Celiac disease (Celiacal sprue = gluten-sensitive enteropathy = netropic sprue) is the all-life genetically determined autoimmune disease with permanent intolerance to gluten, which damages the intestinal mucous membrane and alterates the immune system. The atrophy and typical inflammatory changes of mucous membrane results in malabsorption with diarrhea, general weakness, anemia and weight loss. The clinical picture of celiac disease is considerably heterologous. Only 20-30% of patients suffer from active-classical form of the disease. Non-diagnosed, inactive forms of the disease form 70-80% of cases of celiac disease in adult individuals. The therapy is based on diet without gluten. Application of the diet usually results in clinical improvement and signs of the disease are diminished. The relapse of celiac disease occurs after a gluten load. Celiac disease and dermatitis Duhring are considered to be two equal forms how gluten enteropathy becomes manifest. Celiac disease is often associated with other autoimmune diseases (e.g. insulin-dependent diabetes mellitus, autoimmune thyreoiditis). Untreated celiac disease still represents a serious medical risk, since it is an important precancerosis. Introduction of highly sensitive methods for the determination of antibodies against endomysium and tissue transglutaminase significantly extended possibilities of diagnosis and screening for celiac disease. It became obvious that the real incidence of celiac disease including the non-diagnosed forms of the disease in the European population is greater than 1:200 to 1:250.
- MeSH
- celiakie * komplikace diagnóza patofyziologie terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
The author presents a list of preparations used to influence portal hypertension resulting from cirrhosis of the liver, in particular in treatment or prevention of haemorrhage from oesophageal varices or gastropathy. The author describes the mechanism of action of drugs administered in acute haemorrhage (vasopressin, terlipressin, somatostatin, octreotide)) and preparations used in primary or secondary prevention of this haemorrhage (beta-blockers, nitrates, newly tested preparations or combinations). In the conclusion are recommendations for practical procedures according to principles of evidence-based medicine.
- MeSH
- lidé MeSH
- portální hypertenze komplikace farmakoterapie etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Acute haemorrhage from the upper gastrointestinal tract is a frequent and serious complication which affects 20-60% patients with cirrhosis of the liver and portal hypertension. It is assumed that bacterial infections can be the direct cause of haemorrhage but accurate data on the influence of infection on the development and course of haemorrhage are lacking. Acute haemorrhage as a result of portal hypertension has a very high mortality, 30-50%, and an early relapse of haemorrhage occurs in as many as 40% of these patients. Most recent meta-analyses indicate that bacterial infection is an independent prognostic factor in failure of haemostasis and has a significant impact on the mortality of these patients. The authors examined for the presence of bacterial infection (blood, urine, throat, ascites) 25 patients with cirrhosis of the liver and acute haemorrhage as a result of portal hypertension and compared the results with a group of 25 patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. According to the results in patients with acute haemorrhage due to portal hypertension there is a significantly higher incidence of bacterial infections than in patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. The results confirm the necessity to administer antibiotic prophylaxis to cirrhotic patients with varicose bleeding, not only to patients with symptoms and evidence of infection but also in their absence. Antibiotic prophylaxis extends the survival period of these patients.
- MeSH
- akutní nemoc MeSH
- bakteriální infekce komplikace MeSH
- dospělí MeSH
- gastrointestinální krvácení etiologie mikrobiologie MeSH
- jaterní cirhóza mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- portální hypertenze komplikace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
The author mentions the basic metabolic functions of zinc and copper in the human organism. She emphasizes the relationship of serious diseases, congenital and acquired, associated with deficiency or excess of these mineral trace elements. As to inborn diseases, we encounter most frequently Wilson's disease in impaired copper metabolism, rarely morbus Danbolt in congenital impairment of zinc absorption. In practice we are faced in particular with secondary causes of impaired zinc or copper levels, e.g. in chronic diarrhoeal conditions, coeliac disease, chronic pancreatitis and others.
- MeSH
- gastrointestinální nemoci etiologie metabolismus MeSH
- lidé MeSH
- měď nedostatek metabolismus MeSH
- vrozené poruchy metabolismu kovů komplikace MeSH
- zinek nedostatek metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- měď MeSH
- zinek MeSH
The microflora of the digestive tract is a complex microbial ecosystem, well balanced, which in an aboral direction undergoes specific changes as to the ratio of aerobic and anaerobic microorganisms the functions of which supplement each other--the aerobes ensure for the whole ecosystem the scavenger effect. The microbial profile of the digestive tract is typical by the absence of anaerobic microorganisms in the stomach and conversely their absolute predominance in the distal colon. The basic physiological functions of the microflora of the digestive tract can be characterized as follows: 1. microbial barrier against pathogens and potential pathogens, 2. formation of products of the microflora and their influence on the blood supply of the intestinal mucosa and peristaltics, 3. stimulation of the immune system in the gut, 4. reduction of bacterial translocation, 5. production of vitamins. To this problem in the world literature, contrary to ours, deserved attention has been paid for many years. Knowledge of the problem opens the door to expedient manipulation with the microbial flora of the digestive tract by the use of diet or prebiotics, probiotics as well as antibiotic treatment. The author presents a summary of basic findings which developed on the subject of physiological microflora of the digestive tract successively up to their present shape.
OBJECTIVE: It is known that total parenteral nutrition (TPN) causes liver damage by various mechanisms and leads to an increase of transaminases and obstructional enzymes. From this aspect TPN can be considered an external factor which causes liver damage. In our investigation we wanted to find out whether parenteral administration of essential phospholipids (EPL) can have a protective effect on this damage. PATIENTS AND METHODS: Our investigation comprised 20 patients where TPN was indicated, usually on account of severe acute exacerbation of a non-specific inflammation of the gut. The patients were divided into two groups. Ten patients were treated by intravenous administration of essential phospholipids (Essentiale, Aventis), 50 mg every 6 hours for a period of two weeks. The control group comprised ten patients without hepatoprotection. The bilirubin, ALT, AST, GMT, ALP values were assessed before the initiation of the study, on the seventh and fourteenth day. The results were statistically processed by the paired and non-paired t-test. RESULTS: The baseline results of the mentioned tests did not differ significantly between groups. Bilirubin and AST did not change significantly during the investigation. In the control group we found, as compared with baseline values, a significantly increase of ALT on the seventh and fourteenth day, a significantly increase of GMT on the seventh and fourteenth day and a slight non-significant rise of ALP on the fourteenth day. In the ELP treated group, as compared with baseline values, a significant rise of ALT occurred on the fourteenth day. We did not observe a significant rise of GMT and ALP. Between the ELP treated and control group a significant increase of GMT and ALP occurred in the control group, the other values did not differ between groups. CONCLUSION: Parenteral EPL administration can have a favourable effect on liver damage caused by TPN, associated with cholestasis and biliary sludge. This conclusion can be hypothetically explained by improved bile fluidity and protection of the bile pole of the hepatocyte by essential phospholipids. Therefore their administration during TPN can be recommended.
- MeSH
- dospělí MeSH
- fosfatidylcholiny terapeutické užití MeSH
- lidé MeSH
- nemoci jater diagnóza etiologie prevence a kontrola MeSH
- ochranné látky terapeutické užití MeSH
- parenterální výživa úplná škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
- klinické zkoušky MeSH
- Názvy látek
- essential 303 forte MeSH Prohlížeč
- fosfatidylcholiny MeSH
- ochranné látky MeSH
Gastrooesophageal reflux (GER) and asthma bronchiale are frequent diseases. Asthma affects some 3-10% of adults. Gastrooesophageal reflux is present in some 45-89% asthmatic patients. Symptoms of GER are not only gastrooesophageal, and recently increased attention is focused on extraoesophageal symptoms where in particular the relationship of GER and asthma or chronic cough is investigated. At our clinic we implemented a pilot study with the objective to monitor the presence of pathological GER in patients with asthma and to assess whether antireflux therapy will influence the respiratory complaints of the patients. The group was formed by 14 patients selected at random with different severity of asthma and different symptoms of GER. The patients had a baseline examination evaluating the presence of GER (24-hour pH metry) and pulmonary function (FEV1). In case of a pathological GER the patients were treated by antireflux therapy and then check-up examinations were made. It was found that after treatment of GER in patients with asthma in particular subjective symptoms improved such as cough and pyrosis which leads to a substantial improvement of the quality of life. On the other hand reflux treatment did not exert a basic effect on pulmonary functions and it was not possible to reduce the medication of asthma.
- MeSH
- bronchiální astma komplikace patofyziologie MeSH
- dospělí MeSH
- gastroezofageální reflux komplikace diagnóza farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The authors present the case of a 78-year-old female patient who was admitted on account of acute pancreatitis complicated by acute myocardial infarction. The authors detected in the patient a serum repeatedly high calcium levels and high levels of intact parathormone. Scintigraphic examination revealed marked foci in the middle of the neck at the level of the inferior pole of the thyroid gland. These examinations confirmed the diagnosis of primary hyperparathyroidism. In view of the patient a serious condition, conservative treatment of hypercalcaemia and acute pancreatitis and myocardial infarction was started. The patient was released into domiciliary care after 40 days in hospital in a state of cardiopulmonary compensation, with cystic transformation of the pancreas and without signs of acute pancreatitis.
- MeSH
- akutní nemoc MeSH
- hyperparatyreóza komplikace diagnóza MeSH
- infarkt myokardu komplikace MeSH
- lidé MeSH
- pankreatitida komplikace MeSH
- parathormon krev MeSH
- senioři MeSH
- vápník krev MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- parathormon MeSH
- vápník MeSH
The author summarizes in the submitted review diagnostic possibilities of early stages of chronic pancreatitis. He evaluates from that aspect possibilities of common imaging methods (ultrasonography, computer tomography, endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography (EUS). Evaluation of the secretory exocrine capacity by means of the secretin-cerulein test. Although the method is demanding from the aspect of routine diagnosis, it is a method with comparable sensitivity and perhaps even greater specificity than ERCP. Other tests of exocrine pancreatic secretion are not sufficiently sensitive to be used for this diagnosis. Among imaging methods ERCP which is still considered the gold standard, evaluates even subtle changes in the efferent system. Endoscopic ultrasonography visualizes rather discrete changes of the parenchymatous structure, areas of fibrosis and oedema, or changes in the echogenicity of the duct wall. At present in the diagnosis of early stages of chronic pancreatitis most probably a combination of the method evaluating the exocrine secretory capacity of the pancreas and sensitive imaging methods (ERCP) will be most satisfactory. Further studies will show whether and when EUS could replace ERCP.
- MeSH
- chronická nemoc MeSH
- endosonografie * MeSH
- lidé MeSH
- pankreatitida diagnostické zobrazování MeSH
- radiografie MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
