Výsledky léčby chronické hepatitidy C jsou v České republice srovnatelné s nejvyspělejšími státy světa - editorial

P. Husa

Vnitr Lek 2009, 55(5):446-447  

Algorithm of treatment of glucocorticoid induced osteoporosis - search for criteria - editorial

J. Štěpán

Vnitr Lek 2009, 55(5):448-454  

Epidemiological data indicate twofold increase of low impact fractures (spine, hip, ribs, distal forearm, and shoulder) in patients on glucocorticoid treatment compared with untreated subjects. These risks are mainly independent of BMD and prevalent fracture. Early direct inhibitory effect of glucocorticoid on bone formation and promotion of apoptosis of bone cells are thought to be the major mechanism of glucocorticoid-induced osteoporosis (GIO). Despite differences in pathogenesis of postmenopausal osteoporosis, GIO, and other types of osteoporosis, the algorithm of treatment of GIO should be based on the assessment of the individual absolute risk...

Comparison of various methods of body fat analysis in overweight and obese women

R. Větrovská, Z. Lačňák, D. Haluzíková, P. Fábin, P. Hájek, L. Horák, M. Haluzík, Š. Svačina, M. Matoulek

Vnitr Lek 2009, 55(5):455-461  

Introduction:Body composition assessment and determination of the amount and distribution of body fat, respectively, form an essential part of the basic clinical assessment of an obese patient. However, there are no recommended methods to determine the amount of fat in obese population. The aim of our study was to compare the methods most frequently used to determine the amount of body fat in overweight and obese women in clinical practice (multi-frequency bio-electrical impedance analysis - BIA using the Bodystat, Omron and Tanita machines and the skinfold test using a calliper) with a reference method (DEXA). The study further...

Bioelectrical impedance analysis for comparison of the body composition in type 1 diabetes patients, obese patients and healthy volunteers

L. Baxová, M. Žourek, V. Frantová, K. Kovářová, Z. Rušavý

Vnitr Lek 2009, 55(5):462-467  

Background:Effects of glycaemic control and insulin treatment on body composition in type 1 diabetes patients have not been clearly proven yet. Aim:Comparison of the body composition in type 1 diabetes patients, obese patients and healthy volunteers using multifrequency bioelectrical impedance analysis. Methods:Multifrequency bioelectrical impedance measurements were performed on 153 type 1 diabetes patients, 176 obese patients and on 159 healthy controls of the same age and gender. HbA_1c level, duration of disease and daily dose of insulin were measured in diabetes patients. Results:Significant...

Impact of basal prolactin levels on the prevalence of complications and the prognosis of patients with liver cirrhosis

T. Koller, J. Kollerová, M. Huorka, T. Hlavatý, J. Payer

Vnitr Lek 2009, 55(5):468-473  

Introduction:Prolactin concentration was proved to be associated with complications of cirrhosis. Methods:This relationship was investigated on the group of 90 patients predominantly males with alcoholic cirrhosis. Basic clinical and laboratory data were collected at entry as well as complications of cirrhosis already present. Patients were followed for the mean of 434 days and events such as variceal bleeding, hepatorenal syndrome and death were recorded. Results:We found that 16.7% of patients had elevated serum prolactin levels, and had significantly higher Child-Pugh and MELD scores as well as higher ascites...

Efficacy of combination treatment with pegylated interferon plus ribavirin in patients chronically infected with HCV

P. Urbánek, I. Subhanová, E. Janoušová, L. Dušek, Z. Mareček, R. Brůha, J. Petrtýl, M. Brodanová

Vnitr Lek 2009, 55(5):474-479  

The aim of the study:To evaluate the efficacy of combined antiviral treatment with pegylated interferon α plus ribavirin in patients with chronic HCV infection who have not yet been treated with antivirals (treatment-naive patients). To compare the treatment effect in patients with low (< 600,000 IU/ml) and high (≥ 600,000 IU/ml) initial viremia. Methods and treatment regime:Treatment-naive patients with chronic HCV infection treated with the combination therapy of pegylated interferon-α2a plus ribavirin. Treatment response was evaluated at weeks 12, 24 and 48 when treatment was ongoing and at weeks 12, 24...

CORD: COmparsion of Recommended Doses of ACE inhibitors and angiotensin II receptor blockers

J. Špinar, J. Vítovec, M. Souček, L. Dušek, T. Pavlík

Vnitr Lek 2009, 55(5):481-488  

Objectives:The CORD trials tested ramipril and losartan in patients with hypertension. Patients and methods:CORD IA involving switching from an angiotensin-converting enzyme inhibitor (ACEI) to the angiotensin II receptor blocker (ARB) losartan. 4,016 patients with blood pressure (BP) < 160/100 mm Hg who had been treated with an ACEI for > 3 months were enrolled. The mean age was 62.6 ± 11.6 years and 53.1% were women. The patients discontinued ACEI and switched to losartan 50 mg once daily. BP, heart rate, biochemistry, blood counts and ECGs were measured at day 1 and months 1, 3, 6 and 12. If the BP was...

Extrinsic allergic alveolitis - rarely diagnoticated disease

D. Lauková, I. Marget, J. Plutinský

Vnitr Lek 2009, 55(5):489-500  

Extrinsic allergic alveolitis (EAA), known as hypersensitive pneumonitis, causes interstitial lung involvement by inhaled antigen. The clinical presentation of the disease has been defined as acute, subacute and chronic. The most often symptoms of the acute form of the disease are flu-like symptoms, dyspnoe and cough. The progressive dyspnoe in particullary is characterized for the chronic form of EAA. Dyspnoe is worsed, if the disease is combinied with usual respiratory infection or reexposition of inhaled antigen. It seems the diagnostic definition of EAA should be easy and prevalence of EAA relative high. The disease belongs to the group of interstitial...

Turner's syndrome requires multidisciplinary approach

M. Berková, Z. Berka, Z. Krčová

Vnitr Lek 2009, 55(5):501-505  

Turner syndrome is one of the most frequent genetic disorders, the result of complete or partial monosomy of the X chromosome. It affects 1 : 2,500 live female births. The principal features of Turner syndrome are short stature and ovarian dysgenesis accompanied by estrogen deficit. Turner syndrome is associated with further numerous, more or less serious abnormalities and high risk of cardiovascular mortality. The article concisely summarizes the most frequent problems in Turner syndrome and emphasizes the need of multidisciplinary care for affected patients.

Glucocorticoid-induced osteoporosis treatment algorithm

J. Payer, Z. Killinger, K. Brázdilová

Vnitr Lek 2009, 55(5):506-511  

An excess amount of glucocorticoids represents the primary and most frequent etiological factor influencing secondary osteoporosis. The patients receiving glucocorticoids, but also those with the endogenous form of hypercorticism are at high risk for the loss of bone density, with the subsequent occurrence of pathological fractures. In this review, we summarize the currently available methods of prevention and the treatment of glucocorticoid-induced osteoporosis (GIO). We also include a proposal for both prophylactic and therapeutic approach that takes into account the risk factors typical for long-term users of glucocorticoids.

Ivabradine in patients with stable ischemic heart disease and left ventricular systolic dysfunction: the results of the BEAUTIFUL study

J. Filipovský

Vnitr Lek 2009, 55(5):513-516  

Ivabradine reduces heart rate by inhibiting the I_f channels mediated current, while sinus rhythm is sustained. The aim of the BEAUTIFUL study was to assess whether the administration of ivabradine to patients with stable ischemic heart disease and ejection fraction ≤ 40% will result in reduction of cardiovascular morbidity and mortality. This was a double blind randomized study including 10,917 patients. Half of the patients were administered placebo and half were treated with ivabradine additional to the treatment normally used in the secondary prevention of ischemic heart disease; the starting dose was 5 mg twice a day and could be...

Is there a hope in pharmacological treatment of thromboembolic pulmonary hypertension?

J. Widimský

Vnitr Lek 2009, 55(5):517-522  

Chronic thromboembolic pulmonary hypertension that used to be treated with anticoagulation therapy only had serious prognosis. The five-year survival of patients with the mean pulmonary artery pressure above 50 mm Hg was just 10%. The introduction of pulmonary endarterectomy in clinical practice represented a significant improvement in patient prognosis. However, about 1/3 of patients have distal lesions and are thus not eligible for surgery. In addition, the surgery is not indicated in a number of patients due to serious co-morbidities. Even though milder, pulmonary hypertension persists in 10-15% of post-surgery patients. About 50% of patients are...

Turner syndrome is associated with increased cardiovascular morbidity and mortality

M. Berková, Z. Berka, Z. Krčová

Vnitr Lek 2009, 55(5):523-528  

The authors present a case of an acute myocardial infarction in a patient with Turner syndrome, leading to the death of the patient. An emphasis is put on the need of a thorough examination of cardiovascular system, specialized on congenital heart disease including aortic dilatation with the risk of dissection, and early development of ischemic heart disease. Regular monitoring as well as adequate therapy in patients suffering from this genetically determined disorder is recommended.

Fait T. Antikoncepce. Průvodce ošetřujícího lékaře

Aleš Roztočil

Vnitr Lek 2009, 55(5):534  

Dopisy redakci

Tomáš Doležal

Vnitr Lek 2009, 55(5):529  

Ve dvou se to lépe táhne

J. Špinar, L. Špinarová

Vnitr Lek 2009, 55(5):530-533