Lege Artis Medicinae

[Pharmacies in Byzantium]

JÓZSA László

FEBRUARY 20, 2009

Lege Artis Medicinae - 2009;19(02)

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Lege Artis Medicinae

[I planted a ginkgo biloba]

NAGY Viktor

Lege Artis Medicinae

[Treatment of acute pancreatitis, with special regard to pharmaceutical therapy]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]

Lege Artis Medicinae

[Sudden cardiac death in athletes - cardiac electrophysiology point of view]

VARRÓ András

[Sudden cardiac death of athletes is very rare (1/50 000 to 1/100 000 annually) but it is still 2 to 4 times more frequent than that of the agematched normal population. In addition, it attracts peculiar media attention. Sudden cardiac death in athletes is supposed to not primarily have an ischemic origin but most likely relates to repolarization abnormalities. These may be caused by several independent and/or dependent factors such as benign cardiac hypertrophy developing normally in athletes (athlete’s heart), hypertrophic cardiomyopathy, increased sympathetic activity, genetic defects, seemingly harmless drugs, doping agents, food, and dietary supplements. These factors together can increase inhomogeneities in myocardial repolarization (“substrate”). In this case, an otherwise harmless extrasystole (“trigger”) occurring with unlucky timing may - although very seldomly - elicit fatal arrhythmias. Thus, effective prevention of sudden cardiac death may include new types of cost-effective cardiac electrophysiological screening methods (ECG or echocardiography) and, in case of a high level of suspicion, more costly genetic tests can be considered.]

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[Labiolingual lesions - important symptoms of a rare endocrine syndrome]

SALLAI Ágnes, HOSSZÚ ÉVA, GERGICS Péter, RÁCZ Károly, FEKETE György

Lege Artis Medicinae

[Practical considerations in the state-of-the-art management of ankylosing spondylitis]

SZÁNTÓ Sándor, SZEKANECZ Zoltán

[Ankylosing spondylitis is an inflammatory rheumatic disease characterized by inflammation of the spinal and sacroiliacal joints, which causes chronic back pain and ultimately spinal stiffness, impaired motility, and deformity. Until the last decade, treatment mainly consisted of a combination of physical therapy and non-steroidal anti-inflammatory drugs, but recently tumor necrosis factor-α inhibitors revolutionized therapy and improved clinical outcomes. Tumor necrosis factor-α inhibitors effectively control inflammation of the sacroiliacal and spinal joints as shown by improved signs symptoms, and functions, magnetic resonance imaging findings, and reduction of acute phase reactants. Whether these drugs are capable of preventing radiographic progression and structural damage has, however, to be clarified in future studies. This review aims to highlight recent progress in the treatment of ankylosing spondylitis, and to provide recommendations for its management.]

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[The beginnings and difficulties of peritoneal dialysis at the end of the last century. Part II. Hungarian experiences]

KARÁTSON András

[In Part I, I summarised the beginnings, the theoretical background and the international experiences of peritoneal dialysis. Hungarian publications related to peritoneal dialysis in the 1950s were focusing on the role of the method in the treatment of chronic renal disorders. The first dialysis centres were established in the medical universities of Hungary (Szeged in 1955, Budapest in 1960, Pécs in 1964, Debrecen in 1970) and in Miskolc in 1968. Despite the restricted hemodialysis capacities the intermittent technique of peritoneal dialysis did not spread in accordance with the demand. A survey conducted at the beginning of the 1970’s in the territory of the five counties with 1.5 million inhabitants revealed that considering the numbers of patients with renal diseases requiring dialysis, developing of a network of care and increasing the dialysis capacities is necessary and so is the development of a system of szatellite peritoneal dialysis, which was implemented with our support in 10 units of the county hospitals. A devoted and enthusiastic organiser of the nation-wide system of peritoneal dialysis was professor Taraba, who, due to his untimely death, was deprived of seeing the nation-wide spread of CAPD. At the beginning of the 1980’s the first reports on the favourable effects of CAPD appeared in Hungary. Solutions prepared in pharmacies and the lack of up-to-date equipment resulted in the frequent occurrence of peritonitis. In addition, the unfavourable memories of dialysis performed with bottled solutions (long treatment times, frequently peritonitis) were still vivid among patients and colleagues supervising the treatment. As a consequence, our survey conducted in 1991 revealed that the spread of CAPD all over the world in Hungary resulted in a significant increase of those treated with the intermittent method (more than 10% of the dialysis patients), while those treated with CAPD remained under 2%. Several reports on CAPD and the consequences that followed from them as well as the further training organised in the Szent Margit Hospital, Budapest and in Gánt, and also the guidelines issued by the Society of Hungarian Nephrologists the number of those treated with dialysis has exceeded 6000 in the past decade. 10% of them received CAPD/APD treatment.]

Hypertension and nephrology

[Change in prescribing RAS inhibitors with respect of data of National Health Insurance Fund (NHIF)]

BARNA István, GYURCSÁNYI András

[The authors examined and analyzed monthly data of accounted prescription sales that were supported by the National Health Insurance Fund. They wished to determine how the use of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) had changed. They separately evaluated how much this data was in accordance with the several, recently published articles about clinical trial results that compared inhibitors of the renin-angiotensin system (RAS inhibitors). It seemed worthwhile to examine the use of RAS inhibitors in Hungary and more specifically where RAS inhibitors stand among subsidized drugs based on the National Health Insurance Fund (OEP) database. The processed data was obtained from the National Health Insurance database, in the Decembers of 2007-2012 years and was based on prescription sales in pharmacies that were accounted for by the National Health Insurance Fund. During the data analysis we examined the number of prescriptions accounted for by looking at ATC codes and molecules, and examined the number of products (brands) available by ATC with Social Insurance Support in the given period. We examined the monthly turnover of ACE inhibitors and ARB products and the kedveamount of Social Insurance Support on these prescriptions in the given period. Next, we analyzed how much the average cost of prescriptions was by ATC codes and what kind of molecules have been available in Hungary with Social Insurance Support according to ATC codes.]

Clinical Neuroscience

[A novel analgesic made from cannabis]

SZENDREI Kálmán

[Bayer AG has recently announced that it acquired exclusive rights for the marketing of GW Pharmaceuticals´ new medicine Sativex® in Europe and in other regions. Sativex is a sublingual spray on Cannabis extract basis, and is equipped with an electronic tool to facilitate accurate dosing and to prevent misuses. It is standardized for the THC and CBD. The new analgesic is proposed for the treatment of muscle spasticity and pains accompanying multiple sclerosis and as an efficient analgetic for neurogenic pain not responding well to opioids and to other therapies available. The entirely new mechanism of action through the recently discovered cannabinoid receptor system may offer a real therapeutic potential to the drug. Although the Government of Netherlands has authorized the sale of pharmaceutical grade Cannabis herb by pharmacies in the Netherlands, the availability on the pharmaceutical market of the registered preparation may render requests for the authorization of the smoking of Cannabis herb (marihuana) by individuals suffering of multiple sclerosis, neurogenic pain, AIDS wasting syndrome unnecessary. Nevertheless, the ”old chameleon” plant Cannabis appears to gradually regain its previous status in mainstream therapy and pharmacy. As long as the plant Cannabis and its products continue to be classified as narcotic drugs, medical use of the new preparation will need close supervision.]