Lege Artis Medicinae

[LATE EFFECTS OF TREATMENT FOR DECREASING CARDIOVASCULAR RISK “CARDIOMETABOLIC THERAPEUTIC MEMORY” - A HYPOTHESIS]

JERMENDY György

JULY 14, 2008

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

[In several randomised, controlled clinical studies conducted to decrease cardiovascular morbidity and mortality, there was long-term observational follow-up after the termination of the double-blind phase. There is evidence that the beneficial effect of the therapeutic intervention in the active study phase was maintained in the follow-up period. This phenomenon was observed both for life-style modification and for pharmacological intervention, including the use of ACE-inhibitors, statins, fibrates and intensive insulin treatment. This fact suggests the possibility that even after several years, the body “remembers” the beneficial effects of the cardiovascular risk reduction achieved years earlier. The phenomenon may be called “cardiometabolic therapeutic memory”.]

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[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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