Lege Artis Medicinae

[ASCOT-LLA ]

MATOS Lajos

OCTOBER 20, 2003

Lege Artis Medicinae - 2003;13(07)

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Lege Artis Medicinae

[MOTOR VEHICLE ACCIDENT WITH COMPLETE LOSS OF CONSCIOUSNESS DUE TO VASOVAGAL SYNCOPE]

VARGA Emma, WÓRUM Ferenc, SZABÓ Zoltán, VARGA Mihály, BARTA Kitti, LŐRINCZ István

[INTRODUCTION - Vasovagal syncope is one of the most common causes of complete or partial loss of consciousness, thus it might cause harm to the patients themselves or innocent bystanders while driving a car. CASE REPORT - In our case report we introduce the case of a 60-year-old man who was admitted to hospital after a serious motor vehicle accident due to loss of consciousness. We demonstrate the process and results of complete cardiologic and neurological assessment. Our case report illustrates the importance of recognition of patients with a high risk for incapacitating symptoms due to vasodepressor type vaso vagal syncope and the use of head-up tilt-table test to determine the diagnosis and to guide combined management. CONCLUSION - As transient loss of consciousness during driving may cause potentially fatal accident, it has to be taken into consideration during decision making for issue of driving license in patients with vaso vagal syncope.]

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Lege Artis Medicinae

[DIAGNOSTIC PROCEDURES AND SUCCESSFUL TREATMENT OF A RARE INTRAABDOMINAL NEOPLASM IN AN UNCOMMON LOCALISATION]

KIS János Tibor, PÁLHEGYI Erika

[INTRODUCTION - Primary neoplasms of the grater omentum are rarely revealed. The primitive neuroectodermal tumor of the grater omentum is extremely rare, only one case has been reported in the English literature. CASE REPORT - We report a case of an omental tumour occurring in a 50-year-old man with HBV-positive liver cirrhosis (Child C). The patient had regular check-ups in our outpatient clinic. One of the regular ultrasound scans revealed an epigastrial space-occupying lesion, which was not seen previously. The symptoms and the laboratory tests did not suggest an intraabdominal malignancy. Abdominal CT scan did not raise the suspicion of a neoplastic lesion either. Some weeks later a sudden increase in the amount of ascites has developed. A repeated abdominal ultrasound scan detected the tumour again. The reassessment of the CT scan provided some suspicion of the presence of an abdominal neoplasm. After draining the ascitic fluid by paracentesis an apple-sized nodule was palpable. Abdominal US-guided biopsy was performed. On histopathological examination the diagnosis of a primary peritoneal neuroectodermal tumour was made. Laparotomy proved the precise location but the tumorous conglomeration could not be removed as a whole. Following surgery the patient was treated in the oncology department and a significant improvement could be achieved. CONCLUSION - This case highlights the importance of the correlation of the clinical data and imaging techniques and the necessity of regular patient follow-up.]

Lege Artis Medicinae

[Early Nasojejunal Feeding in Acute Pancreatitis]

OLÁH Attila, PARKAVI Gábor, BÉLÁGYI Tibor, NAGY Attila, ISSEKUTZ Ákos, MOHAMED E. Gamal

Lege Artis Medicinae

[The 18th International Conference on Allergy and Clinical Immunology 7-12 September 2003, Vancouver]

HIRSCHBERG Andor

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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-BPLA]

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]

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.]