Lege Artis Medicinae

[ASCOT-BPLA]

MATOS Lajos

OCTOBER 20, 2005

Lege Artis Medicinae - 2005;15(10)

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Lege Artis Medicinae

[ANGIONEUROTIC EDEMA CAUSED BY ANGIOTENSIN-CONVERTING ENZYME INHIBITORS]

BAKOS Noémi, BENCZÚR Béla

[Angiotensin-converting enzyme inhibitors are used in broad spectrum of cardiovascular pharmacotherapy as evidence based drugs. Cough, which is the most typical adverse effect of ACEinhibitors occurs in relatively high proportion of patients (20-63%) during therapy. Angioedema is a less frequent and often underdiagnosed but potentially life-threatening adverse effect of ACEI-treatment occurring typically on the face and extremities or rarely in a visceral form. Authors review the pathomechanisms of angioedema and the therapeutic options.]

Lege Artis Medicinae

[Even Science is Not the Same Any More?]

BÁNFALVI Attila

Lege Artis Medicinae

[RIGHT HEMICOLECTOMY FOR SUBMUCOUS LIPOMA CAUSING PARTIAL BOWEL OBSTRUCTION]

SVÉBIS Mihály, BORI Rita, KOCSIS Lajos, PAP-SZEKERES József, CSERNI Gábor

[INTRODUCTION - Submucous lipomas are rare tumors of the colon and may be misdiagnosed as cancer because of their exophytic, polypoid growth and threatening bowel obstruction. CASE REPORT - A protruding, ulcerated and firm tumor preventing the investigation of the coecum was found by endoscopy in the ascending colon of a 50-year-old woman, who was subsequently operated on. The preoperative biopsy revealed only necrotic debris. Right hemicolectomy was performed because of threatening bowel obstruction and the presumed diagnosis of cancer. The tumor proved to be a 4 cm-large pedunculated submucosal lipoma. CONCLUSION - Despite recent diagnostic developments and the availability of better tools for the preoperative diagnosis of colonic lipomas, these tumors may still be misdiagnosed as carcinomas. Several circumstances contradict malignant dignity, such as: the relative circumscription of the mass, the trophic and only partial ulceration of the surface which is covered by normal mucosal layer elsewhere. To avoid unnecessary radicality in treatment, colon tumors with an uncertain preoperative diagnosis should undergo further diagnostic steps in order to clarify their nature. This could allow a more optimal therapeutic planning.]

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[Always on the Run... The Life of E. T. A. Hoffmann]

MALINA János

Lege Artis Medicinae

[Unfavourable changes in the epidemiology of pertussis]

BUDAI József

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Lege Artis Medicinae

[CARDIOVASCULAR PREVENTION BY INHIBITION OF THE ANGIOTENSIN CONVERTING ENZYME IN VIEW OF THE RESULTS OF RECENT TRIALS]

PAPP Előd, TÓTH Kálmán

[Angiotensin converting enzyme inhibitors have long been basic drugs in the treatment of heart failure. In the preventive treatment of ischaemic heart disease, however, their mortality-reducing effect has only been proved recently. The HOPE was the first trial that showed a beneficial effect of the angiotensin converting enzyme inhibitor ramipril in patients at high risk for cardiovascular diseases. The EUROPA trial showed a positive role of perindopril in the reduction of hard clinical endpoints in relatively low risk patients with known coronary artery disease. The PEACE trial was designed to show a possible group effect of angiotensin converting enzyme inhibitors, but it failed to demonstrate a beneficial effect of trandolapril in patients with coronary artery disease. The latest data from the EUROPA trial and results from three new prevention trials with perindopril or amlodipine plus perindopril combination and with quinapril have been presented recently. Perindopril was administered in patients over 65 years with previous myocardial infarction and with good left ventricle function in the PREAMI study. By the end of the study period, the combined end point and remodelling had decreased significantly. The ASCOT-BPLA trial (amlodipine plus perindopril versus beta-blocker plus diuretic) showed a reduction in all coronary events, in the risk of stroke and in the prevalence of new-onset diabetes mellitus. Quinapril was used in the IMAGINE trial in patients after coronary bypass surgery; the results did not support the hypothesis that early treatment with angiotensin converting enzyme inhibitors improves clinical outcome. Based on these new results, the indication of perindopril has been extended to the reduction of cardiovascular risk in patients with stable coronary artery disease after myocardial infarction or revascularization.]

Lege Artis Medicinae

[Modern beta-blocker therapy from the cardiologist’s viewpoint]

ÉDES István

[Following the publication of some large, randomised trials (LIFE, ASCOT), the benefits of the use of beta-blockers in hypertension have been questioned. On the basis of these clinical trials it has been posited that beta-blockers administered for the treatment of hypertonia are less effecient for stroke prevention. It has been suggested that first-generation beta-blockers (atenolol) have adverse metabolic effects (insulin sensitivity, lipid parameteres), which might contribute to the differences observed in clinical outcomes. On the basis of a number of clinical trials and meta-analyses performed in recent years it is now evident that the most important goal is to reach target blood pressure levels, which is usually achieved by combination therapy. Choosing drugs on the basis of strict protocols is less important. In general, beta-blockers remain one of the most important drug class for the treatment of hypertension. The author reviews the pharmacology of the cardioselective, vasodilatory drug nebivolol in detail, as well as clinical trials on nebivolol. Nebivolol has a neutral (or rather beneficial) effect on metabolic parameters (lipid parameters, blood glucose level and insulin sensitivity) as well as on left ventricular function. If hypertension is associated with cardiovascular diseases (left ventricular dysfunction, ischaemic hears disease, atrial fibrillation), nebivolol offers an excellent therapeutic alternative due to its excellent tolerability and side effect profile.]

Lege Artis Medicinae

[Treatment of cardiovascular risk of patients with hypertension: the role of fixed combination amlodipin-atorvastatin therapy in light of recent studies]

ALFÖLDI Sándor

[Risk factors for cardiovascular disease commonly coexist in patients with hypertension: high blood pressure is accompanied by alterations of lipid and glucose metabolism, obesity or smoking in the vast majority (70-80%) of patients. In the presence of multiple risk factors, the increment of relative cardiovascular risk caused by individual risk factors is not additive but multiplied. Since the ASCOT trial was published, statin therapy is recommended to every hypertensive patients with LDL cholesterol >2.5 mmol/L and at least intermediate cardiovascular risk (Euro SCORE>3%). Some studies show, however, that in daily clinical practice, blood pressure and lipid targets are achieved in a small percentage of patients with hypertension and dyslipidaemia. This is partly due to the fact that borderline alterations of serum cholesterol and their risk-increasing effects are often neglected during the planning of the therapy, and therapeutic adherence and persistence of patients are insufficient. According to new studies, both factors can be improved significantly if the antihypertensive and lipid-lowering treatments are initiated simultaneously, using a single pill with dual effect.]

Lege Artis Medicinae

[ASCOT-LLA ]

MATOS Lajos

LAM Extra for General Practicioners

[MODERN BETA-BLOCKER THERAPY FROM THE CARDIOLOGIST’S VIEWPOINT]

ÉDES István

[Following the publication of some large, randomised trials (LIFE, ASCOT), the benefits of the use of beta-blockers in hypertension have been questioned. On the basis of these clinical trials it has been posited that beta-blockers administered for the treatment of hypertonia are less effecient for stroke prevention. It has been suggested that first-generation beta-blockers (atenolol) have adverse metabolic effects (insulin sensitivity, lipid parameteres), which might contribute to the differences observed in clinical outcomes. On the basis of a number of clinical trials and meta-analyses performed in recent years it is now evident that the most important goal is to reach target blood pressure levels, which is usually achieved by combination therapy. Choosing drugs on the basis of strict protocols is less important. In general, beta-blockers remain one of the most important drug class for the treatment of hypertension. The author reviews the pharmacology of the cardioselective, vasodilatory drug nebivolol in detail, as well as clinical trials on nebivolol. Nebivolol has a neutral (or rather beneficial) effect on metabolic parameters (lipid parameters, blood glucose level and insulin sensitivity) as well as on left ventricular function. If hypertension is associated with cardiovascular diseases (left ventricular dysfunction, ischaemic hears disease, atrial fibrillation), nebivolol offers an excellent therapeutic alternative due to its excellent tolerability and side effect profile]