Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Jan 2019
ReviewDiagnosing hypovolemia and hypervolemia: from clinical examination to modern methods.
In acutely ill patients, disturbances of circulating blood volume and water homeostasis are frequently encountered. In order to choose adequate treatment strategy a well based diagnostics of these disturbance sis necessary, because fluid therapy possess the potential not only to help but also to worsen patients state. ⋯ Tests of fluid responsiveness are other mean how to ensure that the acutely ill patient will receive just the right amount of fluids. In this review article we will present the current view of the circulating blood volume pathophysiology as well as contemporary diagnostic tools.
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Pericardial diseases have been until recently relatively neglected entity; however, there has been a markedly increased interest in these disorders in the last decade due to new diagnostic as well as therapeutic options. Various clinical manifestations of pericardial diseases may be generally grouped into pericardial syndromes including pericarditis, pericardial effusion, cardiac tamponade and constrictive pericarditis. In this review, the comprehensive analysis of acute and recurrent pericarditis is presented. Acute and recurrent pericarditis represent the most common pericardial disorders in clinical practice, in which major changes in therapeutic procedures occurred based on recently published trials, particularly the introduction of colchicine therapy.
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Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of a metabolic syndrome, is a leading cause of chronic liver disease worldwide with prevalence 17-46 % in adult population. NAFLD is associated with type 2 diabetes, obesity and genetic factors and includes a spectrum of potentially progressive liver disease that comprises of simple steatosis, non-alcoholic steatohepatitis (NASH), variable degree of fibrosis and, ultimately, cirrhosis. Simple steatosis has been considered a benign condition, while the progression to fibrosis and advanced liver disease is related to NASH development. ⋯ Despite intensive effort, no pharmacological treatment of NAFLD has been approved; based on the results of clinical trials the use of vitamin E or pioglitazone could be considered in the treatment of bioptically proved NASH. New antifibrotic and anti-inflammatory agents for the treatment of NASH are under evaluation. Recently, screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes has been advocated.