Lege Artis Medicinae

[BETA-CELL DYSFUNCTION AND PROTECTION IN TYPE 2 DIABETES]

VÁNDORFI Győző, URICH Elemér

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[Type 2 diabetes is caused by increased insulin resistance coupled with the disturbance of the secretion function of beta-cells. While the importance of insulin resistance has been emphasized in the last two decades, the pathogenetic role of beta-cell dysfunction has received less attention. Regarding this latter, several underlying mechanisms have been implicated, including increased secretory demand due to insulin resistance, glucose toxicity, lipotoxicity, islet cell amyloid deposition, and insulin resistance of the beta-cells themselves. In the milestone UKPDS (United Kingdom Prospective Diabetes Study) trial the metabolic status of the patients gradually deteriorated after 1 to 2 year of temporary improvement despite of an intensive sulfonylurea, insulin or metformin treatment. Progression of the disease could be slowed down but not stopped, which was attributed to progressive beta-cell failure. In this regard the insulinsensitizer thiazolidinediones, having recently joined the therapeutic palette, are promising because they protect and spare beta-cells through several ways. However, as the disease carrier progresses, it can reach a point when without using insulin the treatment cannot be successful anymore. Early use of thiazolidinediones may result in a marked delay of this point. This concept is supported by studies completed so far, and further clinical trials are ongoing so as to strengthen the evidence.]

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[Requiem - For the fiftieth anniversary of the foundation of the Institute for Postgraduate Medical Education]

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[LOWER LIMB PAIN OF VASCULAR ORIGIN]

MESKÓ Éva

[The paper describes the characteristics of limb pain associated with acute and chronic arterial occlusions, venous and lymphatic diseases, and underlines the importance of early diagnosis and treatment that may determine the fate of the limb. The type of leg ulcer developing as a complication of an arterial or venous disease can usually be diagnosed by the inspection of the leg. Symptoms that accompany venous thrombosis of the leg often pose serious differential diagnostic problems. The venous sinuses of the leg are of great clinical importance. Thromboses occurring in these are usually recognized late, thus adequate therapy is also started belatedly. Correct diagnosis determines the therapy to be chosen. The diseases of lymphatic vessels often produce tense leg pain by concomitant venous oedema. Peripheral arterial disease has been shown to be an independent risk factor of cardiovascular morbidity and mortality. In view of this, early recognition and adequate therapy of vascular changes in the lower limb may prevent its progression to a life-threatening vascular disease affecting the whole body. In humans, individual vascular diseases develop in various times and locations, but with a similar pathomechanism. Based on this rule, cerebral, cardiac and peripheral localisation of the vascular disease must be searched for in each patient. High professional standards and a uniform diagnostic thinking are key elements of success. This is promoted in the paper by a flow-chart indicating the steps to be taken by the GP in the management and care of patients with vascular disease.]

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[DISEASES OF THE SPINE ACCOMPANIED BY LOWER BACK PAIN]

TÓTH Edit Ágnes

[It is estimated that 80% of the adult population consult their general practitioner for lower back pain at some point in their life. Apart from family doctors all medical specialists may encounter this complaint, which makes the wide-spread knowledge of this topic desirable. Pain associated with spinal diseases has two distinct types, non-inflammatory and inflammatory pain. Non-inflammatory diseases may cause moderate pain that increases with movement or functional limitation lasting for a few days, other times cause a pain pattern of varying intensity that radiates to the lower extremities and is accompanied by neurological symptoms, more rarely, present as cauda equina syndrome. In most cases, the underlying cause of the symptoms is a degenerative disorder of the spine. Spinal pain of inflammatory origin, on the other hand, is characterized by pain that worsens at night, characteristically narrowed mobility, changes in the skin, mucous membranes and joints, and sometimes fever or bad general condition. This type of pain is primarily caused by seronegative spondyloarthritis or, rarely, various pyogenic or non-pyogenic bacterial infections. Management of lower back pain aims to cease pain and restore function. These are achieved by unloading, medical pain relief, antiinflammatory drugs, muscle relaxants and antidepressants, as well as physiotherapy. In special cases the administration of other drugs (e.g., antibiotics) may be necessary along with pain relief. In seronegative spondyloarthritis traditional approaches will hopefully be supplemented by biological therapy in the future. This review of recently published results on spinal diseases accompanied by lower back pain will possibly help doctors in state-of-the art care of their patients.]

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