[Differentiation of malignant and non-malignant origin of ascites by determination of levels of cholesterol and lactate dehydrogenase in ascitic fluid is not absolute].

R Gasko, N Klímová

Vnitr Lek 2000, 46(1):5-11

The authors Castaldo et al. (Clin. Chem., 1994, 30: 478-83) state, that the ascitic lactate dehydrogenase and ascitic cholesterol association correctly identified 100% of malignant ascites from ascites associated with cirrhosis and/or hepatocellular carcinoma, with help of stepwise multiple linear discriminant analysis. The free software Capsules--Ascites is via internet available (http:¿www.leeds.ac.uk/acb), which use the mathematical formula from this article. As we argue, Castaldo's state is not correct. Three independent multidimensional statistical methods--bivariate reference regions (program EVAL-KIT), cluster analysis (program BioAnalyst),...

[Chronic venous insufficiency].

D Musil

Vnitr Lek 2000, 46(1):12-15

The author investigated in a group of 224 patients selected at random (380 extremities), indicated for different reasons for examination of the venous system of the lower extremities by coloured duplex and triplex sonography, the prevalence, site and clinical manifestations of deep venous insufficiency. Only 21.1% patients indicated for examination on account of clinical signs of deep venous thrombosis had objective signs of the disease, while almost half (47.7%) suffered from venous insufficiency. Venous insufficiency was detected also in a large percentage (59.9%) of patients without clinical symptoms. In the great majority of patients (99.8%) combined...

[Regression of deep venous thrombosis].

D Musil

Vnitr Lek 2000, 46(1):16-18

The submitted prospective randomized study investigated the way and rate of regression of deep venous thrombosis of the lower extremities during a six-month out-patient follow up. On discharge on the 5th to 10th day after establishment of the diagnosis the thrombosis had not disappeared in any of the patients, in two patients progression was observed despite anticoagulant therapy. After three months 4.8% thromboses were recanalized, after 6 months 33.3%. In 33.3% of patients recanalization in a distal-proximal direction was found, in 19% in a proximal-distal direction and in 33.3% recanalization occurred throughout the thrombotic occlusion. Thromboses...

[Familial hypercholesterolemia: do we know how to diagnose it correctly?].

V Soska

Vnitr Lek 2000, 46(1):19-23

Familial hypercholesterolaemia is a serious inborn disease of lipoprotein metabolism with a high risk of early cardiovascular complications. The cause of the disease is a congenital defect of LDL receptors. In adults with familial hypercholesterolaemia practically always pharmacotherapy with hypolipaemic agents is indicated. The prerequisite for starting lifelong medication in primary prevention of ischaemic heart disease is a correct diagnosis of this disease. The latter involves in addition to clinical and genealogical examinations, above all correct interpretation of blood lipids in relation to age and the relationship of probands in the affected...

[The hepatic form of Wilson's disease in young patients].

V Smolka, Z Frysák, L Kozák, J Mathonová, V Jezdinská, Z Novák, Y Hrcková, S Vrábelová

Vnitr Lek 2000, 46(1):24-29

UNLABELLED: Wilson's disease (WD) is a hereditary disorder of the copper metabolism with very varied clinical and biochemical symptoms. Hepatic and neurological forms are the most frequent manifestations of this rare disease. In schoolchildren and adolescents symptoms of liver damage predominate. In a retrospective study 19 patients were evaluated with biochemical signs of hepatopathy manifested before the age of 18 years. The diagnosis of WD was established at the age of 7 to 27 years. One female patient was admitted with fulminant hepatic failure which was treated by acute transplantation of the liver in the Institute of Clinical and Experimental...

[The short bowel syndrome].

D Rath, R Keil, J Vecer

Vnitr Lek 2000, 46(1):30-33

The authors demonstrate on case-histories their experience with short-loop syndrome which develops after extensive resections of the small intestine. The clinical picture of the syndrome is characterized by diarrhoea, steatorrhoea, maldigestion and malabsorption with loss of body weight. Non-surgical treatment of the syndrome copies its different stages. The objective of conservative therapy is above all to preserve the nutritional integrity of the organism and gradual adaptation of the gut which will make eventually a change to oral intake possible. This adaptation takes 1 to 2 years. Last not least, treatment should eliminate the diarrhoea. The authors...

[A dissecting aortic aneurysm in a female patient with Turner syndrome].

J Chlumský, F Kölbel, M Buresová, P Sváb, V Krutílková, E Koudelková, P Pavel, V Srnský, E Seemanová, J Zemková, D Novotná

Vnitr Lek 2000, 46(1):34-36

Female phenotype, sexual infantilism, small stature and stigmatization are typical for patients with Turner's syndrome (TS). The most frequent cardiovascular manifestations in these patients are a bicuspidal aortal valve and coarctation of the aorta. In 5% patients dilatation of the aorta is found which can develop into a dissecting aneurysm. In the submitted case-history the authors describe a 34-year-old patient where the diagnosis of TS was proved only in adult age at the time when a dissecting aneurysm of the aorta was detected. The submitted case-history supports the recommendation of regular echocardiographic check-up examinations of patients with TS.

[24-hour ambulatory blood pressure monitoring].

R Skulec, P Petr, Z Matznerová, H Kalová, M Ferebauerová

Vnitr Lek 2000, 46(1):37-44

24-hour ambulatory blood pressure monitoring (ABPM) is the exact, fully automatic and noninvasive method for evaluation of the 24-hour hemodynamic profile of the subject by multiple and regular blood pressure and heart rate measurement. In comparison with causal blood pressure measurement, ABPM allows the definition of daytime and nighttime blood pressure averages, diurnal changes of blood pressure, localization of periods of the most frequent appearance of hypertensive values, specification of hypertensive load, percent time elevation and diagnosing of white coat phenomenon. The use of all mentioned findings leads to the improvement of blood pressure...

[Is nebulized ipratropium bromide effective in the treatment of exacerbations of chronic obstructive pulmonary disease?].

J Musil

Vnitr Lek 2000, 46(1):45-48

The author administrated to 20 patients hospital on account of exacerbation of chronic obstructive pulmonary disease nebulized ipratropium bromide 0.5 mg on admission. Nebulized was repeated, using the same dose after 30 mins. The PEF value increased significantly after the first and second nebulization. After the two nebulizations dyspnoea was alleviated. The value of the respiration rate was significantly lower after both nebulizations as compared with the value before treatment. PaO2 increase significantly as compared with the value before treatment. PaO2 and the pulse rate did not change. An undesirable effect was recorded in one patient. Ipratropium...

[Endothelins and ischemic heart disease].

L Bartůněk

Vnitr Lek 2000, 46(1):49-53

Endothelins (ET) comprise a group of substances which are produced and have a regulatory function in different systems of the organism. The main cardiovascular ET is ET-1 which is so far the most potent vasoconstrictor substance. ET is important in the early stages of atherosclerosis as it is a strong chemical attractant of monocytes and macrophages and causes endothelial and vasomotor dysfunction. In later stages of atherosclerosis it can affect the firmness and integrity of the fibrous part of the atherosclerotic plaque. During myocardial infarction the ET level rises and this leads to vasoconstriction and reduction of the fibrillation threshold....

[Endothelins and chronic cardiac insufficiency].

L Bartůněk

Vnitr Lek 2000, 46(1):54-57

Endothelins (ET) comprise a group of substances which are produced and have regulatory functions in different systems of the organism. The main cardiovascular ET is ET-1 which is so far the most potent vasoconstrictor substance. In the pathophysiology of cardiac insufficiency ET-1 promotes cardiac hypertrophy, is involved in vasoconstriction, delayed relaxation and reduced left ventricular contractility. The ET-1 level correlates with pulmonary vascular hypertension. By vasoconstriction of renal arteries ET leads to volume retention. Big-ET is a very efficient neurohumoral marker in the diagnosis of developed cardiac failure which can lead to more...

[The future of internal medicine, cardiology and patients].

P Jerie

Vnitr Lek 2000, 46(1):58-59