Lege Artis Medicinae

[EUROPA]

NAGY Viktor

DECEMBER 20, 2003

Lege Artis Medicinae - 2003;13(08)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Nobel Prize in Medicine for the Pioneers of MR Imaging]

MARTOS János

Lege Artis Medicinae

[A New Solution in the Treatment of Cerebral Edema in Patients Requiring Decompressive Craniectomy Formation of a Vascular Channel in the Treatment of Cerebral Edema in Posttraumatic and Ischemic Stroke Patients Requiring Decompressive Craniectomy]

CSÓKAY András, EGYÜD László, PATAKI Gergely

Lege Artis Medicinae

[THE VALUE OF RENAL BIOPSY IN DIABETES]

NAGY Judit, DEGRELL Péter, EKNOYAN Garabed, WITTMANN István

[The relentless increase of patients with kidney failure requiring renal replacement therapy has been documented world-wide. Recently, diabetic renal diseases has become the major cause of end-stage renal disease in the United States and in western Europe and is forecasted to become the most frequent cause of end-stage renal disease in Hungary. The most common renal lesion in type 1 as well as in type 2 diabetes is diabetic nephropathy. However, in the last few years numerous studies have demonstrated that there is a difference between patients with type 1 and those with type 2 diabetes in the expression and frequency of their renal disease. In type 1 diabetes a histological examination should only be made when a patient has features atypical of diabetic nephropathy and the indications of renal biopsy are well known. At the same time there is no agreement on renal biopsy indications in type 2 diabetes. In this review, we will summarise the characteristic features of diabetic nephropathy and other kidney alterations in the diabetic patient. Furthermore, we will raise the question of the renal biopsy indications and the more extensive use of the renal biopsy in type 2 diabetic patients for more effective prevention and treatment strategies.]

Lege Artis Medicinae

[CEREBRAL AMYLOID ANGIOPATHY - A FATAL CASE OF RECURRENT MULTIFOCAL CEREBRAL HEMORRHAGE]

POGÁNY Péter, HERMANN Zsuzsa

[Atherosclerosis and hypertension are the leading etiological factors in the pathogenesis of cerebral hemorrhage. With old age though, several other factors may appear of which cerebral amyloid angiopathy (CAA) is of major importance. This condition is characterized by the deposition of β-amyloid in the leptomeningeal vessels as well as in the small and medium sized arteries of the cerebral cortex and it is not associated with systemic amyloidosis. This pathological protein is also seen in the brains of otherwise healthy older individuals and may also appear in other diseases such as Alzheimer disease, Down-syndrome, vascular malformations, spongiform encephalopathy and dementia pugilistica. The condition may be asymptomatic but it may also cause cerebral hemorrhage, dementia or various transient neurological symptoms. Most cases are sporadic, but familial subtypes have also been described.]

Lege Artis Medicinae

[PRESENTATION OF DIFFUSE INTERSTITIAL LUNG DISEASES BY THE NEW CLINICORADIOLOGICAL- PATHOLOGICAL ASPECT]

SZOLNOKI Erzsébet, DÉVÉNYI Katalin, DANKÓ Enikő, DEZSŐ Balázs, SZILASI Mária

[The aim of the authors was to overview the different forms of diffuse interstitial lung disease based on newly established radiological (HRCT) pattern and histopathological analysis beyond the clinical picture. Idiopathic pulmonary fibrosis is emphasized having also historical importance and possible therapeutic antifibrotic interventions are discussed as well.]

All articles in the issue

Related contents

Lege Artis Medicinae

[ACE-INHIBITORS IN THE SECONDARY PREVENTION OF CORONARY ARTERY DISEASE]

SÁRSZEGI Zsolt

[The beneficial effects of angiotensin-converting enzyme inhibitors on biochemical and vascular markers have been proven by many experimental studies. Reduction of the angiotensin-II level has a positive effect on oxidative stress, lipid peroxidation, apoptosis, inflammatory and prothrombotic processes. Two large multicentric trials, EUROPA and HOPE, showed that perindopril and ramipril significantly reduce mortality and the risk of both fatal and non-fatal cardiovascular events in patients with atherosclerosis, thereby making them the base drugs of secondary prevention of coronary artery disease.]

Lege Artis Medicinae

[Examination of the synergic effect between perindopril and calcium channel blockers - Post hoc analysis of the EUROPA study]

NAGY Viktor

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

[ROLE OF TISSUE ANGIOTENSIN CONVERTING ENZYME IN CARDIOVASCULAR DISEASES]

MOHÁCSI Attila, LIZANECZ Erzsébet, ÉDES István, CZURIGA István

[The pathobiological aim of treatment with angiotensin converting enzyme inhibitor is to restore the balance between nitrogen-monoxide and angiotensin II due to inhibition of blood and tissue angiotensin converting enzyme. The clinical consquences of the inhibition of tissue angiotensin converting enzyme in patients with additionally high (HOPE) and low (EUROPA) cardiovascular risk without left ventricular dysfunction has already been demonstrated. Ramipril and the perindopril reduce the risk of combined end-point of these trials such as cardiovascular mortality, reinfarction and resuscitated sudden cardiac death. However, pharmacological and genetic differences in blocking of tissue angiotensin converting enzyme may influence the cardioprotective effect of various angiotensin converting enzyme inhibitors. Thus new, well-designed, controlled clinical trials are needed to determine the role of angiotensin converting enzyme inhibitor with different tissue angiotensin converting enzyme affinity in cardiovascular disease.]