I. Interni Klinika FN Plzen

Plzeň, Czech Republic

I. Interni Klinika FN Plzen

Plzeň, Czech Republic

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Hana V.,III. Interni Klinika 1. LF UK a VFN | Svancara J.,Institute Biostatistiky a Analyz MU Brno | Bandurova L.,III. Interni Klinika 1. LF UK a VFN | Brabec P.,Institute Biostatistiky a Analyz MU Brno | And 25 more authors.
Diabetologie Metabolismus Endokrinologie Vyziva | Year: 2013

Acromegaly is usually diagnosed after several years of duration. The multimodal therapy - surgery, radiotherpy, pharmacotherapy - is necessary to suppress the activity of the disease in the majority of patients. Register of sellar tumors (RESET) collecting data of patients from eight tertiary centers since the year 2000 was established in 2008 to assess the diagnostics and therapy of acromegaly in a daily practice in the Czech and Slovak Republics. Aim of analysis: diagnostics of acromegaly and effectiveness of its treatment in CR and SR in a period 1. 1. 2000-3. 9. 2013. Patients and results: 343 patients (185 + 158 from CR a SR, resp., 189 women, mean age at diagnosis 49 years). Median time of follow-up was 39.3 months. Three quarters had macroadenoma. 44% of patiens had arterial hypertension (38%) or diabetes mellitus (17%), respectively both (11%). Operated were 81% of patients (reoperated 5%). Normalised IGF-1 three months after surgery was in 54.5% of patients with microadenoma and in 42.4% with macroadenoma. Residual hormonal activity after surgery was treated in the majority of patients with combined radiotherapy and pharmacotherapy. Irradiated were 166 patients and 91% of them underwent radiosurgery with gamma-knife. Patients with operation as part of the complex therapy had faster suppression of hormonal activity. Conclusions: Acromegaly is a serious disease frequently complicated with hypertension and diabetes mellitus. 75% of patients have macroadenoma. The fastest suppression of disease activity is achieved when therapy comprise surgery, alone or in conjunction with other modalities. An individually tailored multimodal therapy is necessary in the majority of patients.


Cechurova D.,I. Interni Klinika FN Plzen | Zourek M.,I. Interni Klinika FN Plzen | Jankovec Z.,I. Interni Klinika FN Plzen | Gruberova J.,I. Interni Klinika FN Plzen | And 2 more authors.
Diabetologie Metabolismus Endokrinologie Vyziva | Year: 2013

Wernicke's encephalopathy is not diagnosed in the considerable part of patients. The risk of Wernicke's encephalopathy must be considered not only in patients with alcohol abuse, but in patients with chronic vomiting, nutritional deficit, after abdominal surgery, with increased energy demand (pregnancy, thyrotoxicosis), or in oncology too. The diagnosis is based on patient's history and clinical picture. The delirium, oculomotor disturbances and lower limb ataxia with unsteadiness of gait belong among classical symptoms of the disease. The clinical picture is often incompletely expressed. Magnetic resonance imaging is helpful for diagnosis only in one half of the patients. Serum thiamin level or erythrocyte transketolase activity assessments do not belong to routine laboratory tests. Wernicke's encephalopathy as a complication of home parenteral nutrition and in a patient after a bariatric surgery is described in the form of case reports by authors. It is important not to forget thiamine deficiency prevention in risk patients on the one hand. Adherence of patients to the recommended vitamin substitution must be improved by repeated educations and motivation on the other hand.


Serclova Z.,Chirurgicke oddeleni | Ryska O.,Chirurgicke oddeleni | Bortlik M.,Klinicke a vyzkumne centrum pro strevni zanety | Duricova D.,Klinicke a vyzkumne centrum pro strevni zanety | And 21 more authors.
Gastroenterologia y Hepatologia | Year: 2015

Medical care for patients with inflammatory bowel diseases (IBD) is complex. The gastroenterologist and surgeon are the most engaged specializations. Surgical treatment improves the quality of life, however its results depend on the correct indication for surgery, on the patient's preconditioning and appropriate timing. The aim of the working group for infl ammatory bowel disease is to create a review of conditions for surgical treatment, its relationship to conservative treatment and appropriate operating procedures for optimal care of patients with IBD. The fi rst part of the review is focused on the preparation of patients for surgery.

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