Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Sep 2004
Review[Pathogenesis of the chronic obstructive pulmonary disease (COPD)].
An inflammation in the bronchial wall is usually present already in an early stage of the disease. An inflammatory infiltration cause predominantly mononuclear cells in the mucous membrane and neutrophiles in the phlegm produced by airways. Also eosinophiles can participate in the inflammation. ⋯ Chronic inflammation is a cause of remodeling and narrowing of small airways. Destruction of pulmonary parenchyma and the inflammation cause loss of alveolar connection with small airways and elastic pulmonary stress decreases. Two theories try to explain COPD--a theory of imbalance between proteinases and antiproteinases and a theory of oxidation stress.
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Vnitr̆ní lékar̆ství · Jul 2004
[Analysis and adjustment of acid-base disturbances according to the Stewart-Fencl principle].
In 1983, P. J. Stewart proposed a new approach for evaluation of acid-base balance of body fluids. ⋯ The change of SID value is a consequence of either dehydration (alkalosis) or hyperhydration (acidosis). Other mechanisms of SID deviation are either changes of serum chloride concentration (an increase causes acidosis, a decrease causes alkalosis) or an increase of concentrations of substances not routinely measured (ketones, lactate, exogenous acids). [Atot] value is determined mainly by the serum albumin concentration (alkalosis in hypoalbuminemia, acidosis in hyperproteinemia). The Stewart-Fencl approach to acid-base balance enables to understand and predict what happens to hydrogen ions in body fluids and to control the pH abnormalities quantitatively.
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Localised and following systemic inflammatory reaction accompanying progression of infection causes generation of anti-inflammatory cytokines. They activate leucocytes, endothelium, coagulation and fibrinolysis. Sepsis is usually accompanied by already decompensated disseminated intravascular coagulation which significantly affects mortality of patients with this disease. ⋯ Some microorganisms have specific properties which affect individual components of hemostasis and thus increase their virulence. Because natural inhibitors of coagulation have not only anticoagulation but also strong anti-inflammatory effect, they seem to be an optimum remedy for fluorid coagulopathy during sepsis. Moreover, their use usually does not increase risk of bleeding.
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Vnitr̆ní lékar̆ství · May 2004
Review[Clinical importance of Helicobacter pylori infection in patients with diabetes mellitus].
This paper provides a review of current literature on Helicobacter pylori infection in diabetes mellitus. According to majority of studies there is no difference of Helicobacter pylori infection prevalence between diabetes mellitus and general population. ⋯ In case of anti-helicobacter therapy (due to another indication) eradication rate is lower in diabetics (compared to non-diabetics) and there is a higher risk of re-infection (compared to general population). Several issues (especially dysmotility disorders of the stomach and influence of Helicobacter pylori eradication for the control of diabetes) remain controversial.