IV. interni hematologicka klinika

Hradec Králové, Czech Republic

IV. interni hematologicka klinika

Hradec Králové, Czech Republic

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Srbova L.,Endokrinologicky ustav | Cap J.,IV. interni hematologicka klinika
Diabetologie Metabolismus Endokrinologie Vyziva | Year: 2016

The dose of levothyroxine required for maintaining euthyroid state in patients after total thyreoidectomy may vary depending on several factors. The most important of them is the weight, but there are other physiological (age, height, gender, diet) and pathological or other diseases related factors (drug use, impaired absorption and pharmakokinetics of thyroxine). In groups of 219 and 144 patients after total thyreoidectomy for Graveśdisease and low risk thyroid cancer (with already normal levels of thyreotropine) respectively, we investigated the influence of age, the cause of operation and gender on the need of thyroxine. We found, in accordance with the majority of studies, a lower dose of thyroxine required in the higher age. The difference between men and women was not confirmed, but the results of other works are also controversial.

Maly R.,I. Interni kardioangiologicka klinika LF UK a FN Hradec Kralove | Maly J.,IV. Interni hematologicka klinika
Internal Medicine | Year: 2015

Venous thromboembolic disease which includes both venous thrombosis and pulmonary embolism, is a frequent and potentially fatal disease. Based on the introduction of low-molecular-weight heparins (LMWH) into practice it has been proved that outpatient treatment of venous thrombosis is effective and safe for a large number of patients with VTE. The growing volume of data on LMWH outpatient treatment in recent years shows that up to 50 % of patients with clinically stable pulmonary embolism can be treated at home. In spite of these facts home treatment of pulmonary embolism has not been established as part of common practice as yet. If we were to summarize the conditions for home treatment, we would consider outpatient care for patients at low risk based on auxiliary criteria, free from hemodynamic instability (primarily without a shock state), free from right ventricular failure, prior chronic heart or lung disease, serious comorbidities (gastrointestinal tract disease, kidney disease, blood diseases, advanced cancers), at low risk of early thromboembolism recurrence, free from other indications for hospitalization (pain requiring parenteral analgesics, infections etc.), at low risk of bleeding and with guaranteed patient‘s cooperation and well-organized home care. © 2015, Japanese Society of Internal Medicine. All rights reserved.

Gabalec F.,IV. Interni Hematologicka Klinika | Cap J.,IV. Interni Hematologicka Klinika
Vnitrni Lekarstvi | Year: 2015

Adrenal insufficiency is a potentially life threatening condition. The paper deals with differential diagnostics and limits of dynamic testing, possibilities of de-escalation of corticosteroid therapy and substitution therapy with glucocorticoids, mineralocorticoids and androgens. New replacement possibilities are mentioned including those in development.

Monoclonal gammopathy of undetermined significance (MGUS) is defined as a clinically silent symptomless condition where not met diagnostic criteria for multiple myeloma, Waldenstrom macroglobulinemia, AL-amyloidosis or other malignant lymphoproliferative disease. Long-term monitoring has shown that it is possible to premalignant progression to malignant monoclonal gammopathy in approximately 1% of cases a year, probably all cases of MM arise transformation from MGUS. Within an easy communication, the author tries to answer the question whether it is currently possible to somehow transform MGUS in MM to prevent or at least slow down. The response in MGUS patients is not for now. Given the much higher level of risk of transformation in patients with asymptomatic multiple myeloma than in MGUS patients, further analysis CMG (Czech myeloma group) is focused on this group of patients with the aim to identify the highest risk patients and then subject them to early and, if possible, non-toxic treatment.

Horacek J.,IV. Interni Hematologicka Klinika
Aktuality v Nefrologii | Year: 2012

Hypothyroidism is relatively common in patients with CKD. The risk is higher in women and positively associated with age and negatively with glomerular filtration rate; hyponatraemia may be a warning sign. Hypothyroidism is confirmed by higher serum thyrotropin (TSH) level and treated by usual levothyroxine replacement, aimed at TSH level normalization. An even more common finding in CKD patients is a decrease in serum levels of thyroxine (T4) and namely of triiodothyronine (T3). If TSH is not elevated then low T4 and/or low T3 are probably not due to hypothyroidism but rather due to non-thyroidal illness syndrome. This syndrome is associated with an increased risk of complications, including higher mortality; however, T4 and/or T3 replacement is not indicated.

Cap J.,IV. Interni Hematologicka Klinika
Interni Medicina pro Praxi | Year: 2015

Testosterone level in men declines with age and if symptomatic, testosterone substitution is indicated. Low testosterone level in aging male is associated with increased prevalence of cardiovascular risk factors (obesity, hyperlipidaemia, decreased insulin sensitivity, increased inflammatory markers) and in some studies also with increased total and cardiovascular mortality. In majority of interventional studies testosterone substitution improves these risk factors and in some the decrease of cardiovascular mortality was described. However, recent studies have raised concerns that testosterone therapy may increase cardiovascular risk. This review summarizes these data with conclusion that testosterone therapy can be safely considered in men with increased cardiovascular risk and practical recommendations are given.

Maisnar V.,IV. interni hematologicka klinika
Klinicka Biochemie a Metabolismus | Year: 2016

The new diagnostic criteria was published by the International myeloma working group at the end of 2014 already. Particularly changes in multiple myeloma (MM) and its "smoldering" form are so fundamental that we could not wait with their publication to the next release of overall recommendations. Therefore Czech Myeloma Group responded by issuing Supplement no. 2 of its guidelines. The aim of this article is to introduce the newly recommended criteria for the diagnosis of MM, including a comparison with the previous criteria.

Cap J.,IV. Interni Hematologicka Klinika | Gabalec F.,IV. Interni Hematologicka Klinika
Vnitrni Lekarstvi | Year: 2015

Incidentaloma is an adrenal mass discovered serendipitously. Because of increasing use of imaging techniques it is a common finding, being present in more than 1 % of adults. During work-up malignancy has to be ruled out. Classically imaging using CT or MRI is used. Recently PET-CT with FDG has been used more often as its sensitivity for diagnosis of malignancy is about 97 % and specificity 91 %. Hormonal evaluation should diagnose subclinical hypercortisolism. (Dexamethasone Suppression Test is the method of choice). Aldosterone and Renin should be measured only in patients with hypertension and catecholamines in tumours with higher native density than 10 HU. During follow-up repeated CT scan are needed only in selected patients and the need of routine biochemical follow-up has been questioned as well.

Thromboembolic disease (TED) is a considerable social and health problem. The solution evidently consists in the prevention of TED in clinical fields, not in the treatment itself. We can assume that effective prevention consequently reduces the cost of the following treatment. A lethal pulmonary embolism (PE) can be the first and the final clinical manifestation in patients with an asymptomatic deep venous thrombosis. This makes the systematic prevention of venous thromboembolism in higher risk patients necessary. Unfortunately, pharmacological prevention has been used less than would be needed. Inseparable from the TED prevention are physical methods. Pharmacological possibilities of the thromboembolic disease prevention were significantly extended within the past decade. To ensure the TED prevention after the total replacement (TEP) of hip and knee joints the following rules need to be observed: the TED prevention should be effected with LMWH, fondaparinux, dabigatran, rivaroxaban or apixaban for a period of 28-35 days after the hip joint replacement surgery and for 14 days after the knee joint replacement. The use of ASA, dextran and UFH as a thromboprophylaxis after the hip and knee joint TEP is not justified within the Czech Republic. Physical means (graduated compression stockings or IPC) can be used to support the recommended pharmacological treatment, they should not be used individually except in cases where pharmacological thromboprophylaxis is contraindicated.

Chronic lymphocytic leukemia is a disease of older patients, most of them suffering from significant comorbidities or functional limitations (so-called 'slow-go' patients). Unfortunately, clinical trials in chronic lymphocytic leukemia have until recently focused mainly on the subgroup of younger patients in good overall condition ('go-go' patients). Clinico-biological parameters, such as performance status, calculated creatinine clearance, the number and severity of comorbidities along with individual clinical assessment can help guide decisions relating to the objectives and ultimately the intensity of treatment. Two large randomized studies have recently demonstrated that the addition of monoclonal antibodies against CD20 (obinutuzumab, rituximab and ofatumumab) to chlorambucil in untreated 'slow-go' patients resulted in a significant increase in the number of complete remissions, progression-free survival and even overall survival (for obinutuzumab and rituximab) with an acceptable safety profile. Chemoimmunotherapy combining chlorambucil with anti-CD20 antibody is thus the new standard 1st line therapy in this group of patients. Treatment of relapsed/refractory chronic lymphocytic leukemia in 'slow-go' patients is very difficult and specific data is sparse. In this indication, we have witnessed an extraordinary breakthrough by means of small oral inhibitors interfering with B-cell receptor downstream signaling pathways: ibrutinib, the Bruton's tyrosine kinase inhibitor, and idelalisib, the inhibitor of phosphatidylinositol 3-kinase δ. Both drugs radically changed the approach to the treatment of relapsed/refractory chronic lymphocytic leukemia; relatively mild toxicity also predetermines their use in elderly/comorbid patients. Other treatment options for relapsed/refractory chronic lymphocytic leukemia in this subgroup include alemtuzumab, ofatumumab, high-dose glucocorticoids + antiCD20 antibodies, or bendamustine + rituximab regimen. This review summarizes current data regarding the treatment of elderly and comorbid patients with chronic lymphocytic leukemia.

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