Choroby asociované s imunoglobulinem IgG4 - editorial

Jan Krejsek

Vnitr Lek 2018, 64(3):227-228 | DOI: 10.36290/vnl.2018.031  

Aktuální možnosti biologické léčby idiopatických střevních zánětů - editorial

Tomáš Douda

Vnitr Lek 2018, 64(3):229-231 | DOI: 10.36290/vnl.2018.032  

The prevalence of type 2 diabetes mellitus in patients with autoimmune thyroiditis in hypothyroid stadium

Štefan Sotak, Ivica Lazúrová, Marek Felšöci, Božena Nováková, Hedviga Wagnerová

Vnitr Lek 2018, 64(3):232-235 | DOI: 10.36290/vnl.2018.033  

Introduction:Autoimmune thyroiditis (AIT) and type 2 diabetes mellitus (DM2T) are the two most common endocrinological diseases worldwide. The relationship between T1DM and autoimmune thyreopathies is known and described, but the relationship between thyreopathies and diabetes type 2 is not clarified sufficiently through that studies manifest increasingly the connection between them. Objective:Investigate the prevalence of DM2T in patients with AIT in hypothyroid stadium and compare with common population and investigate a possible association between thyroid and glucose metabolism parameters. Material and methods:The...

Euthanasia and the good life: why euthanasia is (sometimes) ethical

David Černý

Vnitr Lek 2018, 64(3):236-244 | DOI: 10.36290/vnl.2018.034  

In this paper I present the strongest argument, in my opinion, in favour of moral admissibility of euthanasia. In the introduction I briefly mention two important arguments in support of euthanasia - out of respect for autonomy and as a last act of grace, however I refuse them as insufficient. I propose a definition of both forms of assisted death: euthanasia and assisted suicide. I present the basic ideas underlying the theory of the good life and deal with hedonism in greater depth. I define a deprivation concept of the badness of death and, employing hedonism, I specifically describe when death is bad and when it is good. Next I present consequentialism...

Human life as goodness: why euthanasia is morally unacceptable

David Černý

Vnitr Lek 2018, 64(3):245-256 | DOI: 10.36290/vnl.2018.035  

The current discussion of the moral admissibility or inadmissibility of euthanasia should, in my opinion, consider the greatest possible number of the shared premises of the two opinion camps. That is why I followed a thesis in this paper that the question of the good life is the focus of ethical interest, as this is what connects the advocates and the opponents to euthanasia. In the first part of the paper I critically discuss the two main theories of the good life widely embraced among the advocates of euthanasia: hedonism and desire-fulfilment theory. My focus is to show that both of them are descriptively inadequate, not quite in agreement with...

Euthanasia: legal comparison in selected European countries

Adam Doležal

Vnitr Lek 2018, 64(3):257-265 | DOI: 10.36290/vnl.2018.036  

This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victim's Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area. Further, German law is being analysed, with emphasis on Nazi Germany. On that basis,...

Cardiovascular risk of non-steroidal anti-inflammatory drugs

Štefan Alušík, Zoltán Paluch

Vnitr Lek 2018, 64(3):266-271 | DOI: 10.36290/vnl.2018.037  

Non-steroidal anti-inflammatory drugs (NSAIDs) belong to the most widely used drugs. Results of recent large meta-analyses have shown that the cardiovascular risk of NSAIDs is more serious than originally believed and is not associated exclusively with coxibs; it is also increased when using so called traditional NSAIDs. Data obtained to date show the safest drugs of this class in terms of cardiovascular risk are naproxen and ibuprofen at low doses. The position of naproxen as the safest NSAID has been challenged by some more recent findings. The authors examine some results of meta-analyses and conclusions of regulatory agencies.

Splanchnic vein thrombosis

Sylva Lajzová, Radek Kroupa, Alena Buliková, Šárka Bohatá, Barbora Packová, Michal Šenkyřík

Vnitr Lek 2018, 64(3):272-279 | DOI: 10.36290/vnl.2018.038  

Splanchnic vein thrombosis (SVT) represents an unusual manifestation of venous thromboembolism. The etiological factors for SVT can be divided into local and systemic, frequently found concurrently. SVT can be the first presenting symptom in myeloproliferative neoplasms. SVT puts the patients affected in jeopardy of developing the intestinal infarction, impairing the liver function and portal hypertension development with the risk of potentially life-threatening gastrointestinal bleeding. The current guidelines emphasise the role of anticoagulation in acute splanchnic thrombosis. Considering the potentially fatal complications it is necessary to tailor...

Current and prospective biologics and small molecules in the treatment of inflammatory bowel diseases

Milan Buc

Vnitr Lek 2018, 64(3):280-289 | DOI: 10.36290/vnl.2018.039  

Crohn's disease (CD) and ulcerative colitis (UC) belong to chronic inflammatory bowel diseases, which are induced by autoimmune processes. While CD is characterized by over-activity of Th1, ILC1, and MAIT cells, UC is mediated by exaggerated activities of Th2 and ILC2 cells and cytokines they produce. Knowledge of the pathogenesis enabled a rational therapy based mostly on biologics and small molecules. TNF is the principal proinflammatory cytokine in both diseases. Anti-TNF monoclonal antibodies, mostly infliximab or adalimumab were therefore introduced to their treatment. Approximately 50-70 % of CD and more than 33 % of UC patients respond to primary...

Remission of the disease associated/related with immunoglobulin IgG4 accompanied by multiple lymphadenopathy after treatment with rituximab and dexamethasone: a case report

Zdeněk Adam, Zita Chovancová, Markéta Nová, Pavel Fabian, Zdeněk Řehák, Renata Koukalová, Marek Slávik, Luděk Pour, Marta Krejčí, Aleš Čermák, Zdeněk Král, Jiří Mayer

Vnitr Lek 2018, 64(3):290-299 | DOI: 10.36290/vnl.2018.040  

A disease associated with immunoglobulin IgG4 is a rare unit with very variable symptoms. We describe the course and treatment of the disease in a patient who presented with multiple lymphadenopathy and infiltrates in the area of the retroperitoneum and pelvis and signs of chronic sclerosing pancreatitis. The disease was clinically manifested by a significant loss of weight, but also by a loss of perception of taste and smell. The diagnosis was made based on a high amount of IgG4 expressing plasma cells in the sampled tissue and an increased concentration of immunoglobulins of type IgG and mainly subclass IG4. Rituximab in 475 mg/m2 dose was used in...

Hemophagocytic lymfohistiocytosis in adults: review and case report

Jiří Šrámek, Thomas Karvunidis, Daniel Lysák, Martin Harazim, Michal Karas, Pavel Jindra

Vnitr Lek 2018, 64(3):300-307 | DOI: 10.36290/vnl.2018.041  

Hemophagocytic lymfohistiocytosis (HLH) is rare, life-threatening condition, characterized by excessive activation of immune system with subsequent proinflammatory state resulting in multiorgan failure. Most frequently, it appears in infancy as a primary disorder caused by mutation of immune-regulatory genes. Increasingly, HLH is being diagnosed as a secondary - adult - form, which occurs as a result of aberrant immune response. Viral or bacterial systemic infections, malignancy with a predominance of lymphoproliferative disorders and autoimmune diseases are the most common triggers. Early diagnosis and initiation of therapy is crucial and increase...

More safe anticoagulant treatment - use of idarucizumab (Praxbind®): case reports from RE-VERSE AD study and clinical practice

David Tuček, Tomáš Veleta, Martin Havrda

Vnitr Lek 2018, 64(3):309-313 | DOI: 10.36290/vnl.2018.042  

RE-VERSE AD, a prospective multicentric cohort study, examined the effect of idarucizumab on 2 cohorts of patients anticoagulated with dabigatran - in cohort A in patients with uncontrollable or life threatening bleeding, in cohort B in patients who undergo acute surgery. Within the study patients were intravenously administered 5 g antidote divided into 2 doses per 2.5 g within 15 min to eliminate the anticoagulation effect of dabigatran. A series of case studies is presented to describe the use of idarucizumab within the RE-VERSE AD study and in clinical practice in the period of 2015-2016 at the University Hospital Hradec Králové. The included examples...

A case of post-intubation tracheal stenosis mimicking bronchial asthma: case report

Monika Šatánková, Kristián Brat, Zdeněk Merta, Miloš Šteffl

Vnitr Lek 2018, 64(3):314-320 | DOI: 10.36290/vnl.2018.043  

Postintubation tracheal stenosis (PITS) is one of the most frequent causes of lower airways obstruction. Usually, PITS is the consequence of prolonged intubation period, but may occur also after short-term intubation. Diagnosis may be difficult if stridor is not present and the post-extubation period is many years long. Bronchoscopy and CT scanning are the diagnostic gold standard. In some cases, lung function tests may also be helpful. Treatment options include conservative treatment, surgery and endoscopic methods. We present a case report of a 23 year old woman with exercise dyspnoea caused by PITS that was incorrectly treated for bronchial asthma...

Z odborné literatury

Vnitr Lek 2018, 64(3):325-331  

Odešla Jana Musilová

Michal Kršek

Vnitr Lek 2018, 64(3):322-323  

Za profesorem Romanem Čerbákem

Jiří Vítovec

Vnitr Lek 2018, 64(3):323  

Profesor Peter Gavorník sedemdesiatročný

Andrej Dukát

Vnitr Lek 2018, 64(3):324  

Korespondence ke článku

Štefan Alušík

Vnitr Lek 2018, 64(3):321 | DOI: 10.36290/vnl.2018.044