The article describes first two cases of pregnancy in diabetic patients following successful transplantation of both kidney and pancreas in Czech Republic and describes basic issues of this topic.

Key words: transplantation of pancreas, pregnancy, diabetes mellitus, immune suppression

Obese 59 years old female patient (BMI 40 kg/m*2*) with type 2 diabetes mellitus, treated with combined therapy of biguanides and insulins, until now without documented specific organ complications. During prolonged biliary colic accompanied by decreased food intake, vomiting and dehydration patient did not adjust her therapy appropriately. Hypoglycemic coma, acute renal failure and lactate acidosis developed. Intensive therapy was initiated including continuous venovenous hemodialysis (CVVHD), yet respiratory failure developed and artificial pulmonary ventilation was inevitable; the condition was subsequently complicated by a stroke. Due to advanced multiorgan failure the patient was referred to Anesthesiology and Resuscitation clinic. Complex therapeutic approach resulted in restoring of a spontaneous ventilation and diuresis. Still with left hemiplegia it was possible to refer the patient to high dependency unit.

Key words: lactate acidosis, biguanides, continuous venovenous hemodialysis, artificial pulmonary ventilation

Patients with diabetes have a five times higher incidence of ischaemic disease of lower limbs, and there is a twenty times higher probability of gangrene. This case study describes the disease of a 25-year-old patient with diabetes type 1. A diabetes specialist referred the patient with a three-month history of pain and blue appearance of the hallux to our centre for further investigation. The patient’s documentation included several previous examinations by specialists (orthopaedist, neurologist, angiologist) with various conclusions regarding the aetiology of the problem. With the patient admitted to hospital duplex sonography, laser Doppler and angiography were performed. Occlusion of arteria tibialis anterior at the level of talus was manifested. The patient was referred for interventive therapy to an interventive angiology centre. Conservative treatment was ultimately decided due to sufficient collateralisation. Furthermore, the case study discusses various options concerning reconstructive procedures in peripheral arteries.

Key words: arterial occlusion, diabetes mellitus type 1, angiography, reconstructive procedure

The case study describes an elderly patient with recently diagnosed diabetes mellitus developing from asymptomatic necrotising pancreatitis. The study reviews potential causes of such a course and natural history of pancreatitis.

Key words: diabetes mellitus, acute pancreatitis

This case describes 17-year-old diabetic patient, in whom significant proteinuria a microscopic hematuria has been found during preventive inspection. The outcome of renal biopsy confirmed diagnosis of IgA nephropathy. Treatment with steroids failed, quality of diabetes control got worse and daily insulin dose increased. Urine results were normalized during treatment with cyclophilins (cyclosporine A, sirolimus), but remission is only partial.

Key words: type 1 diabetes mellitus, IgA nephropathy, cyclosporine A, sirolimus

A case report of 17-year-old girl suffering from systemic lupus erythematosus with a psychiatric symptomatology as a part of systemic CNS involvement, nephrotic syndrome based on diffuse proliferative lupus nephritis, acute renal failure and pneumonia. The high-dose steroid treatment initiated steroid diabetes development. Due to the progression of metabolic breakdown the patient was referred to our department for further treatment of underlying disease, of its complications and adverse events of immunosuppressive therapy.

Key words: systemic lupus erythematosus, steroids, diabetes mellitus

Type 1 diabetes is frequently associated with other autoimmune diseases. We present a case report of 14-year-old girl with rare co-occurrence of polyangiitis microscopica, type 1 diabetes and chronic autoimmune thyroiditis. We observed a significant improvement of renal and immunological parameters on a combined immunosuppressive therapy (cyclophosphamide, corticosteroids, cyclosporine).

Key words: type 1 diabetes, glomerulonephritis, polyangiitis microscopica

RET gene molecular genetic testing should be offered to probands with any of the MEN 2 subtypes and to all at risk members of kindreds in which germeline RET mutation has been identified in an affected family member.
Nearly all individuals with specific inherited genetic changes of the RET protooncogen will develop symptoms consistent with cancer of the thyreoid and/or adenoma/hyperplasia of adrenal endocrine glands or hyperplasia of the parathyreoid. Familial cases of MTC (medullary thyreoid carcinoma) or MEN 2A will have RET mutations in exon 10, 11, 13 or 14 (codons 609, 611, 618, 620, 634, 768, 804) while individuals with MEN 2B primarily have mutations in exon 16, codon 918.
We have reported a case of a 6-year-old and completely asymptomatic boy, who has inherited an aggressive type of genetic mutation of the RET protooncogen (cys634) from his father.

Key words: multiple endocrine neoplasia type 2 (MEN 2), multiple endocrine neoplasia type 
2A (MEN 2A), multiple endocrine neoplasia type 2B (MEN 2B), medullary thyroid carcinoma (MTC), familial medullary thyroid carcinoma (FMTC), RET protooncogene, prophylactic tyroidectomy, calcitonin producing cells (C cells)

Obesity is characterized by increased body fat (>25 % in males, >30 % in females). In the clinical practice obesity is defined by body-mass index, BMI>30 kg/m*2* and overweight (pre-obesity) as BMI 25,0–29,9 kg/m*2* (Kunešová et Hainer 2002). Prevalence of obesity in adults is about 10-25% in most western European countries and about 20-25% in some countries of the American continent. According to statistics, there are 21 % obese males and 31 % obese females and 50 % males and 35 % women suffering from overweight in the Czech Republic. Obesity is a cause or contributes to progress of severe physical disorders. If it becomes critical it could be restricting for patients. We present a case history of 60 years old, monstrously obese male patient (BMI 55 kg/m*2*), who was admitted to ICU of the Nephrology Department for initiation of the Continuous renal replacement therapy due to cardiorenal syndrome accompanied with anasarca. His condition was complicated by development of a septic shock caused by severe skin defects of lower extremities (large circular ulcers with microbial eczema, severe hyperkeratosis and onychomycosis). Particularly cardiopulmonary complications (identically as described in literature in monstrously obese patients) resulted from initially unfavorable prognosis (El-Solh et al. 2001; Koenig 2001; Knauss et al. 1991; Eadie 2004).

Key words: body-mass index, continuous renal replacement therapy, sepsis, cardiomyopathy induced by obesity, cardiopulmonary resuscitation