Lege Artis Medicinae

[Actual questions of nitrate therapy]


MAY 20, 2003

Lege Artis Medicinae - 2003;13(04)

[The nitrates are one of our oldest medicine. This article summarizes the general and the cardiovascular effect of the nitrates, the question of the nitrate tolerance and the ways of avoiding this. On the basis of the clinical studies the article describes the theoretical and practical results of the nitrate therapy in myocardial infarct and post-MI patients. It also summarizes the cardiac and extracardiac indications of the nitrates with special regard to acute cardiac conditions (acute heart failure, pulmonary edema) and analyses the side effects and the contrindications of the drug.]



Further articles in this publication

Lege Artis Medicinae

[Cervix and breast cancer screening in the districts of Hungary]

SÁNDOR János, SZÜCS Mária, KISS István, BONCZ Imre, SEBESTYÉN Andor, KISS Adrienn, EMBER István

[INTRODUCTION - Life expectancy in Hungary has been increasing recently but in a geographically uneven distribution. The mortality trends has remained disadvantageous for cancer patients and also for the malignancies of cervix and breast that can be preventable with screening. The study aimed to describe the participation at the district level in the screening programmes as well as to investigate the relative role of health behaviour of women and of the health services in determining the screening success. METHODS - Age standardised relative screening participation rates were computed for 150 districts of Hungary using discharge reports of the outpatient services for cervical cytology and mammography. RESULTS - 20,12% of all 25-65 years old women was screened for cervical cytology during 3 years (1. July 1998. - 31. June 2001.) and 17,22% of all women aged 45-65 years participated in mammography in a 23 months period (1. July 1998. - 31. May 2000.). The results scattered in a certain fashion. Summarising the screening results, the highest participation ratios were observed in Bonyhád, Kiskunfélegyháza, Paks, Zalaszentgrót, Pécs while the lowest were in Csengeri, Mór, Nyírbátor, Sárbogárd, Enying districts. The screening performances did not correlate with each other and with the socioeconomic indicators (education, unemployment, income), apart from the significant influence of education on mammography participation rate. The emerging explanation is that the health behaviour was not important determinant of screening participation. In this case, the behaviour of target populations would have affected similarly both screening results resulting in a correlation. CONCLUSIONS - Consequently, the performances of providers responsible for screening organisation have been reflected in the observed screening rates. This result and the wide scattering of screening participation rates, which developed in spite of the uniform legislative-economic environment, emphasises the importance of regular monitoring of screening performance.]

Lege Artis Medicinae

[Human adult lactose intolerance: diagnosis and therapy]

BERÓ Tamás

[Human adult-onset lactase decline, characterised by a decrease in intestinal lactase enzyme activity is a biologic feature characteristic of the maturing intestine in the majority of the world's population. It demonstrates an autosomal recessive pattern of inheritance and it is regulated primarily by the rate of lactase gene transcription. Ingestion of high quantities of lactose-containing foods by patients with adultonset lactase decline results in intestinal symptoms, including bloating, distension, cramps, flatulence and diarrhoea. Due to the differences in the rates of gastric emptying and intestinal transit as well as the abundance of lactosemetabolising bacteria in the colon, the symptoms of lactose intolerance are often quite variable from persons to person. Lactose intolerance usually leads to self-imposed dietary restriction of dairy products, the main source of calcium intake, therefore it appears to be a risk factor for development of osteoporosis. Consumption of milk with solid foods can reduce symptoms in many individuals. Yoghurt containing active cultures are useful substitute for whole milk. Prehydrolized milk and lactase enzyme containing tablets are also available in the treatment.]

Lege Artis Medicinae


Lege Artis Medicinae

[52nd Congress of American College of Cardiology]

KISS Róbert Gábor

Lege Artis Medicinae



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[Experience with coenzyme Q10 in heart failure]

KOHUT László

[INTRODUCTION - The protein complex coenzyme Q10 (CoQ10) has a role in ATP production as a mitochondrial electron transport molecule, and it also has a strong antioxidant effect. Several studies have proved the correlation between the decrease in CoQ10 level and the severity of heart failure. Heart failure is a multifactorial syndrome, the development of which is greatly influenced by an abnormal energy metabolism. CASE REPORT - The 61-year-old woman developed heart failure after a myocardial infarction. She complained of fatigue, dyspnoea and reduced physical endurance even with optimal treatment. When her therapy was completed by CoQ10, her endurance and life quality significantly improved and her symptoms ameliorated. CONCLUSIONS - Medical treatment of chronic heart failure is an evidence-based, complex therapy. Despite the complex management, morbidity and mortality of this condition remain high. A number of studies have shown that CoQ10 substitution can improve the clinical and haemodynamical parameters of patients with heart failure. On the basis of these results, the use of CoQ10 as an adjuvant therapy to complex treatment has an increasing role.]

Lege Artis Medicinae

[The importance of endothelial dysfunction and possibilities of its treatment in chronic heart failure]


[Endothelial cells - under autocrine and paracrine control - may have a central role in the regulation of vascular tone. Endothelial dysfunction is a very early sign of heart failure but the clinical consequence is not well understood. Recent evidence suggests that upregulation of the neuro-endocrine-, and the renin-angiotensin-aldosterone system would lead to increased tissue- and circulating angiotensin-II levels. Elevated concentration of angiotensin-II provides a mechanism by which vasomotor responses to nitric oxide, prostaglandins are blunted, while the effects of vasoconstrictors such as thromboxans, endothelin and chatecholamins are enhanced. The higher basal vascular tone leads to the degeneration and atrophy of skeletal muscle, moreover to the the ischaemic damage of myocardial cells. Because renin-angiotensinaldosterone system is under genetic control, the deleterious effects of angiotensin-II depends on the angiotensin-converting enzyme gene. Pharmacological attempts to counteract endothelial dysfunction in heart failure may include the angiotensin-converting enzyme inhibitor, which can potentially improve the endothel dependent vasodilatation response. The importance of measuring endothelial function by non-invasive techniques is yet unknown, thus, before we introduce the widespread testing of patients for endothelial function, more research has to be done.]

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[Recent advances in the care of acute myocardial infarction have resulted in more patients surviving myocardial infarction than earlier. However, heart failure is a common complication in these patients, which in turn is associated with substantial mortality, primarily due to a remodelling of the left ventricle that already starts in an early stage of the myocardial infarction. The aim of this review article is to present the pathomechanism of this remodelling and to discuss related therapeutic options. Current guidelines recommend the use of an angiotensin- converting enzyme inhibitor combined with or followed by an angiotensin receptor blocker, a beta-blocker, and an aldosterone antagonist in post-infarction patients with concomitant heart failure.]

Lege Artis Medicinae

[Clinical trials for evaluating cardiovascular safety of SGLT-2- inhibitor drugs in patients with type 2 diabetes]


[SGLT-2-inihibitors are considered as a new class among oral antidiabetic drugs. The first derivatives of this class became available in the last couple of years in Hungary. According to the requirements from regulatory bodies, randomized, controlled clinical trials have been initiated in order to evaluate the cardiovascular safety of nearly all new antidiabetic drugs in patients with type 2 diabetes. Among SGLT-2-inhibitors, only one trial with empagliflozine has been completed so far. Based on the endpoints of the EMPA-REG OUTCOME trial a significant decrease in different cardiovascular events and total mortality was observed in type 2 diabetic patients with elevated cardiovascular risk. The exact pathomechanism of this beneficial effect has not been clearly understood. Currently, the position statements and scientific guidelines clearly describe the place of SGLT-2-inhibitor drugs in the treatment algorithm; the beneficial effect of empagliflozine on cardiovascular events should seriously be considered when making therapeutic decision. Together with the results of ongoing studies with SGLT-2-inhibitors (dapagliflozine: DECLARE, canagliflozine: CANVAS), these data will provide a more robust evidence about the cardiovascular safety of this new class of oral antidiabetic drugs. ]

Lege Artis Medicinae

[Effect of beta blockers in hypertension, ischaemic heart disease, heart failure and metabolic syndrome]


[Beta-blockers are among the most widely used drugs for the treatment of cardiovascular diseases. In the mid-90’s, these drugs were recommended as first-line therapies of hypertension. With the introduction of new drugs, the list of first-choice drugs has been extended. The results of recently published major hypertension trials, which compared conventional agents (beta blockers and/or diuretics) with newer agents (angiotensin converting enzyme inhibitors, Caantagonists, angiotensin receptor blockers), raised concerns regarding the role of beta blockers in cardiovascular primary prevention. Subsequently, a metaanalysis of 13 trials has shown that compared with other drug types, beta-blocker therapy is less beneficial in patients with hypertension who do not have heart disease. Nevertheless, in cardiovascular indications other than hypertension (acute myocardial infarction, heart failure and arrhythmias), betablockers retain their dominant position.]