Search

The 6-thioguanine nucleotide (6-TGN) level, may be used to estimate dose-adequacy of azathioprine (AZA) therapy. 6-TGN test is not commercially available. The aim of the study was to determine whether a blood cell changes correlate also with the dose of AZA and may serve as a predictor of the dose adequacy (for MCVgt; 6 fl).Retrospective, multicentre study in subjects with IBD treated with azathioprine. Demographic data, leukocyte, platelet counts, erythrocyte (MCV) and thrombocyte (MPV) volume, azathioprine dose, inflammatory activity in the 3rd, 6th and 12th months of treatment and presence of sideropenia were recorded.103 subjects analysed. To increase the MCV by 6 fl, the AZA dose above 2 mg/kg is needed (p = 0.04). The MCV increases within 165 days (95% CI, 154-181 days, p = 0.002). Sideropenia has no impact on the MCV change. Number of leukocytes and thrombocytes decreases during treatment (plt; 0.001). Change in their number as well as MPV, does not correlate with MCV change and is not affected by activity of the inflammation.The MCV dynamics (gt; 6 fl within 6 months) is the only relevant indicator during AZA treatment. Changes in the number of leukocytes, platelets and their volume can not be used to assess the sufficiency of the AZA dose. Sideropenia has no impact on the dynamics of MCV.

A thymoma belongs to rather rare tumors, although it holds the first place among primary mediastinal tumors in adults. The biological characteristics of thymomas are considerably divergent. The tumors are usually asymptomatic at the begining, later due to a local spread, symptoms from the infiltration or compression of adjacent structures arise, they metastasize rarely. Thymomas are often associated with various autoimmune or endocrinologic diseases. The authors present case of the patient with less common paraneoplasia - autoimmune hemolytic anemia (AIHA). Main strategy of treatment thymom with AIHA isn´t clear. The most important seems to be the early started corticotherapy. Achieving remission of secondary AIHA has importace in following therapy of thymoma - surgical resection or chemotherapy. Thymectomy has positive effect on the course of associated paraneoplastic syndromes and prognosis in general.

Introduction Vitamin D (vitD) is a substance with an immunomodulatory effect. Its insufficiency has negative impact also on inflammatory bowel disease (IBD) where it is often present. The recommended daily intake for general population is 600 UI/day (units/day). What is the necessary dose for IBD patients remains unknown. The aim of the study was to verify whether the 2,000 IU/day of vitD is sufficient for maintaining sustained levels in these patients. Methods Patients with Crohns disease (CD) or ulcerative colitis (UC) were supplemented orally with 2,000 IU of cholecalciferol daily during winter time. The level of 25-hydroxyvitamin D (25OHD) was established at the beginning of substitution period (October to December) and in Month 4. Demographic data, Ca, P, parathormone levels, dose of vitD used, and patients compliance were observed. Results 108 patients with CD and UC (71/37) were analysed, out of them 51 females, average age 43.3 ± 16.2 years. The level of 25OHD increased from 60.2 ± 26.5 nmol/l to 68.1 ± 27.1 nmol/l (p l 0.001) during the period with the average substitution dose of vitD 1 858 ± 464 IU/day. 60.2 % of subjects complied with the recommended dosing of vitD. The dose of 1,820 IU vitD/day showed to be sufficient for maintaining sustained levels in the model. No changes of Ca, P serum levels occurred during observation period. Conclusions Substitution doses of vitD recommended for general population are insufficient for IBD patients. A dose of up to 2,000/day, which is safe, is necessary to maintain normal levels of 25OHD. Noncompliance with the use of vitD is high.

Resekce žaludku podle Billrotha I (B I) se provadi velice zřidka. Cilem teto retrospektivni studie je zhodnotit nase zkusenosti s diagnostickou a terapeutickou endoskopickou retrogradni cholangiopankreatikografii (ERCP) u pacientů po resekci žaludku podle Billrotha I. U pacientů se stavem po resekci žaludku podle B I trvalo studium souboru 20 let (listopad roku 1994 - prosinec roku 2014). V praci byli retrospektivně hodnoceni 3 pacienti po resekci žaludku podle B I, kteři měli projevy biliarni obstrukce. K provedeni ERCP byl ve vsech připadech použit standardni (tedy jako za normalni anatomicke situace) terapeutický videolateroskop Olympus. Kanylacniho uspěchu při diagnosticke ERCP bylo dosaženo u 3 pacientů ze 3 - tedy jednalo se o 100% uspěsnost diagnosticke ERC. U vsech těchto 3 pacientů byla při ERCP nalezena CDL. Dale pak u vsech těchto 3 pacientů s patologickým nalezem CDL na ERCP byla bezprostředně po diagnosticke ERCP realizovana endoskopicka lecba, jejimž uvodnim krokem byla vždy standardnim způsobem (tedy jako u normalni anatomie) provedena suficientni endoskopicka papilotomie (EPT). Nasledně byla provedena endoskopicka extrakce veskere CDL z hepatocholedochu do duodena. Celkem byla tedy terapeuticka ERCP kompletně uspěsna u vsech 3 pacientů ze 3 (100 % ze 3), u kterých byla původně endoskopicka lecba zahajena. V nasem souboru 3 pacientů se nevyskytly žadne komplikace. Při ERCP u pacientů po resekci žaludku podle B I jsme měli u vsech těchto nasich nemocných (3 pacienti s CDL) 100% uspěsnost diagnosticke i terapeuticke ERCP.

Cast pacientů vyžaduje před koloskopii specifický přistup. Důvodem je mala ucinnost připravy nebo přidružene komorbidity,předevsim kardialni a renalni. U pacientů s předpokladaným horsim vycistěnim střeva je zvlastě nezbytne dodržet bezezbytkovoudietu a roztok vypit v dělenem režimu. Připadně můžeme připravu dalsi den opakovat a doplnit laxativum. Perspektivni alternativoujsou peroralni sirany. Při renalni insuficienci je bezpecný polyetylenglykol. Pro starsi nemocne jsou vhodnou alternativounizkoobjemove roztoky.

Background: Portal vein thrombosis (PVT) is a partial or complete thrombotic occlusion of the portal vein and is rare in noncirrhotic patients.Patients and methods: 78 adult patients with n...

Vitamin D (vitD) is a substance with an immunomodulatory effect. Its insufficiency has negative impact also on inflammatory bowel disease (IBD) where it is often present. The recommended daily intake for general population is 600 UI/day (units/day). What is the necessary dose for IBD patients remains unknown. The aim of the study was to verify whether the 2,000 IU/day of vitD is sufficient for maintaining sustained levels in these patients.Patients with Crohns disease (CD) or ulcerative colitis (UC) were supplemented orally with 2,000 IU of cholecalciferol daily during winter time. The level of 25-hydroxyvitamin D (25OHD) was established at the beginning of substitution period (October to December) and in Month 4. Demographic data, Ca, P, parathormone levels, dose of vitD used, and patients compliance were observed.108 patients with CD and UC (71/37) were analysed, out of them 51 females, average age 43.3 ± 16.2 years. The level of 25OHD increased from 60.2 ± 26.5 nmol/l to 68.1 ± 27.1 nmol/l (plt; 0.001) during the period with the average substitution dose of vitD 1#8239;858 ± 464 IU/day. 60.2 % of subjects complied with the recommended dosing of vitD. The dose of 1,820 IU vitD/day showed to be sufficient for maintaining sustained levels in the model. No changes of Ca, P serum levels occurred during observation period.Substitution doses of vitD recommended for general population are insufficient for IBD patients. A dose of up to 2,000/day, which is safe, is necessary to maintain normal levels of 25OHD. Noncompliance with the use of vitD is high.

Compliance to therapy is a key factor in the efficacy of treatment in clinical practice. The aim of our study was to evaluate the rate of compliance with mesalazine in patients with ulcerative colitis (UC), to examine risk factors of noncompliance and especially find ways on how adherence can be improved.A total of 198 outpatients with UC completed two anonymous questionnaires including information on basic demographics, details of patient´s disease and the use of mesalazine medication and quality of life.We found noncompliance (percentage of used medication per day less than 80%) with 5-ASA in 21.2% patients. Our study proved that the education level of patients significantly influenced the compliance of patients using mesalazine. A significant difference (p = .014) was found between the compliance of patients with secondary school education (84.1 ± 16.73) and those with university education (94.1 ± 9.9). The majority of patients preferred mesalazine once daily and are less likely to forget to take medication in the morning. Better quality of life was observed based on our data from WHOQOL-BREF questionnaire in statistically significant way in patients using concomitant therapy of immuosuppressive or biological therapy, lower daily doses and using sachets not tablets.Our study proved that compliance with mesalazine in patients with UC was related only to education level. If we target mesalazine therapy based on patient's preferences, we can improve the adherence with mesalazine. Our data could be beneficial for the treatment strategy in clinical practice.

Receptors for vitamin D are present almost in all body tissues. Vitamin D does not only act as a regulator of calcium and phosphorus metabolism, but also a substance which modulates the immunity system function, regulates cell proliferation. Genetic, epidemiological and experimental data indicate a possible role of vitamin D deficiency in the development of some diseases, mainly of autoimmune diseases and tumours. The benefit of curative intake of vitamin D has so far not been proven. There is no reason why the deficiency of vitamin D should not be covered. The substitution should start with the replenishment of the lacking amount of vitamin D (which may even be several hundred thousand units) and involve ongoing intake of the recommended substitution dose of 800-1000 vitamin D units per day.