Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Feb 2009
Review[The combination of an ACE inhibitor and a calcium channel blocker is an optimal combination for the treatment of hypertension].
Combination of drugs from different classes of antihypertensives provides an additional antihypertensive effect thus minimising the probability of adverse effects related to the dose of antihypertensive. Combination therapy is indicated for the following groups of hypertensive patients: (a) all hypertensive patients whose systolic blood pressure exceeds the target systolic blood pressure value by > 20 mm Hg, or whose diastolic blood pressure exceeds the target diastolic blood pressure value by > 10 mm Hg; (b) in patients with diabetes mellitus (because the target values are < 130/80 mm Hg); (c) patients with target organ damage; (d) patients with a kidney or cardiovascular disease (patients with IHD, patients after a cerebrovascular accident); (e) patients with overall cardiovascular risk according the SCORE > or = 5%. The advantage of fixed combinations resides in the fact that they increase compliance with treatment by reducing the number of pills taken by the patients. ⋯ The fixed combination of perindopril and amlodipine will be indicated for hypertensive patients with uncontrolled hypertension or cardiovascular risk factors. This fixed combination will also be ideal for patients with a higher risk of diabetes mellitus, i.e. patients with a higher fasting glycaemia, in patients with impaired glucose tolerance and in patients with the metabolic syndrome. We strongly believe that it will improve the control of hypertension in our hypertensive patients, and improve the cardioprotective and nephroprotective effect of hypertension therapy.
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Vnitr̆ní lékar̆ství · Nov 2008
Case Reports[Langerhans cell histiocytosis in adult patients--a disease with many faces. Experience of a centre and an overview of the disease symptoms].
Over a period of 18 years, 17 patients with proven Langerhans cell histiocytosis (LCH) were treated at the Haematological Clinic in Brno. In 13 of them, the disease was diagnosed at adult age, and 4 patients were referred to the centre with LCH diagnosed at early child age. One of these 4 patients suffered from repeated recurrences of the disease at adult age and was diagnosed with progressive neurodegenerative damage of the CNS at the age of 25 which in its terminal phase resulted in the patient's immobility, loss of sphincter control, incapacity to communicate and death at the age of 32. ⋯ Therefore each new osteolytic lesion should be submitted for histological exam, as well as each pathologic formation, because diagnosing the disease without a microscopic and immunohistochemical exams is not possible. In the case of occurrence of diabetes insipidus at adult age, LCH should be considered as one of the possible underlying diseases. LCH pulmonary involvement should be considered in patients with an interstitial pulmonary process and the examinations should be focused accordingly (thoracoscopy with sampling for histological exams or bronchoalveolar lavage) plus the indispensable immunohistochemical examination.
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Sepsis is the leading cause of mortality in non-coronary intensive care units. The uncontrolled and deregulated systemic inflammatory response to infection plays a central role in the pathophysiology of sepsis. ⋯ This "detoxification" forms the theoretical basis and biological rationale for the use of hemopurification therapies as an adjunctive treatment of sepsis. Our article reviews the current evidence of hemopurification methods in the supportive treatment of sepsis, briefly discusses new trends and summarizes the recommendations for clinical practice.
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Vnitr̆ní lékar̆ství · Jun 2008
[Overcooling during mild hypothermia in cardiac arrest survivors--phenomenon we should keep in mind].
Mild hypothermia (MH) in cardiac arrest survivors has became a routine part of early postresuscitative support. Overcooling is a frequent phenomenon with the unknown outcome. ⋯ Induction of MH by conventional cooling approach is burdened by high risk of overcooling. This phenomenon is probably associated with worse outcome.
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Vnitr̆ní lékar̆ství · May 2008
Review[Education of diabetic patients with chronic kidney disease and after transplantation].
Despite recent advances in the management of diabetes, diabetic nephropathy is the most frequent cause ofend-stage renal disease. Even when diabetic nephropathy is established, patient's care should be optimized to delay progression of nephropathy or other diabetic complications. Evidence exists for the effectiveness of diet intervention, blood pressure and diabetes control and treatment of metabolic syndrome. ⋯ Effectiveness of each of these recommendations is critically assessed. Patients after kidney or combined kidney and pancreas transplantation have to be educated mainly in symptoms of rejection and diabetic foot care. They are recommended to take regularly the prescribed medicines, to distinguish the adverse events of immunosuppression and keep all doctor's appointments.