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

[LIMB LENGTHENING]

VÍZKELETY Tibor, KISS Sándor

[The method of gradual limb lengthening plays a significant role in equalizing limb discrepancies, making dwarfs taller, correcting axial and other deformities coexisting with limb deficiency. Limb lengthening is carried out by one of two basic methods: diaphyseal lengthening with the Wagner unilateral distraction apparatus or metaphyseal lengthening with a series of rings and crossed K-wires. Gradual limb lengthening is presently having its golden days. At our institution 302 limb lengthening intervention were done between 1977 and 2002, 164 cases with Wagner, 137 cases with Ilizarov method, and one distraction epiphyseolysis. In average, 4.1 cm lengthening was achieved, 18.4% of the original length of the bone. The high incidence of complications was due to superficial infections at the entry points of the Kwires, infrequently worsening the outcome of the operation. Operative limb lengthening performed with appropriate indications and technique is a successful and rewarding area of orthopaedic surgery.]

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

[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.]

Lege Artis Medicinae

[NEW DISORDERS OF EATING AND OF BODY IMAGE]

TÚRY Ferenc, LUKÁCS Liza, RÁCZ Olimpia, HORVÁTH Krisztina

[Eating disorders show an important change in the last few decades concerning their frequency and clinical picture, as well. Besides bulimia nervosa, which was described two decades ago, muscle dysmorphia appeared ten years ago as a special body image disorder of males, regarded as a reverse form of anorexia nervosa in females. Eating disorder, body builder type was described only in 2000, meaning an overconcern about the body composition and muscle mass, accompanied by strict dieting rules. Another type of these disorders was described also in 2000, the nontraditional gender role in women, which is a strong preference for male characteristics and activities, the person being comfortable with her sex, while there is no intersex condition. This overview discusses the proposed diagnostic criteria and the role of some sociocultural factors in these recent disorders.]

Lege Artis Medicinae

[EXERCISE-INDUCED BRONCHOCONSTRICTION]

VIZI Éva, CSOMA Zsuzsanna, HUSZÁR Éva

[Exercise-induced bronchoconstriction describes the transient narrowing of the airways occurring during and most often after vigorous exercise. The mechanism of exercise-induced bronchoconstriction remains elusive, although airway drying and cooling plays a prominent role. The severity of this reaction depends on the temperature and the water content of the inspired air, the type and concentration of air pollutants inspired and the intensity of the exercise. Diagnosis of exercise-induced bronchoconstriction should include baseline spirometry followed by an exercise challenge test. The exercise can be a free-running test or a laboratory based test using a cycle-ergometer or a treadmill. Pre- and post-exercise pulmonary function should be compared, 10%-15% postexercise fall in forced expiratory volume in 1 second (FEV1) is used as a diagnostic criteria (10% in laboratory test, 15% in free-running test). Heat loss, water loss, post exertional airway rewarming and the role of several mediators have been proposed as possible mechanisms responsible for the airway obstruction induced by exercise. Exercise-induced bronchoconstriction can be easily diagnosed and treated in the majority of patients. When properly treated, asthmatic individuals should be able to participate or compete in the majority of sports.]

All articles in the issue

Related contents

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.]

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.]