In paediatrics we face growing incidence of diabetes mellitus type 1. Considerable part of such diagnosed cases come too late, in the phase of diabetic ketoacidosis. Self-immunity process, which leads into clinically manifesting diabetes mellitus, proceeds for months even years. What are the chances of our early diagnosis? Is it possible to notice the diagnosis in pre-clinical phase? When should we consider diagnosis called MODY? In connection with obesity we must think about diabetes mellitus type 2 in childhood as well.

Key words: hyperglycaemia, diabetes mellitus type 1, diabetes mellitus type 2, MODY, ADA diagnostic criteria, transient hyperglycaemia

The paper decribes the case of a patient suffering from type 1 diabetes, with proximal diabetic neuropathy, which was confirmed by the clinical development and electromyographically following the elimination of a pathological process in the lumbar region of the spine canal.

Key words: proximal diabetic neuropathy, symmetric distal neuropathy, electromyography, alpha-lipoic acid

The case report of a 63-year-old man suffering from type 2 diabetes mellitus. Diabetes is well compensated by dieting. The sexual intercourse was impossible during the last year. The combination of biological therapy and psychotherapy has a good result.

Key words: type 2 diabetes mellitus, erectile dysfunction, combinated therapy

The International TRIGR studies (Trial to Reduce IDDM in the Genetically at Risk) are in progress. The research project is trying to prove whether the absolute exclusion of cow’s milk proteins in the diets of babies aged over six months can reduce the risk of type 1 diabetes mellitus in children in a high genetic risk group. Currently 2,818 children are included in worldwide studies out of which 1045 children with a risk genotype are participating in the study. In the Czech Republic 99 children are registered out of which 42 are taking part in the study (October 2004). In 52 % of children included in the project worldwide the mothers suffer from diabetes, 32 % of the fathers, 13 % of the siblings and in the case of 3 % more than one member of the family. In the Czech Republic the statistics point to similar figures: 50 % of the children participating in the research have mothers suffering from diabetes, 38 % of the fathers, 17 % of the siblings. More than one member of the family has diabetes in 1 % of the population. According to percentages children with a confirmed genotype diabetes risk reflect a higher chance of occurrence of diabetes in a family where the father is a diabetic. We are looking for volunteers to help us in the research project to continue until March 2006. We therefore appeal for cooperation in our search to pregnant women who comply with the conditions for participating in the study (future mothers, fathers, or some of their children who suffer from type 1 diabetes).

Key words: type 1 diabetes mellitus, prevention, nutrition, cow’s milk

Diabetes patients suffering from ulcers on their lower limbs pose a significant problem. Often such treatment is costly, has a negative influence on the patient’s functional status and sound state of health.
A high-quality concept for treatment presumes a correct diagnosis of the state of the wounds, an evaluation of the circulation conditions and, depending on the general condition of the organism, stipulating the healing phases. An effective conservative possibility of treating diabetic ulcers lies in wet therapy, which may be applied as such or combined with surgical treatment. Wet therapy was used in treating complicated torpid ulcers of a mixed aetiology on both lower limbs.

Key words: diabetes mellitus, diabetic leg

Arterial hypertension is one of most prevalent conditions in all developed countries. The costs of management are immense and represent a great global burden. Individual risk of a hypertensive person usually needs to be controlled by pharmacotherapy because of nonpharmacological life style modifications are not enough effective. In contrast, risk of general population which is linearly increasing with BP increased already of 110 mmHg systolic can be influenced by sodium restriction decreased of the prevalence of the obesity and increase of physical activity in the general population. An average decrease of BP in the population by 2-3 mmHg would be followed by an decrease of the incidence of stroke about 6 % and CHD by 3-4 %. These measures represents one of priority for clinical medicine and health service.

Key words: blood pressure, epidemiology of hypertension

The authors describe the case of a patient admitted to hospital following a hypertension crisis together with an acute renal failure and subsequent anuria as well as pulmonary oedema requiring immediate haemodialysis. The patient’s problems were caused by a bilateral renal artery occlusion. A radiologist succeeded in improving the blood flow through the right renal artery. Following a transitional polyuric phase the kidney function was almost completely renewed and blood pressure significantly reduced, whereby ultimate values were achieved by merely applying monotherapy for hypertension. The paper demonstrates the unusual cause of a hypertension crisis and the treatment possibilities.

Key words: hypertension crisis, renovascular hypertension, renal artery occlusion, renal failure, percutaneous angioplast procedure

The paper describes the case of a diabetes patient suffering from fairly significant renal insufficiency who was admitted to our clinic because of an emergent hypertension crisis. Considering the stenocardiac indications in the hypertension crisis we referred the patient to SKG. The actual operation and the subsequent post-operation entailed many complications which we describe in our paper.

Key words: peripheral embolism, microaspiration, emergent hypertension crisis

In a young women the combination of papillary thyroid cancer and demyelinisation of central nervous system has been recorded. During the treatment of cancer (thyroidectomy and application of 131 I in hypotyroid state) neurologic syndrom markedly worsened. This unfavorable tendency may be overcome using the recombinant TSH – Thyrogen. This expensive treatment should be reserved for strictly indicated patients (at lest in the next future). 

Key words: papillary thyroid cancer, demyelinisation, recombinant TSH (Thyrogen)

The paper describes the case of an 80-year-old patient who had an operation of a multinodose struma at the age of 30. At the time – in 1948 – it was customary to perform subtotal operations of the thyroid gland. Our patient, too, was left with a partial thyroid gland and following the operation she was not treated with thyroidal hormones for very long. Fifty years after the operation a relapse was noted of a bilateral nodose struma. The patient was sent for an endocrine examination only after having admitted to pains in her throat. First she was treated by conservative methods with the application of small suppressive doses of Euthyrox, but we decided on an operation as the growth progressed. The operation was carried out without any complications; during the operation a microcarcinoma was found.

Key words: nodose struma, microcarcinoma, suppression, hypertrophy, hyperplasia, ultrasonography, thyroidectomy, substitution, cystoid

The paper describes the case of a seventy-year-old patient who was diagnosed with secondary diabetes mellitus while in hospital for treatment of a hypertension crisis. In the following six months she was treated successfully on the whole by keeping to a diet and taking oral antidiabetics. Since she suffered from serious hypertension maximums the patient underwent examinations to verify or disprove a suspicion of secondary hypertension. The diagnosis led to a pheochromocytoma of the left suprarenal gland. On its removal the oGTT returned to absolute normal and hypertension disappeared.

Key words: pheochromocytoma, secondary diabetes mellitus

This paper deals with a patient in whom thanks to a timely diagnosis of primary hyperparathyreosis, discovered accidentally in a sonographic examination, and the prescription of HRT (hormone replacement therapy), resulted in a cure and enhanced the prevention of changes in the skeleton.

Key words: primary hyperparathyreosis, hormone replacement therapy