Lege Artis Medicinae

[EVET ]

MATOS Lajos

OCTOBER 20, 2003

Lege Artis Medicinae - 2003;13(07)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Scientific Browsing]

Lege Artis Medicinae

[NEW MODALITIES IN THE TREATMENT OF CHRONIC VIRAL HEPATITIS C: PEGYLATED INTERFERONS]

GERVAIN Judit, NEMESÁNSZKY Elemér, CSEPREGI Antal

[Interferon-α proved to be the most effective therapy of chronic hepatitis C. Its combination with ribavirin enhances the antiviral activity and this modality has become the therapeutic standard recommended worldwide during the past few years. Metaanalysis of the international studies revealed that only 12-19% of the patients became virus-free following a 48-week long course of α interferon monotherapy. The combination treatment with ribavirin for 48 weeks increased the proportion of sustained responders to 35-45%. The introduction of pegylated interferons resulted in significantly higher response rates. The new therapeutic possibilities are due to the modified pharmacokinetic characteristics of the drug by changing the size and the structure of the molecules. Multicentre studies investigating the clinical effectiveness of the 40 kD sized pegylated interferon α-2a as well as the 12 kD sized pegylated interferon α-2b in combination with ribavirin reported 56% and 54% response rate, respectively. However, there is significant heterogeneity in the results according to the type of drug administered and to the genotype of the hepatitis C virus, as well as in the basal viral level and the stage of hepatic fibrosis, respectively. The message and the conclusion of the viral kinetic studies are worth remembering: if the result of the HCV nucleic acid test is still positive at week 12 or 24, therapy should be ceased due to the patient non-responder status. Since pegylated interferons are also available in Hungary the authors felt useful to give an overview of the current knowledge, summarizing the results of the relevant studies and provide a suggested state-of-the-art therapeutic protocol based on international consensus.]

Lege Artis Medicinae

[Going further on the footprints of the past]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[ASCOT-LLA ]

MATOS Lajos

Lege Artis Medicinae

[AGRESSIVE STRATEGIES IN THE TREATMENT OF INFECTIVE ENDOCARDITIS]

LENGYEL Mária

[Without treatment, infective endocarditis (IE) is a fatal disease and in spite of contemporary diagnostic and therapeutic tools its prognosis is still poor. The most important first step is the early rise of clinical suspicion which should be confirmed by the new clinical criteria. Echocardiography is a major criterium: transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) both in the diagnosis and in the detection of complications of infective endocarditis. Complications can be valvular (embolism, valvular dysfunction) or perivalvular (abscess, pseudoaneurysm formation) with hemodynamic consequences. TEE is recommended as the first line diagnostic technique (mostly in prosthetic valve infective endocarditis) or as a second study following negative TTE or positive TTE with high clinical risk factors or to define embolic risk. In addition to classical surgical indications, early ”preventive” indications are emphasized which can decrease the still high operative mortality. Improvement of outcome in infective endocarditis can only be expected with agressive management meaning early suspicion, early TEE and early operation.]

All articles in the issue

Related contents