Critical evaluation of the optimal medical therapy in the cardiac resynchronization therapy candidates - single centre experience

D. Vondráková, F. Málek, J. Dvořák, L. Šedivá, J. Kupec, J. Petrů, M. Táborský, P. Neužil

Vnitr Lek 2011, 57(10):799-802  

The aim of the present study was to evaluate the optimal medical therapy in the chronic heart failure (CHF) patients referred from the comunity centres and the outpatients cardiology clinics for the cardiac resynchronization therapy with defibrilator (CRTD) to the Department of Cardiology, Na Homolce Hospital with the device implantation between 1st January 2008 and 30st September 2009. Methods:The optimal medical therapy was analysed retrospectively from the medical records of 179 consecutive CHF patients NYHA class III-IV. Beta-blockers (BB) were used only in 81% subjects referred for CRTD, ACE inhibitors (ACEI) were used only...

Cost of acute heart failure related readmissions

B. Říhová, J. Pařenica, R. Miklík, M. Felšöci, K. Hořáková, A. Šulcová, J. Jarkovský, J. Špinar

Vnitr Lek 2011, 57(10):803-807  

Aim of study:To assess direct in-patient cost and length of stay in the intensive care unit (ICU) and the standard cardiology unit in acute heart failure (AHF) readmissions. Results:Out of 1 759 patients hospitalized with acute heart failure, 223 patients were readmitted to Faculty Hospital Brno-Bohunice (Czech Republic) during study period (61.4% male; mean age 71.2 years) with mean total cost CZK 85 120 (€ 3 095) per length of stay 9.2 days and interventions. Comparing to the first hospitalization of study cohort (223 pts.) the decrease was recorded in mean room rate, length of stay and need of ICU stay (from 48% to...

Vaccination against hepatitis B in patients with chronic renal failure - twenty years follow-up

L. Rožnovský, J. Tvrdík, L. Kabieszová, L. Petroušová, I. Orságová, L. Hozáková, I. Lochman, A. Kloudová, I. Valkovský, P. Letocha, S. Schwarzová, M. Hladík, A. Zjevíková

Vnitr Lek 2011, 57(10):808-814  

Aim:The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. Patients and Methods:Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 μg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 μg HBsAg in 269 patients till 2000. Blood samples were...

Normal pulmonary circulation pressure values in healthy subjects at rest and during exercise

J. Widimský

Vnitr Lek 2011, 57(10):815-818  

The paper is based on the results of an earlier retrospective international WHO study of normal pressure values in the pulmonary circulation and the right heart in 468 healthy individuals. The results of this study suggest that the pulmonary hypertension should be defined by the mean pulmonary artery pressure at rest of ≥ 20 mmHg and not ≥ 25 mmHg. Pulmonary wedge pressure should be < 12 mmHg. These results have recently been confirmed by the so far largest retrospective international study of normal values published by Kovacs et al and involving 1187 healthy volunteers. However, this study does not include pulmonary wedge pressure values....

Diagnostika a léčba komunitní pneumonie dospělých

V. Kolek, M. Kolář, V. Kašák, J. Beneš, J. Dindoš

Vnitr Lek 2011, 57(10):858-866  

Resynchronization therapy for heart failure - still many question marks

P. Murín, P. Mitro, G. Valočik, B. Stančák

Vnitr Lek 2011, 57(10):819-825  

At present, the potential benefit of resynchronization therapy, i.e. an improved quality of life and prolonged survival in patients with heart failure, is not achieved in every patient. The 30% non-response has prompted a search for new criteria predicting patient response to resynchronization treatment. An absence of mechanical dyssynchrony, viability of the myocardium and an inadequate positioning of the intracardiac left ventricular lead probably limit the response to resynchronization therapy. ECG remains essential for the selection of suitable patients.

Diagnostic algorithm of syncope: integrative approach

J. Plášek, V. Doupal, J. Václavík, N. Petejová, A. Martínek, M. Táborský

Vnitr Lek 2011, 57(10):826-833  

Syncope is a symptom, defined as transient loss of consciousness and postural tone with spontaneous and mostly prompt recovery. At first it is necessary to differentiate other non-syncopal transient loss of consciousness and simple falls, where thorough history taking is pivotal. EGSYS and OESIL risk scores seem to be contributional in initial risk stratification, however they are neither widely accepted nor a part of national guidelines. They are part of the European society of cardiology guidelines, though. Next it is essential expert ECG evaluation, thorough physical status examination, supine and standing blood pressure measurement and carotid...

Treatment of acute exacerbation of the obstructive pulmonary disease with hospitalization at an Intensive Care Unit.

Y. Staňková, J. Skřičková, S. Potrepčiaková

Vnitr Lek 2011, 57(10):834-838  

Bronchodilatation is preferably achieved with β-2-agonists (SABA), salbutamol. Therapy is intensified with anticholinergics (ipratropium bromide monohydrate). A combined preparation may also be used (ipratropium bromide monohydrate and fenoterole hydrobromide). Methylxantines (theophylline) are the second line option. Corticosteroids are administered orally (prednisolone) or intravenously (methylprednisolone or hydrocortisone). Patients who have problems expectorating are administered mucolytics (ambroxol hydrochloride or bromhexine hydrochloride). Some patients are treated with antibiotics. Oxygenotherapy is indicated in patients with hypoxemia....

The role of central nervous system in etiopathogenesis of peripheral organ diseases

B. Mravec

Vnitr Lek 2011, 57(10):839-846  

Current research on the etiopathogenesis of diseases of peripheral organs is primarily focused on the study of processes affecting those organs directly altered by diseases. As a result, therapeutic interventions are focused on the cells of those organs affected by pathological processes. However, pathological processes are not restricted to any "circumscribed" group of cells. Cells of tissue affected by pathological process interact with cells in the surrounding tissues. Moreover, pathologic processes also induce changes in the activity of the neuroendocrine and immune systems, which also affect the progression of pathological processes. The neurobiological...

Prognostic markers in chronic lymphocytic leukemia

M. Motyčková, P. Žák, V. Vroblová, C. Andrýs, D. Belada, J. Malý, L. Smolej

Vnitr Lek 2011, 57(10):847-857  

Chronic lymphocytic leukemia is the most common leukemia type in Western countries. Even incidence of chronic lymphocytic leukemia is high, this disease remained beyond interest for a very long time. However, in the last few years the view of this disease fundamentally changed and due to intensive study, new knowledge especially on pathogenesis, prognostic factors and therapy based on intensive therapeutic procedures were made. Today we know that usage of classical prognostic factors is insufficient for prognosis evaluation in the individuals. However modern (IgVH mutation status, cytogenetic abberations) and new markers (LPL/ADAM29 ratio, microRNA,...

Benign solitary cecal ulcer

A. Halčín, J. Malina, E. Šteňová, Š. Galbavý, K. Kubranská, R. Brnka

Vnitr Lek 2011, 57(10):867-870  

Solitary benign cecal ulcer is a non-usual finding without characteristic clinical or radiological performance. Because of its little frequency and its clinical symptoms often suspicious for the presence of severe diseases like are malignancies, acute abdomen or lower gastrointestinal bleeding, this finding is only rarely diagnosed preoperatively. Definitive diagnosis is almost always made pathologically. In this case report we describe clinical, radiological and pathological findings in our patient with difficulties caused by a solitary benign cecal ulcer.

MR-documented remission of pituitary stalk infiltration in patients with Langerhans cell histiocytosis following treatment with 2-chlorodeoxyadenosine

J. Vaníček, Z. Adam, K. Balšíková, M. Krejčí, L. Pour, P. Szturz, L. Zahradová, R. Hájek, R. Koukalová, Z. Řehák, Z. Král, J. Mayer

Vnitr Lek 2011, 57(10):871-875  

In adult patients, Langerhans cell histiocytosis (LCH) manifests most frequently with one or more osteolytic lesions or, alternatively, with pulmonary involvement with nodules and cysts or with skin lesions. Infiltration of the central nervous system is a rather rare sign of LCH. The LCH cells have an unexplained affinity to hypothalamus and to pituitary stalk and, consequently, central diabetes insipidus is the most frequent clinical sign of brain involvement in LCH. We describe treatment of 2 adult patients with LCH in whom central diabetes insipidus was the first sign of LCH and MR confirmed pituitary stalk infiltration. The first man was...

K 90. narozeninám MUDr. Jaroslava Ulricha, CSc., *30. 4. 1921 (Osobní zprávy)

MUDr. Pavel Jerie

Vnitr Lek 2011, 57(10)

Intersticiální plicní procesy. Od etiopatogeneze přes radiologický obraz k histopatologické diagnóze (Z odborné literatury)

MUDr. Martina Doubková, prof. MUDr. Jana Skřičková, CSc.

Vnitr Lek 2011, 57(10)