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Internal Medicine

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Aortic dissection

Aortic dissection

A breach in the integrity of the aortic wall allows arterial blood to enter the media, which is then split into two layers, creating a “false lumen“ alongside the existing or “true lumen“. The primary event is often a spontaneous or iatrogenic tear in the intima of the aorta. Disease of the aorta and hypertension are the most important aetiological factors. The aortic dissection is a relatively rare condition, but it may rupture and have fatal consequences. The case report describes a dissection of the descending aorta in a 55-year-old patient.

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author: Katarína Demková, Jana Grofčíková | discipline: Cardiology, Angiology, Internal Medicine | published on: 1.1.2018 | last modified on: 30.4.2018 | Creative Commons License

Posterior wall myocardial infarction

Posterior wall myocardial infarction

Isolated posterior myocardial infarction is occurring in 3-11% of all infarctions. ST - segment depression in leads V1-V3 suggests myocardial ischaemia, especially when the terminal T - wave is positive (ST - segment elevation equivalent), and confirmation by concomitant ST-segment elevation ≥ 0,5mm recorded in leads V7-V9 should be considered as a mean to identify posterior myocardial infarction. Emergent coronary angiography and percutaneous coronary intervention of the infarct - related artery is indicated.

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author: Marianna Vachalcová | discipline: Cardiology, Angiology, Internal Medicine | published on: 8.12.2017 | last modified on: 30.4.2018 | Creative Commons License

Cardiac tamponade due to cardiac metastases

Cardiac tamponade due to cardiac metastases

Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid or gas in the pericardial space, resulting in reduced ventricular filling and therefore decreased cardiac output (Figure 1). The condition is a medical emergency with resultant cardiogenic shock and death if not treated immediately. The presented case report describes a 63-year-old oncological patient who developed cardiac tamponade with the need of pericardiocentesis.

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author: Ivana Trojová | discipline: Cardiology, Angiology, Internal Medicine | published on: 4.12.2017 | last modified on: 30.4.2018 | Creative Commons License

Pleuropneumonia

Pleuropneumonia

Community-acquired pneumonia (CAP) is a serious public health concern and a major cause of mortality and morbidity. Despite advances in antimicrobial therapies, microbiological diagnostic tests and prevention measures, pneumonia remains the main cause of death from infectious disease in the world. An important reason for the increased global mortality is the impact of pneumonia on chronic diseases, along with the increasing age of the population and the virulence factors of the causative microorganism.
In 2013, the Global Burden of Disease Study based on data from 188 countries around the world, reported that lower respiratory tract infection was the second most common cause of death. In Europe, mortality rates for CAP vary widely from country to country, ranging from <1% to 48%.

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author: Ivana Paraničová | discipline: Internal Medicine, Respiratory Medicine | published on: 1.1.2018 | last modified on: 16.4.2018 | Creative Commons License

Autoimmune hepatitis

Autoimmune hepatitis

Autoimmune hepatitis is chronic hepatitis associated with hypergammaglobulinaemia and the presence of circulating autoantibodies. In most cases it responds favorably to immunosuppressive therapy. Diagnosis is challenging, in general, all other possible causes of chronic hepatitis should be excluded. The case report describes a case of type 1 autoimmune hepatitis in a 69-year-old patient.

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author: Katarína Demková | discipline: Gastroenterology and Hepatology, Internal Medicine | published on: 2.1.2018 | last modified on: 16.4.2018 | Creative Commons License

Obesity hypoventilation syndrome

Obesity hypoventilation syndrome

Obesity hypoventilation syndrome (OHS) is defined as the combined presence of obesity (BMI > 30kg/m2) with awake arterial hypercapnia (pCO2 > 6.0 kPa / 45 mmHg) in the absence of other causes of hypoventilation. The exact prevalence of OHS in the general population remains unknown, and most prevalence data describe subjects with obstructive sleep apnoea, wherein its prevalence has been estimated to range from 10% to 38% in different groups. On the other hand, patients with OHS often suffer from sleep-related breathing disorders. Prevalence of obstructive sleep apnoea may reach up to 90-95% in OHS patients.

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author: Ivana Paraničová | discipline: Internal Medicine, Respiratory Medicine | published on: 22.12.2017 | last modified on: 16.4.2018 | Creative Commons License

Home mechanical ventilation in a patient with Duchenne muscular dystrophy

Home mechanical ventilation in a patient with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disorder that is inherited in X-linked recessive pattern. Mutation of dystrophin gene results into a loss of integrity and function of muscular fibres and their replacement by adipose and connective tissue. Muscle degeneration leads to motoric impairment and loss of walk around 12th year of age. Myocardium is also frequently affected. Respiratory muscles impairment and other complications lead to respiratory failure. If left untreated, death occurs around 20th year of life, usually due to cardiac or respiratory causes. Respiratory insufficiency development is treated by mechanical ventilation support.

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author: Ivana Paraničová | discipline: Internal Medicine, Neurology, Respiratory Medicine | published on: 23.12.2017 | last modified on: 16.4.2018 | Creative Commons License

Systemic lupus erythematosus with multiple organ complications

Systemic lupus erythematosus with multiple organ complications

Systemic lupus erythematosus (SLE) is an autoimmune disease, mostly with a chronic course, that can affect almost all important organs, most commonly skin, joints, heart and vessels, kidneys, central nervous system and lungs. The disease is characterized by B-lymphocyte hyperactivity, which leads to the formation of autoantibodies predominantly directed against non-specific antigens. This case study describes a case of SLE with multiple organ complications in a 29-year-old female patient.

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author: Katarína Demková | discipline: Internal Medicine, Rheumatology | published on: 2.1.2018 | last modified on: 16.4.2018 | Creative Commons License

Parainfectious myocarditis

Parainfectious myocarditis

Myocarditis is an acute inflammatory condition that can have an infectious, toxic or autoimmune aetiology. Myocarditis can complicate many infections in which inflammation may be due directly to infection of the myocardium or the effects of circulating toxins. The clinical picture ranges from a symptomless disorder, sometimes recognised by the presence of an inappropriate tachycardia or abnormal ECG, to fulminant heart failure. Myocarditis may be heralded by an influenza-like illness. In most patients, the disease is self-limiting and the immediate prognosis is excellent. However, death may occur due to a ventricular arrhythmia or rapidly progressive heart failure. Myocarditis has been reported as a cause of sudden and unexpected death in young athletes. Some forms of myocarditis may lead to chronic low-grade myocarditis or dilated cardiomyopathy. The case report describes a case of parainfectious myocarditis in a 20-year-old patient.

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author: Katarína Demková | discipline: Cardiology, Angiology, Internal Medicine | published on: 2.1.2018 | last modified on: 16.4.2018 | Creative Commons License

Newly diagnosed COPD - obstructive ventilatory impairment

Newly diagnosed COPD - obstructive ventilatory impairment

Presented case report documents an example of a patient with an accidentally diagnosed chronic obstructive pulmonary disease (COPD) based on clinical signs. Diagnosis was confirmed by a pneumologist using spirometry. A bronchodilation test was carried out to confirm the irreversibility of detected obstructive ventilatory impairment. The patient was given combined bronchodilator treatment with ß2-mimetics and anticholinergics to relieve symptoms, improve functional parameters and prevent subsequent exacerbations.

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author: Pavol Pobeha | discipline: Internal Medicine, Respiratory Medicine | published on: 17.12.2017 | last modified on: 16.4.2018 | Creative Commons License
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