Mnohočetná angiomatóza - několik poznámek - editorial

Tomáš Svoboda

Vnitr Lek 2017, 63(10):632  

Medication adherence to non-vitamin K antagonist oral anticoagulants at non-valvular atrial fibrillation - the literature review

Simona Dvořáčková, Kateřina Ládová, Josef Malý, Jozef Kolář, Miroslav Penka

Vnitr Lek 2017, 63(10):633-639 | DOI: 10.36290/vnl.2017.125  

Medication adherence is a complex problem reflecting variations in terms of medication taking behavior. It is essential in maximizing of the effect and risk minimization of the therapy and health care costs reduction, even in the case of oral anticoagulants (non-vitamin K antagonist oral anticoagulants - NOACs). The aim of this paper was to review the published literature and to discuss results in the field of medication adherence to NOACs in patients with non-valvular atrial fibrillation (NVAF). Based on the searching in databases Embase and PubMed 25 studies were identified, of which conclusions were summarized in this paper. Patients treated with...

Surgical treatment of aortic root aneurysm: comparison of Bentall procedure and David reimplantation of aortic valve

Jiří Ničovský, Jiří Ondrášek, Jan Černý, Daniela Žáková, Petr Němec

Vnitr Lek 2017, 63(10):640-645 | DOI: 10.36290/vnl.2017.126  

Introduction:The aortic root aneurysm is associated with a more frequent occurrence of aortic dissection and development of aortic regurgitation. The aim of this study was to compare outcomes of composite graft replacement and valve sparing root replacement in treating aortic root aneurysms. Methods:From January 2006 to December 2015 a total of 137 patients (mean age 46.3 ± 14.5, range 16-65) underwent elective surgery for aortic root aneurysm without valvular structural defects. Replacement by mechanical composite graft (Bentall procedure) has been performed in 46 patients while 91 patients underwent valve sparing...

Treatment strategy of type 2 diabetes used in Czech Republic after metformin therapy failure

Štěpán Svačina, Petra Ovesná, Matyáš Kuhn, Martina Nováčková

Vnitr Lek 2017, 63(10):647-657 | DOI: 10.36290/vnl.2017.127  

Introduction:Type 2 diabetes is an enormous medical problem caused by increasing prevalence of the disease and increasing prevalence of severe chronic complications of diabetes. New ADA/EASD guidelines and also Czech diabetes society guidelines enable effective individual approach to the patient. Goal of the therapy is optimal compensation of diabetes and prevention of acute and chronic complications of diabetes and decrease of mortality. Diabetes therapy is started by education in diet a regime combined with metformin. According to the progressive character of the disease it is usually necessary to intensify the therapy by adding antidiabetics...

Issues related to secondary osteoporosis associated with growth hormone deficiency in adulthood

Martin Kužma, Peter Jackuliak, Zdenko Killinger, Peter Vaňuga, Juraj Payer

Vnitr Lek 2017, 63(10):658-661 | DOI: 10.36290/vnl.2017.128  

Growth hormone (GH) increases linear bone growth through complex hormonal reactions, mainly mediated by insulin like growth factor 1 (IGF1) that is produced mostly by hepatocytes under influence of GH and stimulates differentiation of epiphyseal prechondrocytes. IGF1 and GH play a key role in the linear bone growth after birth and regulation of bone remodelation during the entire lifespan. It is known that adult GH deficient (GHD) patients have decreased BMD and increased risk of low-impact fractures. Most data gathered thus far on the effect of GH replacement on bone status comprise the measurement of quantitative changes of bone mass. Some animal...

Is it possible to improve long-term compliance of patients to statin therapy?

Vladimír Soška, Ondřej Kyselák

Vnitr Lek 2017, 63(10):663-666 | DOI: 10.36290/vnl.2017.129  

Statins are key drugs for patients in secondary prevention of cardiovascular disease, as well as for primary prevention patients at high or very high risk of fatal cardiovascular events. However, long-term compliance of patients to statin therapy is relatively low, decreasing with the time of statin use; moreover a significant proportion of patients stop statins medication over the course of several years. To the early termination of statin treatment often contributes apprehension of the occurence of statin's side effects (i.g. increased creatine kinase in the blood and muscle problems), although these symptoms are usually not causally related to statin...

COSYREL - an efficient fixed combination for treatment of hypertension, stable ISHD and heart failure

Jiří Widimský

Vnitr Lek 2017, 63(10):667-671 | DOI: 10.36290/vnl.2017.130  

Fixed combinations of two or three drugs are being frequently used in cardiovascular diseases. This approach markedly increases adherence of the patients to prolonged therapy and thus leads to better control of the diseases. Fixed combinations are often used in hypertension and coronary artery disease (CAD). Cosyrel is the first fixed combination of betablocker (bisoprolol fumarat) and ACE inhibitor (perindopril arginin) available in czech market. The advantage is availability in several concentrations (10 mg/10 mg, 10 mg/5 mg a 5 mg/10 mg a 5 mg/5 mg) , when first indicates bisoprolol dose and the second perindopril. This combination is indicated...

Endocrine orbitopathy: the present view of a clinical endocrinologist

Jan Jiskra

Vnitr Lek 2017, 63(10):690-696 | DOI: 10.36290/vnl.2017.137  

Graves' orbitopathy (GO) occurs in 25-50 % cases of Graves' disease. Only in 5 % of patients the eye threatening GO is present. About 5-10 % and 10 % cases are present in euthyroid and hypothyroid patients respectively. All patients with GO should be assessed for activity (clinical activity score - CAS) and severity of the disease. Basic preconditions of the treatment are maintenance of euthyroidism, an effort to stop smoking, and referring of patients with moderate to severe and sight threatening GO to specialized thyroid eye centers. The first line treatment includes maintenance of wet eye (lubricants), supplementation of selenium deficiency, intravenous...

Faster Insulin Aspart - a new prandial insulin analogue

Milan Flekač

Vnitr Lek 2017, 63(10):697-702 | DOI: 10.36290/vnl.2017.138  

Preventing postprandial blood glucose excursions is one of the most challenging aspects of achieving adequate control, especially in patients with better long-term compensation of diabetes. Contemporary prandial insulin analogues that have more favorable properties than human insulin in terms of accelerated absorption, earlier onset of action and shorter duration of action are still significantly slower than endogenous insulin in healthy individuals. Fast-acting insulin aspart (FIAsp - faster aspart) is insulin aspart enriched with two excipients, of which niacinamide is responsible for accelerating absorption after subcutaneous administration. The...

Intestinal adaptation following gut resection

Jarmila Křížová, Pavel Trachta, Eva Kotrlíková

Vnitr Lek 2017, 63(10):703-706 | DOI: 10.36290/vnl.2017.139  

Gut resection is followed by wide changes in the gastrointestinal tract. The goal is to increase nutrient, water and mineral absorption in the remnant intestine. These changes are going on for several months. They affect gut mucosa structure, intestine peristaltic activity and enterocytes function. The crucial role is ileum preserving. Ileum has higher adaptation ability comparing to jejunum and inhibits peristaltic function of proximal parts of GIT. A lot of factors involved in intestinal adaptation were identified, hormones, growth factors, regulating peptides, intracellular signalizing cascades, cytokines and tissue factors. The most important seems...

Osteoarthritis as part of metabolic syndrome?

Karel Pavelka

Vnitr Lek 2017, 63(10):707-711 | DOI: 10.36290/vnl.2017.140  

Osteoarthritis (OA) is the most frequent joint disease, whereas etiopathogenesis of OA is not entirely clarified. It is a heterogeneous disorder and genetic as well as biomechanical, endocrine and inflammatory effects may be involved in its origin. The author examines the problems concerning relationships between the metabolic syndrome and OA, and states that the prevalence of metabolic syndrome in patients with OA is higher than in those without OA (59 % vs 23 %). It remains problematic that one of the main components of metabolic syndrome is obesity which in itself is a risk factor for arthrosis development in the weight-bearing joints, not for OA...

Metabolic syndrome and the role of the polypill in the prevention of its complications

Hana Rosolová

Vnitr Lek 2017, 63(10):712-716 | DOI: 10.36290/vnl.2017.141  

The first mention concerning occurrence of cardiometabolic risk factors together appeared 100 years ago. Metabolic syndrome brings 5times higher risk for type 2 diabetes development and 2-3times higher cardiovascular (CV) risk in comparison to the subjects without that syndrome. Healthy life habits and rational pharmacotherapy of hypertension, dyslipidemia and hyperglycemia represent an effective way for high cardiometabolic risk reduction. The problem are patient's low adherence and persistence to the recommendation and pharmacotherapy. Right now polypill (fixed combination of antihypertensives and lipid modifying drugs) are solving in the CV disease...

Diabetes mellitus and cognitive disorders from the diabetologist's perspective

Alena Šmahelová

Vnitr Lek 2017, 63(10):717-720 | DOI: 10.36290/vnl.2017.142  

Diabetes mellitus is associated with cognitive impairment which may convert to vascular or neurodegenerative dementia. Impairment of cognitive functions affects patients with type 1 and especially type 2 diabetes, with a number of vascular, metabolic and psychosocial factors involved in its development. As hyperglycemia and hypoglycemia also play an important role, important is the correct strategy of diabetes therapy which utilizes a combination of metformin with modern safe antidiabetics (incretin drugs, gliflozins, insulin analogues). It seems that some antidiabetic drugs (metformin, incretin drugs) and nasal form of application of insulin could...

Gliflozins slow down the progression of diabetic kidney disease

Vladimír Tesař, Jan Vachek

Vnitr Lek 2017, 63(10):723-727 | DOI: 10.36290/vnl.2017.143  

Until recently progression of diabetic kidney disease could have been slowed down only by the inhibition of the renin-angiotensin system. Inhibitors of SGLT2 (sodium-glucose transporter 2) in the proximal tubulus of the kidney induce natriuresis and by the activation of the tubuloglomerular feedback increase the tone of the afferent arteriole and decrease the glomerular pressure. Empagliflozin in the study EMPA-REG Outcome significantly decreased the risk of progression of diabetic kidney disease and further analyses also demonstrated its potent antiproteinuric effect. Taking into consideration the concomitant cardioprotective and renoprotective effect...

Physical activity - the Holy Grail of modern medicine?

Vladimír Tuka, Martina Daňková, Karel Riegel, Martin Matoulek

Vnitr Lek 2017, 63(10):729-736 | DOI: 10.36290/vnl.2017.144  

Movement is the basic attribute of life. It is not surprising that the return to regular physical activity is a very effective and cheap means of preventing and treating most non-cummunicable diseases. Therefore, every physician should be able to prescribe a suitable physical activity. The minimum amount of physical activity with proven effects in primary prevention of chronic diseases is relatively low: 150 minutes of moderate physical activity or 75 minutes of high intensity exercise per week or a combination of the two. The simplest and safe way of physical activity is walking (at least 10 000 steps/day or 6 000 steps/day on top of daily activities)....

The benefit of new angiogenesis (bevacizumab and aflibercept) inhibitors for multiple angiomatosis therapy: a case report

Dagmar Brančíková, Lenka Ostřížková, Zdeněk Adam, Tomáš Nebeský, Luděk Pour, Zdeněk Král, Jiří Mayer

Vnitr Lek 2017, 63(10):672-678 | DOI: 10.36290/vnl.2017.131  

Angiomatosis is a term for multiple, gradually proliferating hemangiomas (angiodysplasia), affecting multiple organs or tissues at the same time. We describe a 12-year course of treatment of a patient with multiple hemangiomas located in the abdomen, retroperitoneum, oesophagus, mediastinum and also in vertebrae. The diagnosis was made in 2005 within probatory laparotomy, at the age of 28 years. The treatment was commenced right after making the diagnosis with interferon α. Due to its adverse effects (fatigue, anorexia), the use of interferon α was limited to the first year, after which the interferon dose was gradually being reduced until...

Peter Salaj et al. Poruchy hemostázy

Miroslav Penka

Vnitr Lek 2017, 63(10):682  

Ivana Štětkářová et al. Moderní terapie v neurologii

Karel Urbánek

Vnitr Lek 2017, 63(10):683  

ESC Congress 2017. 26.-30. august 2017, Barcelona, Španielsko

Ján Murín

Vnitr Lek 2017, 63(10):679-681  

Použití redukovaných dávek přímých perorálních antikoagulancií není vždy tou správnou volbou

Jiří Veselý

Vnitr Lek 2017, 63(10):685-686  

Základní interní kmen - pracovní verze významného dokumentu vzdělávacího programu

Výbor České internistické společnosti České lékařské společnosti J. E. Purkyně

Vnitr Lek 2017, 63(10):630-631  

Prof. MUDr. Štěpán Svačina, DrSc., MBA, předseda České lékařské společnosti J. E. Purkyně slaví 65 let

Richard Češka

Vnitr Lek 2017, 63(10):689