and therapy of esophageal diseases].

T Hildebrand, J Podracký, M Zakuciová

Vnitr Lek 1993, 39(2):132-135

In reflux disease the authors emphasize the following diagnostic procedures: a satisfactory case-history, endoscopy, aimed biopsy, radiographic evidence of reflux, radionuclide reflux scintigraphy and pH-metry. As to subsidiary examinations, they recommend Bernstein's perfusion test. In 50% of the patients with non-coronary chest pain the complaints are caused by diseases of the oesophagus. The latter include achalasia, dysphagia, idiopathic diffuse spasm, hyperdynamic oesophagus and irritable oesophagus. In the treatment of reflux disease the stage of the disease is decisive. Treatment is prolonged and the doses of drugs are higher than in duodenal...

[The effect of creatine phosphate (Neoton) in acute myocardial infarct (a prospective multicenter pilot study].

M Stejfa, K Zeman, L Groch, J Marek, J Komárek, T Janota, F Vávra, F Kölbel, I Charvát, O Weinbergová

Vnitr Lek 1993, 39(2):136-142

The authors investigated in a group of 106 patients with a first myocardial infarction treated by thrombolysis the effect of i.v. administration of creatine phosphate (a new drug with cardioprotective action--Neoton Alfa Schiapparelli Wassermann Co). In the course of treatment electrocardiographic changes were recorded and the presence of arrhythmias examined by the Holter technique. The Neoton group displayed a statistically insignificant but nevertheless obvious trend of electrocardiographically less serious forms of infarction and a lower incidence of infarctions, as compared with the control group.

[Protective effect of Neoton during cardiovascular surgery. Hemodynamic and biochemical aspects].

R Záhorec, H Holomán, E Bilcíková, M Simo, R Tomlain, I Pechán

Vnitr Lek 1993, 39(2):143-152

The authors present the preliminary results of an experimental study where to a group of patients (n = 10) subjected to cardiosurgery, using extracorporeal circulation, to the cardioplegic solution creatine phosphate was added (Neoton of Alfa Schiaparelli Wasserman Co.)--2 g.l-1. The authors investigated haemodynamic and biochemical parameters and compared them on the day of operation with the same parameters assessed in a group of controls operated in the same way but without addition of creatine phosphate to the cardioplegic solution. Apart from insignificant differences in haemodynamic parameters the group of patients given Neoton had a lower malondialdehyde...

[The effect of creatine phosphate in patients after surgery in ischemic heart disease].

J Cerný, P Nĕmec, J Bucek, E Cerný, F Papousek, A Lojek

Vnitr Lek 1993, 39(2):153-159

The authors submit their experience with the use of creatine phosphate in patients operated on account of coronary heart disease. They divided 50 consecutive patients into three groups. Group A--controls, group B--creatine phosphate was added to the filling of the apparatus for extracorporeal circulation and group C--creatine phosphate was added to Bretschneider's cardioplegic solution. During operation and during the early postoperative period the CK and CK MB levels were evaluated as well as levels of free acid radicals, the haemodynamic state of the patients, the incidence of ventricular dysrhythmias, the need of defibrillation, histological and...

[The optimal diagnostic approach in myocardial infarct].

P Widimský, P Gregor, J Dvorák, T Sládková, M Herold, R Jirmár, S Hrdlicka

Vnitr Lek 1993, 39(2):160-165

In the submitted review the authors discuss rational criteria for the diagnosis of myocardial infarction, indications for thrombolysis, coronarography and possibly PTCA, the method of indirect (non-invasive) assessment of an occluded coronary artery and the most frequent mistakes in the diagnosis of infarction. Essential examinations in the acute stage of myocardial infarction are: case-history, ECG, CK-MB (possibly echocardiography). For indication of thrombolysis of acute PTCA case-history and ECG (or echocardiography) are sufficient. Indications of early coronarography before discharge from hospital: postinfarction angina pectoris, malignant arrhythmia...

[Arrhythmia in acute myocardial infarct].

J Murín, J Kasper

Vnitr Lek 1993, 39(2):166-171

The authors present a review of optimal treatment and prevention of dysrhythmias in the acute stage of myocardial infarction (AIM). They emphasize the necessity to shorten the pre-hospitalization stage of the disease (the prevalence of malignant dysrhythmias culminates) and elaborate in every hospital region an optimal plan of emergency care (ensure CPR, electrical defibrillation, pharmacological prevention of VT and VF). They draw attention to the fundamental importance of the therapeutic limitation ensuing from the size of the focus which implies at the same time prevention and treatment of an impaired cardiac rhythm. The authors recommend early...

[The present status of nitrates in the treatment of ischemic heart disease].

M Stejfa, J Vítovec

Vnitr Lek 1993, 39(2):172-177

The authors describe the development of nitrates from substances of the first generation (nitroglycerin and isosorbit dinitrate) to the second generation (isosorbit-5-mononitrate). They explain the mechanism of their action, haemodynamic effects and the problem of nitrate tolerance. Indications of their rational use are given.

[The stress interview after acute myocardial infarct].

P Vávra, V Sluka

Vnitr Lek 1993, 39(2):178-182

Patients suffering from myocardial infarction (MI) form the high risk group. Residual ischemia, impaired left ventricular function and dysrhythmias are life endangering. Sudden death is more frequent in this group than in the one of patients with CHD. Therefore before discharge from the hospital we applied to the patients after MI series of noninvasive methods to disclose ventricular dysrhythmias. 136 patients after MI, mean age 56 (36-74), were examined. From those 90 patients underwent early exercise test and stress interview--application of common and specific mental stress. Holter ambulatory monitoring was applied to 18 post MI patients and echocardiography...

[24-hour monitoring of blood pressure in patients with essential hypertension].

J Siegelová, B Fiser, J Dusek, B Semrád, F Halberg, G Cornelissen

Vnitr Lek 1993, 39(2):183-190

The aim of the study was to determine the efficiency of enalapril therapy during 24-hours blood pressure monitoring. A group of healthy subjects (C, n = 11), a group of patients with essential hypertension without therapy (EH, n = 9) and a group of patients with essential hypertension II (WHO) treated with enalapril (Acepril Lachema) in once a day doses (13.0 +/- 2.1 mg per kg) during at least 10 months (EH A, n = 8). In all groups of patients and healthy subjects 24-hours blood pressure measurement was provided using Accutracker II equipment. The mean values of systolic (SBP) and diastolic blood pressure (DBP) from 24-hours measurement (+/- SD) were...

[Pharmacologic therapy of hyperlipoproteinemia and its pitfalls].

R Ceska

Vnitr Lek 1993, 39(2):191-197

Hyperlipoproteinaemias, in particular those associated with hypercholesterolaemia are considered one of the most significant risk factors for the development of early atherosclerosis and ischaemic heart disease. Effective reduction of plasma lipids and lipoproteins is associated with a decline in the prevalence of ischaemic heart disease and cardiovascular mortality. Pharmacotherapy of hyperlipoproteinaemias is therefore considered a rational procedure in preventive cardiology. After a brief review of comprehensive treatment of hyperlipoproteinaemias the author discusses in particular contemporary possibilities of their medicamentous treatment. He...

[Cardiovascular changes in Turner's syndrome].

J Musilová, F Kölbel, J Král, D Simper, K Michalová

Vnitr Lek 1993, 39(2):198-202

25 adult asymptomatic patients with Turner's syndrome were evaluated by clinical examination, ECG, M-mode and two-dimensional echocardiography and 24 h Holter monitoring. Patients with Turner's syndrome had a significantly higher resting heart rate (83.3 versus 73.7/min in controls, p < 0.01) and a shorter PQ interval (122.3 ms versus 147.1 in controls, p < 0.01). The short PQ interval was not associated with the karyotype (45,X vs. mosaic karyotypes and structural abnormalities of X and Y chromosome), hypertension, estrogen treatment, or congenital valvular abnormalities. No significant arrhythmias were present. On 24 hours ambulatory ECG monitoring...