Lege Artis Medicinae

[ACE Inhibitor for Everyone?]

CZURIGA István

OCTOBER 20, 2001

Lege Artis Medicinae - 2001;11(10)

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Lege Artis Medicinae

[TRANSMYOCARDIAL LASER REVASCULARIZATION. FACTS AND QUESTIONS]

SZÉKELY László

[Transmyocardial laser revascularization (TMLR) is a relatively new technique for the treatment of patients with angina refractory to other medical interventions, such as CABG or PTCA. The laser drills channels through the myocardial wall into the cavity of the ventricle. While the mechanism of action is still debated, clinical data show incentive results suggesting favorable outcome for patients. In the article, the published clinical and experimental data relevant to theoretical mechanisms and clinical results are reviewed.]

Lege Artis Medicinae

[Epidemiology and Pathogenesis of Inflammatory Bowel Diseases]

KARLINGER Kinga, GYÖRKE Tamás, MAKÓ Ernő, MESTER Ádám, TARJÁN Zsolt

Lege Artis Medicinae

[The 2nd Congress of the Cardiovascular and Interventional Society, Hungary October 2001, Győr]

LÁZÁR István

Lege Artis Medicinae

[Consensus or Chaos? The Former One!]

RÁK Kálmán

Lege Artis Medicinae

[Small Bowel Ileus of Rare Etiology]

SUGÁR István, ONDREJKA Pál, ISTVÁN Gábor

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[ROLE OF TISSUE ANGIOTENSIN CONVERTING ENZYME IN CARDIOVASCULAR DISEASES]

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[The pathobiological aim of treatment with angiotensin converting enzyme inhibitor is to restore the balance between nitrogen-monoxide and angiotensin II due to inhibition of blood and tissue angiotensin converting enzyme. The clinical consquences of the inhibition of tissue angiotensin converting enzyme in patients with additionally high (HOPE) and low (EUROPA) cardiovascular risk without left ventricular dysfunction has already been demonstrated. Ramipril and the perindopril reduce the risk of combined end-point of these trials such as cardiovascular mortality, reinfarction and resuscitated sudden cardiac death. However, pharmacological and genetic differences in blocking of tissue angiotensin converting enzyme may influence the cardioprotective effect of various angiotensin converting enzyme inhibitors. Thus new, well-designed, controlled clinical trials are needed to determine the role of angiotensin converting enzyme inhibitor with different tissue angiotensin converting enzyme affinity in cardiovascular disease.]

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[GASTROINTESTINAL COMPLICATIONS OF LOW-DOSE ASPIRIN TREATMENT]

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[Since its synthesis more than 100 years ago aspirin has become one of the most successful drug. Low-dose, long-term aspirin therapy reduces the risk of myocardial infarction, the frequency of cerebral stroke and also reduces the mortality of peripheral arterial diseases and systemic embolisms. With aspirin therapy becoming more and more widespread current knowledge is also getting more concerned about the gastrointestinal risks and beneficial effects. Aspirin therapy causes gastrointestinal damages by the inhibition of endogenous prostaglandin synthesis. The ion trapping effect and the injury of mucosal barrier as well as the inhibition of platelet aggregation are also responsible for gastrointestinal damages. According to epidemiological studies lowdose aspirin treatment increases the risk of acute upper gastrointestinal bleeding by 1.5-2.0 fold. However, endoscopic studies indicate that gastroduodenal ulcers may develop even in 10 percent of cases on long term aspirin treatment, most frequently in a symptom-free form. Older age as well as Helicobacter pylori infection increase the risk of aspirin induced ulcers. Beside Helicobacter pylori eradication therapy, preventive proton-pump-inhibitor treatment and the widespread of new non-toxic aspirin derivates may decrease the risk of gastrointestinal complications. Capsule endoscopy also seems to be a promising diagnostic tool for detecting aspirin induced small bowel erosions and ulcers. Long-term aspirin treatment increases the risk of acute bleeding from large bowel diverticulas especially with non-steroidal anti-inflammatory drug co-therapy present. Long-term, low-dose aspirin treatment is a promising method for the chemoprevention of colorectal cancers.]

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[The incidence of melanoma is increasing, and although most of the melanomas are diagnosed at low tumour thickness, the number of metastatic cases is also increasing. In systemic treatment of metastatic and/or unresectable melanoma, targeted molecular inhibitor or immunotherapy can be used as fi rst-line option depending on molecular pathological report. Targeted treatment results in rapid decrease of tumour burden in high percentage of cases; however, the loss of effect is also frequent due to acquired drug resistance. Further improvement on prognosis of metastatic disease is expected from proper sequencing and/or combination of targeted and immunotherapy.]

LAM Extra for General Practicioners

[CHRONIC COUGH - THE OTOLARYNGOLOGISTS’ POINT OF VIEW]

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[Chronic cough can have a profound impact on the psychosocial function of patients. Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastro-esophageal reflux disease (GERD), and laryngo-pharyngeal reflux (LPR) are the most common causes of chronic cough in immunocompetent, non-smoking patients who are not taking angiotensin-converting enzyme (ACE) inhibitors and present with a negative chest x-ray. No diagnostic test has yet been found to define those who have PNDS other than the response to a first-generation antihistamine. Examination of the available evidence suggests that the theory of mechanical stimulation of the pharynx by mucus does not explain the occurrence of cough. Inflammatory mediators’ levels in the lower airways are higher in PNDS, cough variant asthma, and GERD, and the theory that an inflammatory process is affecting “one airway” is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through a yet undefined pathway. Mediation by eosinophil and mast cells appears to be a likely mechanism. In this paper, the author summarizes all potential pulmonological, otolaryngological and other reasons of chronic cough, suggesting a systematic therapeutic algorithm.]

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[ENDOTHELIUM PROTECTION IN HYPERTENSIVE PATIENTS]

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[The author presents a review about the fundamental principles of normal endothelial function and the main causes for the development of endothelial dysfunction. First of all, endothelial dysfunction results in structural alterations in the wall of the vessel - the „vascular remodelling” in hypertension - and that is the base of hypertensive microangiopathy and target organ damage. In patients with high blood pressure the reactivity of vessels is impaired by the endothelial dysfunction. The members of the main drug groups can influence the vasoactive factors produced in endothelium differently. This different effects of drugs create different clinical benefits. Especially, the ACE inhibitors, the calcium antagonists (mostly the new generation of dihydropyridines) have endothelial protective effects, but some β-blockers, α-1 adrenergic blockers and - in a totally different way of action - the statins are capable of influencing the endothelial dysfunction.]