Lege Artis Medicinae

[MEDICINAL HERBS IN THE TREATMENT OF LIVER DISEASES]

SCHULLER János

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[Today, alternative medicine is increasingly popular among patients. Patients with liver diseases surprisingly often use complementary treatment, mainly medicinal herbs, with or without the knowledge of their physician. This is one of the reasons why doctors may not ignore alternative medicine. Another reason is that twenty to thirty percent of medicaments now used in conventional therapy were originally produced from herbs. This means that some of the herbal medicines now applied in alternative therapy may become a conventional drug in the future. This paper reviews publications of evidencebased medicine on herbal medicines most often used in the treatment of liver diseases, including silymarin, glycyrrhizin, phyllantus amarus, CH- 100, LIV.52, sho-saiko-to, bin-gan, compund 861 and oxymatrine. It is important for physicians to be also knowledgeable about potentially hepatotoxic medicinal herbs.]

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[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.]

Lege Artis Medicinae

[ANTICOAGULATION IN OBSTETRICS]

DOMJÁN Gyula, GADÓ Klára

[The risk of thrombosis is increased about 5 to10 times during pregnancy and in the puerperium. Beside the classic risk factors, this is also due to special obstetrical causes. Delivery, especially Cesarean section further increases susceptibility to thrombosis. Prophylactic or therapeutic anticoagulant treatment can significantly reduce maternal and fetal morbidity and mortality. Just like in the non-pregnant state, subcutaneous low molecular weight heparin or intravenous or subcutaneous unfractionated heparin is recommended in pregnancy if anticoagulation is indicated. Warfarin is contraindicated in the first trimester because of its teratogenicity and also in the third trimester because of its long-lasting effect. Heparin does not cross the placenta, but its long-term administration may cause several side effects. Dosage, starting time and duration of the treatment depend on the measure of the risk of thrombosis. In certain cases (such as antiphospholipid syndrome) anticoagulant therapy is supplemented by low-dose acetylsalicylic acid. The date of delivery can be electively planned to minimalize bleeding and thrombotic complications. Vaginal delivery is preferred because of its lower risk of bleeding compared to Cesarean section. Intensity of anticoagulant therapy in the peripartum period should depend on the risk of thrombosis. The third phase of delivery should be actively driven by giving oxytocin to avoid bleeding complications. Since anticoagulant therapy is often continued during breast-feeding, it is important to know that neither warfarin, nor heparin is secreted in milk. When planning the treatment, each case requires individual consideration based on the type and number of risk factors, gestation time and, importantly, compliance of the patient.]

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KAZY Zoltán, PUHÓ Erzsébet, CZEIZEL Endre

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[Medical anthropology - medical students fieldwork experiences]

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[Legal status and regulation of complementary and alternative medicine in Europe]

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[OBJECTIVE - This study aims to review the current legal status of complementary and alternative medicine (CAM) in the 27 member states and 12 associated states of the European Union (EU). METHODS - We contacted national Ministries of Health and educational institutions of all participating countries, international, local and regional CAM associations and members of the EU project CAMbrella. Literature search was performed in governmental, scientific and popular science websites as well as the web sites/databases of health ministries and EU and Hungarian law documents. RESULTS - All 39 nations have different legislative frameworks and different regulations of CAM. CAM activities are regulated by health legislation in 17 member states, 11 of which have created a specific CAM law, and 6 of which include sections related to CAM in their general health laws. Some countries only regulate several CAM treatments. Preparations, agents and herbal products used in CAM are subject to similar authorization requirements in all countries, comparably to other medicinal products. One exception is the requirement for documentation of efficacy studies. The Directives, Regulations and Resolutions of the EU will affect the conditions that might influence CAM treatment(s) in Europe. CONCLUSION - We experienced an extraordinary diversity in EU countries with regard to the regulation and practice of CAM, but did not find differences in the regulation of herbal products and medicines used in CAM. This motivates patients, practitioners as well as researchers when crossing the borders of European countries. In the current legislative environment we think that harmonisation of law is possible within the EU: individual states within culturally similar regions should harmonise their CAM legislation and regulation. This would probably safeguard against inadequately justified, over- or underregulated practice at national levels. In Hungary, modifications of the decree regulating on CAM are currently being prepared following professional recommendations. This outdated decree needs to be reconsidered, as 17 years of practice have shown which practices are worthy to be maintainted, taught and applied within the healthcare system and which should be omitted.]

Clinical Neuroscience

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.