[Treatment of Crohn's disease]. / Lécba Crohnovy choroby.

Dietetic treatment of Crohn's disease has the objective to calm down the gut either by a polymeric or elemental diet. In superacute conditions also total parenteral nutrition can be used. In the quiescent stage the patient must have an adequate energy intake and a low-residue (low-fibre) diet. As to medication, sulfasalazine which has some side-effects is abandoned and 5-ASA (5-aminosalicylic acid) preparations are used, either by the oral route or in enemas, while 4-ASA is little used in this country and is known as PAS. The administration of corticoids which also have side-effects will be abandoned in favour of so-called rapidly metabolized corticoids (Tixocortol pivalate, beclomethasone, budenoside and fluticasone) by the oral route and in enemas and foams. As antimicrobial treatment ciprofloxacine is used combined with metronidazole. As to immunosuppressive drugs azathioprine, 6-mercaptopurine, cyclosporin A, cyclophosphamide and methotrexate are tested. A hope for the future is so-called biological treatment (anticytokines, monoclonal antibodies against cytokines, against CD4+ TNF, interleukines IL-10 and 11, immunoglobulin; plasmapheresis is also tested). Treatment must be individual and surgery as late as possible, only in case of complications, and should be very sparing, stenoses should be treated by plastic operations of strictures.

[Current views on the development and course of Crohn's disease]. / Soucasné názory na vznik a prubeh Crohnovy choroby.

Among etiological factors suspected of causing Crohn's disease a number of bacteria was listed (Yersinia, Mycobacterium kansasi, Mycobacterium pseudotuberculosis) as well as viruses (measles). None of them however can be considered as the only agent. As to external influences, we know the adverse effect of smoking, the toxic effect Al and oral contraceptives. The listed causes may enhance the development of mesenteric thromboses or immunocomplex vasculitis with ischaemization of a certain portion of the small or large intestine with subsequent inflammation. So far we do not know what starts the immunological reaction, but subsequently the process takes place via cytokines, prostaglandin PGE2, leukotriene LTB4 and liberation of free oxygen radicals (this knowledge is applied in therapy). The authors discuss the problem whether Crohn's disease is one clinical entity with a different course or whether a single diagnosis comprises two or more pathological units.

[Bone demineralization in Crohn's disease, its diagnosis, therapy and prevention]. / Demineralizace kostí u m. Crohn, její diagnostika, lécba a prevence.

In 20-60% of patients with Crohn's disease bone demineralization is found, usually osteoporosis, but also osteoporosis with malatic features. The cause is the reduced calcium intake (loss of appetite, lactose intolerance and malabsorption), reduced vitamin D intake and corticoid therapy. Nowadays the diagnosis is facilitated by the use of densitometers (ultrasonic and DEXA) and markers of osteoresorption and new bone formation. In treatment in addition to calcium and vitamin D used for a long time, fluorides are administered (only as monofluorophosphate), nasal thyrocalcitonin and bisphosphonates of the third series (alendronate). In postmenopausal women also hormonal treatment can be used unless contraindicated. However, burdening of the bones with regular exercise is a necessity. For prevention adequate calcium and vitamin D intake is important, non-smoking, and exercise.

[Changes in cellular immunity after administration of nucleotides]. / Zmeny celulární imunity po podání nukleotidu.

BACKGROUND: Nucleotide deficiency in the diet of experimental animals reduces cellular immunity, and conversely it is assumed that an increased intake could improve the immunity also in humans. METHODS AND RESULTS: The authors administered to 12 women with malignant tumours the dietetic preparation Preventan containing nucleotides, 1 x 1 mg/day, and followed up for four weeks some immunological parameters. There was a considerable decline of CRP and conversely an increase in the number of T-lymphocytes (CD3+), T-lymphocyte helpers (CD4+) and suppressor/cytotoxic T-lymphocytes (CD8+), almost to double values. There was also an increase of the cytotoxic activation and activated T-lymphocytes. As to parameters of humoral immunity, except for a small rise of IgG, no major changes were recorded and the number of B-lymphocytes did not change (CD19). CONCLUSIONS: Supplementation with a dietetic preparation containing nucleotides increases the number of T-lymphocytes, their sub-populations and their activation, and thus has a favourable impact on cell-mediated immunity as apparent from the marked decline of CRP.

[Renaissance of fluorides and calcium in the treatment of osteoporosis]. / Renesance fluoridu a vápníku v lécbe osteoporózy.

After the initial enthusiasm for fluorides in the treatment of osteoporosis there was a regression after some time and a "campaign" against fluorides. Recently in particular after the introduction of monofluorophosphate instead of NaF there is a revival of the use of fluorides in the treatment of osteoporosis, along with Ca, vitamin D and exercise as the classical combination of four. This can be supplemented by HRT in women, thyrocalcitonin, alendronate and other drugs with individual consideration of the optimal combination of these drugs. Also in future fluorides remain the foremost representative of the group of agents stimulating new formation of bone.

[Steroid osteoporosis]. / Steroidní osteoporóza.

The author demonstrates on a group of 292 patients (207 women, 85 men) treated on account of various diseases with corticoids laboratory parameters and bone density and records of bone fractures. The bone metabolism is negatively influenced by the action of corticoids on the vitamin D transformation into its active metabolites; as a result of reduced calcium absorption from the gut the reduced calcium level in blood causes secondary hyperparathyroidism and osteoclastic bone resorption is enhanced. On the other hand, corticoids inhibit new formation of bone by suppressing the proliferation of osteoblasts and by interfering with osteoid formation. One quarter of the patients suffers moreover from osteoporomalacia. Two and a half times as many women have steroid osteoporosis, and bone demineralization is enhanced also by other factors caused by the basic disease (immobilization, hypercalciuria, lactose intolerance). By comprehensive treatment using a combination of Ca + F, vitamin D, exercise, thyrocalcitonin, Osteogenon and recently also the third series of bisphosphonates it proved possible to increase within one year the bone density on average by 4.5% of normal values. The number of fractures declined dramatically.

[Disorders of bone mineralization and their treatment in Crohn's disease]. / Poruchy mineralizace kostí u Crohnovy choroby a jejich lécba.

Frequent complications of Crohn's disease include disorders of bone mineralization. They are due to a reduced dietary calcium supply in patients with lactose intolerance and a certain degree of malabsorption of calcium as well as vitamin D. The position is made worse by corticoids used in treatment of the basic disease, because they interfere not only with vitamin D conversion into its active (and much more effective) metabolites but also with osteoid formation In the early diagnosis of demineralization a densitometer can be used; markers of bone metabolism are used so far less frequently. As to treatment either blockers of enhanced bone resorption can be used (Ca, vitamin D, bisphosphonates and thyrocalcitonin) or substances stimulating new formation of bone (F, growth factors, in postmenopausal women hormonal substitution treatment) or a combination of preparations from both groups can be used. An irreplaceable part is played also by exercise, depending, of course, on the patient's general condition.

[CA 125 in the department of internal medicine--a marker of ovarian tumor, thoracic fluid or ascites?]. / CA 125 v podmínkách interního oddelení--marker ovariálního tumoru nebo fluidotoraxu ci ascitu?

The authors describe three cases of falsely elevated values of the tumour marker CA 125 which in medical practice is considered above all a sign of ovarian tumours. In one case CA 125 was elevated in fibrinopurulent pleuropneumonia and refractory ascites and in one instance haemorrhagic fluidothorax was involved associated with pleuritis and in one instance an abscess of the subhepatic region. From data in the literature ensues that this increase can be associated with activation of mesothelioma cells (either in the pleura or peritoneum) in non-malignant diseases. Therefore in patients with elevated CA 125 and fluidothorax or ascites, unless ovarian carcinoma is proved, this fact should be taken into account in diagnostic considerations.

[Fluorides and bones]. / Fluoridy a kost.

Fluorides began to be used in the treatment of osteoporosis in the sixties when it was found that in areas with a high fluoride content of drinking water the prevalence of this disease is low. Fluorides stimulate osteoblasts to form more osteoid, and moreover larger crystals of bone mineral are formed which are more resistant to resorption by osteoclasts. Fluorides must be, however, administered always in combination with calcium and vitamin D. In the eighties a certain group of osteologists started a "campaign" against fluorides and maintained that after fluorides bone is of poor quality and there in a greater risk of fractures. All was explained by the fact that these authors administered fluorides alone in large doses. Recently with the introduction of monofluorophosphate into treatment instead of NaF there was a revival of fluorides which in combination with calcium and vitamin D are among the best stimulators of new formation of bone; after fluorides the bone density improves and they are used also in osteoporosis and preventively to avoid fractures.

[Laterality differences in ultrasonic densitometry]. / Stranové rozdíly pri ultrazvukové denzitometrii.

The authors discuss lateral differences between heel bones during ultrasonic bone densitometry using the apparatus Achilles Lunar. While the mean values for the whole group are statistically insignificant (162 patients) in different parameters (SOS, BUA, stiffness) in one quarter of the patients the differences between the two extremities are greater than 9% which may be a source of errors when evaluating the state of the skeleton and when subsequently deciding on treatment.

[Osteomalacia]. / Osteomalacie.

Osteomalacia is a metabolic bone disease caused by deficiency of vitamin D or its active metabolites. Despite a very typical X-ray picture and laboratory finding, it is very poorly diagnosed in the field and thus not treated. This may be due to its atypical clinical picture and also because this disease is frequently omitted in diagnostic considerations. After assessment of the diagnosis the vitamin D treatment or treatment with its metabolites is rapid and successful moreover these substances have also an immunomodulating and anabolic effect.

[Advances in the pharmacotherapy of osteoporosis]. / Pokroky ve farmakoterapii osteoporózy.

In the pharmacotherapy of osteoporosis administration of calcium, small amounts of vitamin D and fluorides still is the basic treatment. Thyrocalcitonin can be also administered, recently also in the form of a nasal spray. It does not only prevent reabsorption of bone but has also an analgetic effect. In the treatment of postmenopausal osteoporosis we use conjugated oestrogens in cyclic preparations with gestagens. Biphosphonates prevent bone resorption but also apposition of the mineral. As to new preparations, Ipriflavone and TGF-beta seem most promising, moreover, there is the perspective of the use of other preparations: small doses of PTH, tamoxifen and raloxifen, promethazine and vitamin K. The author emphasizes the comprehensive character of therapy and the urgent necessity to initiate it early.

[Hormonal therapy of osteoporosis in women after ovariectomy]. / Hormonální lécba osteoporózy u zen po ovarektomii.

In 25 women with ovariectomy made before the menopause and in a control group of 11 women after the menopause the authors examined laboratory values of the calcium phosphate metabolism and bone density. They repeated the examinations 6 and 12 months after treatment with a combined sequence oestrogen and gestagen preparation--Presomen 0.6 comb. of KaliChemie (Solvay), FRG. After one year of treatment the calcium and phosphate blood levels did not change substantially nor the alkaline phosphatase activity or its bone isoenzyme (although an insignificant increase occurred after six months). On the other hand, the originally elevated calciuria suggesting enhanced resorption of bone mineral, declined in the group of ovariectomized women on average by 3.02 mmol/d, i.e. the women lost by 120 mg less Ca, and the density increased by 6.80%! In a group of postmenopausal women the calciuria declined on average by 2.80 mmol (urinary Ca losses were by 113 mg lower) and the density increased by 4.18%. The results of this investigation support unequivocally not only the benefit but also the necessity of combined hormonal treatment after ovariectomy made before the menopause and provide also evidence of its importance in the prevention of osteoporosis in postmenopausal women.

[New therapy for osteoporosis]. / Novinky v terapii osteoporózy.

The author reviews contemporary drugs and procedures used in the treatment of osteoporosis. Long time known substances such as calcium, vitamin D and fluorides are enlarged by the use of thyrocalcitonin, combined treatment with oestrogens and gestagens in post-climacteric women, biphosphonates, and an essential prerequisite remains burdening of the bones by exercise. As to new preparations, the most promising ones seem to be Ipriflavone and TGF-beta; the use of anabolics is tested again, as well as small doses of parathormone and tamoxifen. In the conclusion the author emphasizes the comprehensive character and prolonged period of treatment of osteoporosis and the necessity of perfect cooperation between patient and physician.

[Bone mineralization in women after ovariectomy]. / Mineralizace kostí u zen po ovarektomii.

The author investigated parameters of the calcium phosphate metabolism and level of bone mineralization in 82 women with ovariectomy performed before the natural menopause and compared them with a group of women with ovariectomy after the menopause. In the first group calciuria was significantly elevated and their bone mineralization is highly significantly lower than in women with ovariectomy after the menopause low values were reached that the number of fractures of vertebral bodies or other bones was increased. The values of calciuria and bone mineralization in women ovariectomized after the menopause does not differ essentially from values recorded in women of similar age without ovariectomy. From the investigation ensues that early hormonal prevention is essential in women subjected to ovariectomy before the menopause.

[Irritable bowel syndrome]. / Syndrom drázdivého tracníku.

Irritable bowel is a functional gastrointestinal disorder with chronic or relapsing symptoms of abdominal pain and impaired frequency and consistency of the faeces caused by obscure structural or biochemical deviations. The frequency of the condition in civilized countries is estimated to amount to 15-20% of the population and it accounts for 25-50% of all patients in gastroenterological ambulatory departments. From the clinical aspect the type with dominant diarrhoea, typically in the morning and very compelling, and the type with pain and constipation are known but even combinations of the two types are encountered. A psychosomatic disorder of the motility of the large bowel and its tonus is involved associated with enhanced pain perception. Despite great efforts to find aetiopathogenetic factors, knowledge still is at the level of obscure theories. The diagnosis is still established per exclusion after all organic causes are ruled out, i.e. we always have to differentiate between an irritable bowel from an irritated one. In therapy the patient's confidence in his doctor is most important and it is essential to gain the patient's active cooperation. In case of diarrhoea a low-residue diet is used, calcium carbonate, codeine, loperamide, conversely in constipation adequate dietary fibre, intake metoclopramide or cisapride. Pain is relieved by spasmolytics or Ca channel blockers in the smooth musculature of the large bowel. The associated dysbiosis is transformed into eubiosis by Lactobacillus or other bacterial products.

[Lactobacilli in the treatment of dyspepsia due to dysmicrobia of various causes]. / Laktobacily v lécbe dyspepsie pri dysmikrobii ruzného puvodu.

In 30 patients with dyspepsia caused by dysbacteriosis of the gastrointestinal tract the authors administered the preparation Lactobacillus acidophilus (Rossel Co. Canada)--1. capsule with 2 billion live bacteria, in the morning after breakfast. The patients were divided into four groups: maldigestion, malabsorption, radiation enterocolitis and administration of antibiotics. The patients recorded themselves their subjective symptoms: pain, pressure, bloating, flatulence and appetite, and as to objective symptoms, the number and consistency of bowel movements, changes of body weight. The most rapid effect was achieved in dysbioses after antibiotics--within 3-4 days normalization occurred which persisted even after discontinuation of the drug. In maldigestion after one week bloating, flatulence, abdominal pain and pressure in the epigastrium was milder, and within two weeks the condition improved further. An excellent effect was achieved in radiation enterocolitis. In patients with lactose intolerance the tolerance of dairy products improved. No side-effects were observed, the preparation was very well tolerated; the mean body weight increment was 0.75 kg in three weeks. The preparation proved a new useful probiotic which is highly effective in dyspepsias caused by dysbiosis of the intestinal microflora.

[Idiopathic hypercalciuria--the effect of physical stress on calciuria]. / Idiopatická hyperkalciurie--vliv telesné záteze na kalciurii.

UNLABELLED: The authors investigated calciuria (dU-Ca) in a group of 37 patients with confirmed idiopathic hypercalciuria. The group comprised 17 men, mean age 46.1 +/- 10.4 years, and 20 women, mean age 55.7 +/- 14.9 years (on statistical evaluation the group of women was significantly older, p > 0.01). After a load the calciuria declined in men by 27.3%, in women by 31.3%, in the total group by 27.85% (all reduced values are statistically significant as compared with controls, p < 0.001). In individual subjects calciuria declined by as much as 58%. Similar results were achieved during treatment with hydrochlorothiazide: the drop of calciuria during a physical load in men was 27.60%, in women 34.70%. The group of patients who participated in the whole programme, i.e. rest/load and rest/load after one month hydrochlorothiazide treatment, 25 mg/day, is too small for conclusive evaluation. CONCLUSION: physical load and hydrochlorothiazide reduce the amount of calcium excreted in urine by patients with idiopathic hypercalciuria.