Lege Artis Medicinae

[HYVET (HYpertension in the Very Elderly Trial)]

MATOS Lajos

JULY 14, 2008

Lege Artis Medicinae - 2008;18(06-07)

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Lege Artis Medicinae

[UNSOLVED THERAPY - COMPLEX TREATMENT OF BUERGER’S DISEASE]

SZOMJÁK Edit, DÉR Henrietta, KEREKES György, VERES Katalin, DEZSŐ Balázs, TAKÁCS István, TÓTH Judit, MÓZES Péter, SOLTÉSZ Pál

[INTRODUCTION - Buerger’s disease is a nonatherosclerotic, segmental, inflammatory, progressive obliterative disease of the blood vessels that most commonly affects the small and medium-sized arteries and also the veins of the lower limb. It is strongly associated with tobacco use. CASE REPORT - A 37-year-old heavy smoker forest worker presented with severe gangrenous changes on the fingers as the upper limb manifestations of Buerger’s disease, which required acral amputation. After complex medical treatment, pharmacological sympathectomy on the left side and surgical sympathectomy on the right side, bilateral conserving necrectomy, cessation of smoking and 2 cycles of cyclophosphamid, the patient's status significantly improved, his pain diminished and, although to a limited extent, he could use both hands. CONCLUSIONS - Buerger’s disease is a disorder with unclear aethiology and is difficult to diagnose. Despite of a good prognosis, a causal treatment is not yet possible, so any antithrombotic, haemorheological, vasodilator or immunosuppressive therapy that have been reported to have beneficial effect should be considered for treatment.]

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[“I Want Magic!” A Discussion with Dóra Elek, Director of the Baltazár Theatrical Group]

GYIMESI Ágnes

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BAJOR Judit

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BALIKÓ Zoltán

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BODA Zoltán

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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