Lege Artis Medicinae

[LOWER LIMB PAIN OF VASCULAR ORIGIN]

MESKÓ Éva

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[The paper describes the characteristics of limb pain associated with acute and chronic arterial occlusions, venous and lymphatic diseases, and underlines the importance of early diagnosis and treatment that may determine the fate of the limb. The type of leg ulcer developing as a complication of an arterial or venous disease can usually be diagnosed by the inspection of the leg. Symptoms that accompany venous thrombosis of the leg often pose serious differential diagnostic problems. The venous sinuses of the leg are of great clinical importance. Thromboses occurring in these are usually recognized late, thus adequate therapy is also started belatedly. Correct diagnosis determines the therapy to be chosen. The diseases of lymphatic vessels often produce tense leg pain by concomitant venous oedema. Peripheral arterial disease has been shown to be an independent risk factor of cardiovascular morbidity and mortality. In view of this, early recognition and adequate therapy of vascular changes in the lower limb may prevent its progression to a life-threatening vascular disease affecting the whole body. In humans, individual vascular diseases develop in various times and locations, but with a similar pathomechanism. Based on this rule, cerebral, cardiac and peripheral localisation of the vascular disease must be searched for in each patient. High professional standards and a uniform diagnostic thinking are key elements of success. This is promoted in the paper by a flow-chart indicating the steps to be taken by the GP in the management and care of patients with vascular disease.]

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[Hormone depletion after menopause results in the dramatic increase of the incidence of a number of diseases. It should seem reasonable to substitute female hormones to prevent or treat these disorders. However, hormone replacement therapy has not fulfilled the expectations in its current form. While the first large, prospective, randomized, controlled primary prevention trial showed a beneficial effect of hormone replacement on bone fracture and colorectal cancer, the incidence of cardiovascular diseases and breast cancer increased. The overall effect of treatment was assessed by the so called global index. Based on the global index, the overall health risk exceeded benefits from 5 years use of combined oestrogen plus progestin among healthy postmenopausal women. In another study, oestrogen alone did not affect the incidence of coronary heart disease or colorectal cancer, neither was the increase in breast cancer rate significant. Similarly to combination therapy, the beneficial effect on bone fracture rate and the adverse effect on the incidence of cerebrovascular events have remained. Overall, oestrogen monotherapy had no effect on the global index. There is not enough data available yet to draw a conclusion on the overall effect of fitooestrogens that also target oestrogen receptors and tibolon, a steroid hormone with tissue-specific effects. Raloxifene, a selective oestrogen receptor modulator considerably decreases the rate of vertebral fractures. In a study it also decreased the number of peripheral fractures in a subgroup of patients with severe vertebral fractures. It reduced the rate of cardiovascular and cerebrovascular events in patients at increased cardiovascular risk. The incidence of breast cancer dropped both in the original 4-year study period and in its 4-year extension. Based on the beneficial change of the global index, it is only raloxifen that can currently be recommended for the complex treatment of postmenopausal women.]

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Lege Artis Medicinae

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