Lege Artis Medicinae

[Antiatherosclerotic effect of ACE inhibitor drugs]

CZURIGA István

MARCH 20, 2001

Lege Artis Medicinae - 2001;11(03)

[Based on animal and human research data, it is likely that renin-angiotensin-aldosteron system has an important role in the pathogenesis and progression of atherosclerosis. It has been demonstrated in several large clinical trials that ACE inhibitors reduce the risk of ischemic events in patients with left ventricular dysfunction. Whereas some benefits of ACE inhibitors may be related to the lowering of blood pressure, other specific effects on vasculature have also been proposed. ACE inhibitors appear to possess unique cardioprotective and vasculoprotective properties even for patients without hypertension or left ventricular dysfunction. Recent data suggest that most patient with atherosclerotic cardiovascular disease should be considered for ACE inhibitor therapy, unless they are intolerant or have contraindication for the drug. The goal of this article is to review the data from clinical trials that support the anti-atherosclerotic and antiischemic effects of ACE inhibitors.]

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Lege Artis Medicinae

[Treatment of pneumothorax in cystic fibrosis]

CSISZÉR Eszter, CSEKEŐ Attila

[INTRODUCTION - More and more children affected by cystic fibrosis reach adulthood. The frequency of complications, such as pneumothorax, increases parallel with the long disease course. PATIENTS AND METHODS - The treatment of 17 manifestations of pneumothorax in 10 young adult cystic fibrosis patients in our institute was analysed retrospectively. RESULTS - Depending on the extension of pneumothorax and the clinical state of the patients the first choice of the treatment was observation alone in 6 cases, insertion of pleuracan in 3 cases and tube thoracostomy in 8 cases. Due to ineffective suction, thoracotomy was necessary in 6 patients, bilaterally in 3 cases. CONCLUSION - The outcome of conservative treatment even in "small, circumscribed pneumothorax" cases of symptom-free patients is uncertain and risky. Insertion of a pleuracan is recommended only in urgent, life-threatening cases, but definitive result should not be expected. If possible, chest drainage should be chosen as the first procedure. After 5-7 days of ineffective chest suction, thoracotomy is mandatory. Recurrence of the pneumothorax is direct indication for surgery. Antibiotic treatment is suggested for the duration of drainage, as well as for the surgical procedure.]

Lege Artis Medicinae

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Lege Artis Medicinae

[The role of chief pathologist in training the new generation]

MAGYAR Éva

[INTRODUCTION - The present situation of pathology is disadvantageous, can even be considered critical in Hungary. There are not enough pathologists, the number of experienced, competent specialists is decreasing and young doctors do not prefer the specialty. We try to analyze the background of this situation based on our experience as tutors in medical education. METHODS - Participants of the annual fiveweek long exam preparation course took part in an anonymous survey. Based on this, we collected data on professional activity, working conditions and continuing education of young pathologists before their national specialist examination. Data were collected from the period 1991-2000. RESULTS AND CONCLUSION - Our experience suggest that chief pathologists of hospitals play key role for the future existence of this specialty in Hungary besides financial appreciation of the specialists. For successful replacement of elder colleagues with young specialists the task is threefold: 1. Getting young doctors acquainted with the specialty and help them prepare for the national exam. 2. In case of young specialists, professional support through continuous education as well as career-preserving support is necessary. 3. Choosing the best possible successor among colleagues for the position of chief pathologist and helping to prepare for this task.]

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[Stroke is the third leading cause of death and a leading cause of major adult disability in developed countries. The annual incidence of hospitalized stroke varies between 400-500 per 100 000 inhabitants every year in Hungary. In the past decade, cholesterol lowering with 3- hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors (statins) has proved to reduce risk of stroke in patients with and without coronary disease (CAD). In patients with CAD, statin therapy reduces the risk of first stroke by 25% to 35% versus placebo and, moreover, intensive statin therapy to LDL-C targets below 2.6 mmol/L (100 mg/dL) appears to reduce the risk further. More recently it has also been shown that intensive statin therapy can reduce risk of recurrent stroke in nondiabetic as well as diabetic patients with recent stroke or transient ischaemic attack but no CAD. The overall reduction of stroke and TIA was 23%. Evidence from retrospective studies suggests that in addition to risk reduction statin pretreatment may improve stroke outcome. It may due to their pleiotropic effects that include improvement of endothelium function, anti-inflammatory, antithrombotic, and immunomodulatory effects. As statins have both an excellent safety profile and simple administration, physicians should consider using statins, at dosages shown to have efficacy in clinical trials, in all patients whose cardiovascular risk profile puts them at high risk of stroke.]

Lege Artis Medicinae

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