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I Duris

Publications and source records attributed to I Duris.

At least 19 recordsLinked to original sources
PubMed2000

The concept of general internal medicine of the Slovak Society of Internal Medicine.

The data demonstrated a trend toward increasing subspecialisation and away from generalism. The European Federation of Internal Medicine and American Society of Internal Medicine warn that such development could be disadvantageous for patients and society. Changes in age distribution of the population, polymorbid patients, limited financial sources, drug interactions, multisystemic disorders, urgent medicine and indication of surgical intervention are main reasons for the need to preserve General Internal Medicine. The ideas presented in this paper are trying to solve the problem.

Journal Article↗
PubMed2000

[Professionalism of teachers of theoretical and clinical disciplines in medical schools].

Authors submit their view on the possibility of performing a serious evaluation of professionalism of teachers of theoretical and clinical subjects, particularly at school of medicine. The authors compare their ideas with those of A.C. Orstein and D.U. Levine (1989). In conclusion they point out the extraordinary position of university teachers so-called clinicians in the system of pregradual and post-gradual education, and their evaluation. (Fig. 1, Ref. 15.)

Faculty, Medical↗
PubMed2000

[Effect of pancreatic substitutes on fecal and serum elastase and on pain in patients with chronic pancreatitis].

Views on the existence of a negative feedback between pancreatic secretion and intraduodenal of proteases in humans are controversial. The objective of the study was to find out whether enzyme substitution will have an impact on pancreatic enzyme secretion and pain in chronic pancreatitis. The preparation Panzytrate 2500 (2 x 3 capsules/day containing 1250 units of proteases per capsule) was administered for a 4-week period. In 18 patients with chronic pancreatitis (7 with the severe and 11 with the medium severe and mild form of pancreatitis) the faecal and serum pancreatic elastase was assessed one day before and one day after enzyme substitution therapy. A significant reduction of the faecal elastase concentration (p = 0.03) and serum elastase (p = 0.00375) was recorded in patients with mild and medium severe CP. The values of faecal and serum pancreatic elastase 1 were insignificantly reduced also in patients with severe chronic pancreatitis. Pain relief was statistically significant already after two weeks' administration of enzyme substitution therapy (p = 0.0233) and after four weeks' treatment (p = 0.00766). The results support the importance of the negative feedback on regulation of pancreatic secretion and the positive effect of substitution therapy on pain in chronic pancreatitis.

Adult↗
PubMed1998

Etiology and risk factors of 180 cases of native valve endocarditis. Report from a 5-year national prospective survey in Slovak Republic.

Risk factors, etiology, and outcome of 180 cases of infective endocarditis (IE) in the Slovak Republic for 5 years were prospectively studied in a national survey. According to the Duke Endocarditis Service Criteria (1994), 169 cases were considered definitive and 21 possible/probable. The aortic valve was infected in 46.7%, mitral in 47.2%, and tricuspidal/pulmonary in 6.1% of cases. The majority of endocarditis cases was caused by Staphylococcus aureus and coagulase-negative staphylococci (CNS) (33.3%); only 12.2% were due to viridans streptococci; 11.7% were due to Enterococcus faecalis; 6.1% due to Haemophilus spp.; 10.1% due to other organisms; and 26.7% were culture negative. Single positive cultures of CNS were not considered clinically significant. More than 25% of 180 patients were older than 60 years. Rheumatic fever was a risk factor in 35.5%, dental surgery in 20.5%, prior cardiosurgery in 7.8%, and neoplasia in 6.7%. All patients were treated with antimicrobials (average length of therapy was 29.5 days) and 33.3% of patients also had surgery (valvular prosthesis replacement). Forty (22.2%) died, and 140 (77.8%) survived at day 60 after the diagnosis of endocarditis was made. All 40 deaths were attributable to infection. Univariate analysis comparing deaths and survivors did not show significant differences in most of the recorded risk factors between both groups, except age > 60 (40.0% versus 21.4%, p < 0.05), staphylococcal etiology (55.0% versus 27.1%, p < 0.04), and antibiotic therapy < 21 days (without surgery) (65.0% versus 3.6%, p < 0.01). These risk factors were significantly more frequently associated with deaths. Viridans streptococcal IE and surgical therapy in addition to antibiotics were associated with lower mortality in comparison to staphylococcal endocarditis (p < 0.045) or to cases treated with antibiotics only (p < 0.05). In comparison to other nationally based surveys in Europe (Greece, Croatia, France), the percentage of culture-negative endocarditis and spectrum of pathogens differed significantly.

Adult↗
PubMed1998

Native valve staphylococcal endocarditis: etiology, risk factors and outcome in 53 cases.

Fifty-three cases of staphylococcal endocarditis from a national endocarditis survey were analyzed for risk factors and outcome. Thirty of 53 patients had predisposing heart disease (39.6% rheumatic fever) but only 3 were on dialysis, only 2 had central venous catheter, only 2 intravenous drug abuse but 7 had prior cardiosurgery. Mortality was 39.6%. In analyzing risk factors for death, attributable mortality was significantly associated with skin infections (P < 0.05), embolization (P < 0.02), inappropriate therapy (P < 0.005) either because of too short therapy (P < 0.003) or wrong antibiotic combination (P < 0.01). Surgical therapy was associated with better outcome (4.8% deaths vs. 31.2% survivors, P < 0.04).

Adult↗
PubMed1998

[Bone changes in gastrointestinal diseases].

BACKGROUND: Gastrointestinal (GIT) diseases are a common cause of metabolic bone changes. The aim of the study was to indicate GIT diseases (lactose intolerance, non-lactose intolerance, Crohn's disease, ulcerative colitis, pancreatic insufficiency, states after gastric resection, chronic diseases of the liver, and coeliac disease) by means of literature data and the authors' own results coinciding with the detected low bone density and thus increased risk of fracture. Bone changes coinciding with GIT diseases are frequent and are commonly asymptomatic for a long period. CONCLUSION: In coincidence with GIT diseases the authors indicate the necessity of being aware of the risk of bone changes development and to investigate them actively. An early diagnosis aids to introduce preventive and therapeutical measures and to halt or at least slow down the origin of bone changes. (Ref. 21.)

Bone Diseases, Metabolic↗
PubMed1998

[Etiology and pathogenesis of acute pancreatitis].

The theory of pancreatic gland autodigestion by pancreatic enzymes assumed by Chiari 1886 as the crucial moment in the pathogenesis of acute pancreatitis (AP) remains accepted so far. The appearance of mutations of cationic trypsinogen gene on the 7th chromosome in several families with hereditary AP, supports the significance of trypsin in the initiation of AP. The generally recognized etiologic factors of AP include the biliary tract disease and alcohol. Opie in his "Common Channel theory" assumed that the impacted gallstone in the ampulla of Vater could cause a permanent obstruction and subsequently AP. Later clinical studies have confirmed that a short-term block of the common pancreatic duct caused by migrating gallstones is associated with onset of AP. Chronic consumption of alcohol evokes subclinical pancreatic disturbances already prior to the onset of AP. PAP (pancreatic associated protein) being the marker of pancreatic inflammation was significantly increased in chronic alcoholism without signs of AP. Many pathophysiological concepts and effective therapeutic procedures which were successful in the animal studies have not turned out to be appropriate in man. The destruction of both cellular structure and cellular connections is an early event in the development of experimental AP. There is much evidence that free oxygen radicals and the disturbances of microcirculation determine the severeness of AP. The roles of NO (nitric oxide) and kinins remain to be clarified cytokins a interleukin 2 (IL2) and interleukin 10 (IL10) had a protective effect in experimental AP. In humans the antagonist of PAF (platelet activating factor) had reduced the occurrence of organ failure. There is hope, that this knowledge, will lead to new therapeutic possibilities.

Acute Disease↗
PubMed1998

[Therapy of acute pancreatitis].

The mortality rate in acute pancreatitis (AP) is significantly lower in patients hospitalized directly at the intensive care unit than in patients admitted to hospital in 2 weeks after the assessment of diagnosis, prophylactic administration of low-molecular protease inhibitor reduces the occurrence of post ERCP pancreatitis a well a coincident complications. Despite rational considerations concerning the significance of pryphylactic administration of antibodies (ATB) in severe AP, there still not enough convincing data which could be recommended a standard therapy. One of the concepts of causal therapy of AP. Suggest that inhibition of exocrine pancreatic enzymatic secretion reduces autodigestion of the gland (setting the gland at rest). The reports on success of secretin-inhibiting substances a glucagon, calcitonin, atropine and somatostatin require confirmation in randomized or accurately defined comparable groups. The initial studies on the therapeutic significance of lexipanphate-antagonist of platelet activating factor (PAF) in acute pancreatitis is promising. A long-term lavage had reduced the mortality.

Acute Disease↗
PubMed1998

[Acute intermittent porphyria].

Acute intermittent porphyria is an autosomal dominant condition caused by a genetic defect of the deaminase gene located on the 11. chromosome. Due to this defect only 50% of the normal enzyme quantity is produced. The disease becomes manifested only in the case of increased demands on given metabolic pathway resulting in porphobilinogen accumulation and storage in the organism. Clinical pattern involves abdominal, neurologic and psychiatric symptomatology. Laboratory diagnosis is based on the detection of delta-aminolevulinic acid, porphobilinogen, uroporphyrin and coproporphyrin in the urine. Between the attacks may only the detection of porphobilinogen deaminase in erythrocytes, leukocytes and skin fibroblasts be positive. The therapy is based on infusions of 20% glucose solution and hydromineral imbalance correction. When neurologic symptoms occur it is necessary to administer hem-arginate intravenously. The case report presents almost textbook case of a young female patient suffering from the disease. (Ref. 7.)

Adult↗
PubMed1997

[Bone changes in ulcerative colitis].

One of the complications of ulcerative colitis with frequent relapses is mineral deficiency (potassium, calcium, magnesium and phosphorus). The objective of the present work is to examine the bone density and laboratory parameters of bone metabolism in 25 patients with a medium severe and severe form of ulcerative colitis. In patients with ulcerative colitis a significantly reduced bone density was found in the era of neck of the femur (p < 0.05), a a non-significantly reduction of the bone density in the era of the lumbar vertebrae and an elevated level of osteocalcin (p < 0.05). These findings indicate a higher prevalence of bone changes in patients with ulcerative colitis. Early detection of bone changes makes adequate prevention and treatment of bone complications possible.

Adult↗
PubMed1997

[Endogenous levels of somatostatin, C-peptide and insulin in acute pancreatitis].

The authors compared in seven patients with acute pancreatitis the levels of endogenous somatostatin, insulin and C-peptide to assess their mutual correlation and relation to the development of the disease and serum amalyse levels. The results were compared with values recorded in 11 healthy volunteers. The levels of endogenous somatostatin were in patients with acute pancreatitis significantly higher (p < 0.05) than in the control group. The authors found an inverse relationship between the somatostatin and amylase level (correlation coefficient 0.75). They did not observe a significant correlation between somatostatin and insulin levels nor between somatostatin and C-peptide levels. The elevated somatostatin level may be due to the counteregulatory reaction during secretion, stimulated by endogenous or exogenous factors (cholecystokinin, alcohol, food).

Acute Disease↗
PubMed1996

[Triple combination antimicrobial therapy of Helicobacter pylori and basal levels of serum gastrin].

BACKGROUND: The etiopathogenic relationship of Helicobacter pylori (HP) infection to chronic active antrumgastritis and peptic ulcer disease has been confirmed by a number of studies. The key role in the development of peptic lesions belongs to hypergastrinemia. This is supposed to be related to ammonium synthesis in the antral area influenced (promoted by HP and resulting in interruption) weakening of the negative feedback mechanism maintaining intraluminal acidity. OBJECTIVES: In our present study we focus our attention to the effectiveness of triple antimicrobial therapy in HP positive patients with chronic active antrumgastritis residing in the lowering of the level of serum gastrin. METHODS: There was a group of 15 patients in our current study with HP positivity as well as chronic active antrumgastritis documented by endoscopy, histology, microbiology and serology respectively. Endoscopical and histological findings were classified according to "The Sydney System". The whole group was evaluated on an ambulatory basis, those with active ulcer, endocrinopathy and biliary tract disorders were excluded. The basal level of serum gastrin was evaluated by RIA-test-gastrin before and after successful antimicrobial therapy. RESULTS: In our group of 15 patients with HP infection in coexistence with chronic active antrumgastritis we have found a significant decrease in the basal level of serum gastrin (p = 0,01) after successful therapy. CONCLUSION: The decrease in the basal level of serum gastrin after eradication of HP confirms the importance of HP infection in the pathogenesis of peptic lesions in stomach and duodenum. We consider the antimicrobial therapy in chronic active antrumgastritis in HP positive patients to be a fully indicated therapeutic approach. (Tab. 1, Fig. 1, Ref. 10.).

Adult↗
PubMed1996

[Lactilol (Importal, 10g in powder made by ZYMA) in the treatment of portal systemic encephalopathy].

In a group of 15 patients with portal systemic encephalopathy (PSE) associated with cirrhosis of the liver with portal hypertension and spontaneous systemic shunt of the portal circulation the authors administered Lactitol (Importal, powder à 10 g Zyma), in amounts up to 40 g/day for a period of 56 days. In the course of treatment every patient was repeatedly examined before the onset of treatment and three times during treatment. The grade of PSE was assessed on the basis of the score of the neuropsychiatric examination from which the PSE index was worked out. In the investigated group of patients with PSE the authors found a significant improvement of the PSE index during treatment with Importal Zyma. The mental condition of the patients improved, the NCT period was reduced, asterixis receded, on the EEG the delta and theta activity receded and normal alpha activity developed. The serum ammonia levels declined but did not reach statistical significance. During treatment the authors did not record changes of normal values of glucose, sodium and potassium in serum and did not detect any adverse side effects. Based on the assembled results the authors conclude that lactitol treatment extends possibilities of PSE treatment.

Adult↗
PubMed1996

[Intracavitary thrombosis--unusual complications in ulcerative colitis].

The statement of echocardiographic differential diagnosis of intracavitary masses is not simple even for an experienced echocardiographist. It is mainly caused by the resemblance in echo-densities of thrombi and myxoma. Atypical localization of masses makes the differential diagnosis even more difficult. Authors report a case of a 30 year-old man with the history of ulcerative colitis, in whom sepsis occurred as a complication of an inflammatory bowel disease. They report the diagnosis of thrombus in the right atrium, probably of infectious genesis, formed on the endocardium which had been damaged by a catheter tip and potentiated by activated coagulatory system. In the documented period, histological examinations of colonoscopic and peroperative biopsies were performed repetitively. Neither these examinations answered the question of differential diagnosis between ulcerative colitis and Crohn's disease. The authors report an echocardiographic diagnosis and they follow-up the genesis and subsequent disappearance of the pathological mass in the right atrium which was finally diagnosed as a thrombus. The final diagnosis was based on the clinical follow-up and disappearance of the mass. (Fig. 3, Ref. 7.).

Adult↗
PubMed1996

[Risk factors in stomach diseases].

The opinions on precanceroses of the stomach have lately changed essentially. The problem does not involve only terminology and morphology, but also the functional aspect of this group of diseases which is still not entirely defined. Regarding the difficulties in following the process of changing of dysplasias into carcinomas of the stomach, the human pathology chooses the term risk diseases. (Ref. 78).

Humans↗
PubMed1996

[Therapy of metastasizing carcinoid tumor].

Carcinoids are tumors producing excessive amounts of serotonin. The authors briefly characterize the possibilities of diagnosis. The case of a 43-year-old patient with a multifold carcinoid of the ileum with metastases in the liver is used for the description of the therapy strategy. They summarize the current opinions on the therapy of this disease. (Tab, 1, Fig. 4, Ref. 14.)

Adult↗
PubMed1995

[Serum gastrin and somatostatin in diseases of the stomach].

Gastrin and somatostatin are enterohormones which influence several physiological processes in the gastrointestinal tract. Gastrin has a pro-malignant and pro-ulcerogenic effect, while somatostatin deficiency has a similar effect. The authors examined in their investigation the 24-hour secretion of both hormones in patients with gastric ulcer and atypical gastric conditions. They revealed a significant difference in the 24-hour somatostatin level which was higher in patients with atypical gastric conditions (p < 0.05). The finding may suggest a more intense reaction of somatostatin to malignant than to non-malignant disease. In the other compared parameters no statistically significant difference was revealed.

Adult↗