Vnitr̆ní lékar̆ství
-
Vnitr̆ní lékar̆ství · Mar 2009
Review[Cardiac surgery as a significant interference with a patient coagulation status].
Cardiac surgery has been advancing intensively in recent years. However, it is often forgotten that cardiac surgery interventions represent a significant interference with patient's coagulation status. ⋯ The overview provided suggests that cardiac surgery conducted with the support of extracorporeal circuit represents a significant interference with the coagulation status of the patient. Awareness of the above listed changes is necessary to secure correct post-operative management of coagulation disorders.
-
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.
-
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.
-
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.
-
Pulmonary alveolar proteinosis is a rare disease characterised by excessive accumulation of surfactant components in the alveoli and the distal airways with minimum inflammatory reaction and fibrosis of pulmonary interstitium. Three clinical forms of pulmonary alveolar proteinosis are distinguished - congenital, primary and secondary. Results of ultrastructural, biochemical and functional analyses and studies performed on genetically modified mice support the presumption that accumulation of surfactant in pulmonary alveolar proteinosis is a result of a degradation disorder and of diminished clearance of the surfactant from the alveolar space rather than of excessive synthesis of surfactant components. ⋯ In most cases, the prognosis for the disease in adult patients is good, even though there is a 10 to 15% rate of patients who develop respiratory failure. Total pulmonary lavage is considered to be the standard method of treatment. In recent years, recombinant human GM-CSF has been studied as a prospective therapy for the treatment of pulmonary alveolar proteinosis.