[Diuretic treatment]
RADÓ János
FEBRUARY 20, 2003
Lege Artis Medicinae - 2003;13(02)
RADÓ János
FEBRUARY 20, 2003
Lege Artis Medicinae - 2003;13(02)
[Diuretics are used almost in all fields of medical practice for treating patients in various conditions associated with or without oedema. They exert their effects through profound alterations in the fluid volumes, ion content of the body and in the osmoregulation. They act mainly on the kidneys but the functions of several other organs are also influenced including the heart and vessels, the lungs, liver and the brain. Summarising our knowledge on the diuretics is justified by the broadened use of these drugs and the differences regarding their site of action, potency, way of administration, dosing and side effects. The special indications for diuretic therapy and combined usage of different diuretics are also reviewed.]
Lege Artis Medicinae
[INTRODUCTION - The most frequent manifestations of primary hyperparathyroidism are renal stones or calcipenic osteopathy. The aim of authors was to examine how bones are affected (change of bone mineral density and frequency of fractures) in the renal form of primary hyperparathyroidism. METHODS - Mean age of the patients was 57 years (26 -81 years), (4 men, 33 women). Bone mineral density was measured in the lower third of the radius, femoral neck and lumbar 2-4 vertebrae by densitometers. Moreover, occurrence of fractures and biochemical parameters characteristic for hyperparathyroidism (serum parathyroid hormone levels, calcium, phosphorus, alkaline phosphatase, urinary calcium/ creatinine) were examined. RESULTS - Bone mineral density was normal in 6 cases, osteopenic in 10 patients and 21 patients had osteoporosis. Altogether five patients had fractures. Bone mineral density and biochemical parameters were not different in patients with or without fractures. CONCLUSIONS - Bone mineral density decreases in renal form of primary hyperparathyroidism even if there is no bone disease in the clinical picture. Therefore, bone mineral density measurement is advisable for every patient with hyperparathyroidism.]
Lege Artis Medicinae
Lege Artis Medicinae
[Author gives a review of the surgical procedures, advantages and disadvantages of urinary diversion and bladder replacement techniques. Orthotopic bladder replacement is presented in detail, outlining also the complications. The questions affecting general practitioners, as well as gynaecologists, surgeons and internists are also discussed at length. The different techniques of bladder replacement have become widely accepted in Hungary within the past few years. It is important therefore that all physicians involved in the care of these patients become well acquainted with the possible complications and the changes in the lifestyle of these patients.]
Lege Artis Medicinae
[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]
Hypertension and nephrology
[It is known that hypertension shows several gender specific elements both in pathogenesis and in therapy. Understanding this phenomenon may bring us closer to individualized therapy. That was the reason why we examined process of hypertensive adaptation on the level of small intramural coronary arteries. 10-10 male and female Sprague-Dawley rats were used in this study. Animals received osmotic pumps in anaesthesia, which emitted 100 ng/bwkg/min angiotensin II acetate for four weeks. After four weeks treatment, animals were sacrified and heart weights were measured. We isolated intramural, small branches of the left anterior descendant coronary artery, placed them into vessel chamber and tested biomechanical properties and pharmacological reactivity. Heart weight and wall thickness were higher in females comparing to males. However, basal vascular tone and thromboxane-mediated vasoconstriction were elevated in males. Bradykinin relaxation was bigger in females. In female animals inward eutrophic remodeling was found, while in males increased wall stress and elastic moduli dominated the adaptation process. In conclusion, initial steps of angiotensin II mediated hypertension induced markedly gender dependent alterations.]
Hypertension and nephrology
[Resistant hypertension developed in a 60-year-old male patient with chronic renal insufficiency due to untreated high blood pressure for decades despite of the coadministration of furosemide, β-blocker, calcium channel blocker, angiotensin converting enzyme inhibitor and angiotensin receptor blocker. Breakthrough could be achieved by the combination of a tiazide compound and a loop diuretic (furosemide). It seemed to be worthwile publishing the case because the tiazide drug could be successfully administered below 30 ml/min GFR, where it is generally thought to be ineffective, and because both elements of the combination was given in very low doses relative to the kidney disease. The literature of the most important combinations of the tiazide preparations and the loop diuretics are reviewed and some historical aspects are given as well.]
LAM Extra for General Practicioners
[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]
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