Lege Artis Medicinae

[Consensus or chaos?]

GRÉTSY Zsombor

APRIL 20, 2001

Lege Artis Medicinae - 2001;11(04)

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Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[Reducing lung cancer mortality through prevention]

KOVÁCS GÁBOR, OSTOROS Gyula, PATAKI Géza

[Effective therapy for lung cancer is yet unknown and the role of prevention has continuously increased. In practice, primary prevention of lung cancer means the reduction of smoking either by cessation or by patient education. Screening for lung cancer, considered as a secondary prevention measure, has long been debated. The previously negative attitude for screening has slowly changed in the past years. New studies have been organised recently to make screening more effective. In high risk groups, helical CT-scans with low dose X-ray exposure are preferred and the effectivity of sputum citology completed with immunocytochemical tests is under investigation. Determining the risk group, we focus on age, smoking history, airway obstruction and certain tumour markers. With the help of traditional chest X-rays approximately one third of new cases of lung cancer are discovered in Hungary. Our reasonable target is to identify 60-70% of the new NSCLC cases by risk group screening (age>40 years, smoking>20 P.Y., decrease of FEV1>15%, family lung cancer history and previous asbestos exposure) and by organising population screening more effectively.]

Lege Artis Medicinae

[New oral antidiabetic agents - New aspects in the management of type 2 diabetes mellitus]

GERŐ László

[During the past years several new oral antidiabetic agents have become available and more new drugs of this type are expected to appear on the market. New products appeared in both groups of insulin sensitizers and insulin secretagogues. Modern insulin secretagogues are characterized by immediate and short action. As a consequence, insulin secretion will approach the physiological secretory pattern. The rapid, short-term insulin output prevents the abnormal increase of postprandial glucose level and - at the same time - the danger of late hypoglycemia will decrease. The combination of insulin sensitizers with the new insulin secretagogues provides the possibility to apply the basisbolus therapeutical principle to type 2 diabetic patients treated with oral agents.]

Lege Artis Medicinae

[Percutaneous coronary intervention in ischaemic heart disease]

VOITH László

[In ischaemic heart disease, if the medically treated patient’s anginal complaints and/or ischaemic symptoms are persistent, coronary angiography, and according to its results, coronary intervention (surgery or dilatation) may become necessary. The intervention is required in critical stenosis (>70% diameter) of the main vessels, the emergency depends on the clinical situation. Basic method of coronary angioplasty is the balloon dilatation, other tools (stent, rotablator, laser wire, atherectomy device, etc.) are also available. Periprocedural anticoagulant (heparin) and platelet aggregation inhibitor (aspirin, ticlopidine, GP IIb/III/a receptor blocker) treatment is required, the latter after the procedure as well. After stent implantation the lumen of the vessel is bigger and the incidence of major adverse cardiac events (acute myocardial infarction, repeated intervention, fatal outcome) is diminished. Decrease of serum lipid level improves the outcome of coronary angioplasty. It is applicable successfully for multiple lesions, occluded vessels, stable and unstable angina, in the early phase of myocardial infarction, in patients who underwent coronary surgery, and in old age too. Risk factors of the intervention are: tortuous vessel, significant calcification, stenosis in angle or ostium, luminal thrombus, urgent intervention, old age, female gender, congestive heart failure, unstable condition and acute myocardial infarction. When indicating the intervention, besides the probable results, it is necessary to consider the possibility of complications (myocardial infarction, malignant rhythm disorders, acute heart failure, bleeding, etc.). In left main stem stenosis, 3 vessel disease and in the case of 1 functioning coronary artery surgery would be preferable. With the present facilities the ratio of urgent surgical intervention as well as the mortality is below 1%.]

Lege Artis Medicinae

[TONE]

MATOS Lajos

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Lege Artis Medicinae

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