Lege Artis Medicinae

[QT dispersion - the surface ECG marker of arrhythmic risk]

KUN Csaba, CZURIGA István, LŐRINCZ István

SEPTEMBER 20, 2002

Lege Artis Medicinae - 2002;12(09)

[During the past decade numerous publications have reported the pathophysiological and clinical value of QT dispersion. Increased QT dispersion was observed to be associated with proarrhythmic drug effects, prediction of mortality in heart failure and risk assessment after acute myocardial infarction. Based on the results of the repolarization process research and other significant clinical studies, the meaning and the usefulness of QT dispersion seems to be challenged. The original concept of portraying QT dispersion as a direct measure of regional heterogeneity of myocardial refractoriness is seriously flawed. At the same time, disproving this concept is not a good reason for stating that QT dispersion does not exist. The measurement of QT dispersion seems to be an approximate expression of repolarization abnormalities and should not be taken as a gold standard for a noninvasive estimate of repolarization abnormalities. However, we presently have no decent and widely available alternative to address repolarization abnormalities in standard 12-lead ECG. The authors present the pathophysiological meaning of QT dispersion, the controversies of automatic and manual methodology and the possible clinical relevances based on the most recent studies.]

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Lege Artis Medicinae

[The effect of angiotensin receptor antagonists in diabetic nephropathy]

BÍBOK György

[Influencing the renin-angiotensin system through receptor blockade has become a new therapeutic approach toward the treatment of several morbidities, i.e. hypertension, cardiac failure and diabetic nephropathy. The current paper reviews the importance of diabetic nephropathy, the physiology of the renin-angiotensin system and specific effects of receptor blockade on different organs based on 3 new studies (published last year) using angiotensin-II receptor blockers. The paper gives a summary of the IRMA, IDNT and RENAAL studies, including their clinical and therapeutic significance in general practice as well as in specialized diabetes care. The new therapeutic approach (with an excellent safety profile, and infrequent side effects) could delay the progression or might even prevent the manifestation of diabetic nephropathy not only with lowering blood pressure but with its direct effects on target tissues as well. The angiotensin-II receptor blocking agents might be useful for the treatment of cardiac failure in hypertensive patients.]

Lege Artis Medicinae

[Drug treatment possibilities in chronic liver diseases]

HAGYMÁSI Krisztina, LENGYEL Gabriella, FEHÉR János

[Alcoholic and drug induced liver diseases, nonalcoholic steatohepatitis, hepatitis C and B chronic hepatitis, autoimmune diseases (primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis) and metabolic disorders (hemochromatosis, Wilson's disease) are the main chronic liver diseases. Authors summarize, based on the latest literature data, the medications of chronic liver diseases, emphasizing the treatment of the everyday practice. Natural and synthetic antioxidants are approved for the treatment of chronic alcoholic liver diseases besides abstinence, with diet of adequate quality and quantity. Nucleoside analogues (lamivudin) are recommended for the first-line therapy of the treatment of chronic hepatitis B. Interferon is presently considered the optimal treatment for only certain patients. Interferon and ribavirin combined therapy is well-established in the treatment of chronic hepatitis C. Ursodeoxycholic acid is the beneficial treatment option for primary biliary cirrhosis and primary sclerosing cholangitis. Prednisolon and azathioprine constitute the basic therapy of autoimmune hepatitis. Presumably, in the future, new strategies based on immunosuppressive combinations will play a crucial role. The chelating deferoxamine has less important part in the treatment of hemochromatosis. D-penicillamine still plays principle role in the medication of Wilson's disease.]

Lege Artis Medicinae

[Reference price system as a potential method for pharmaceutical cost containment]

KALÓ Zoltán, VINCZE Zoltán, LOVAS Kornélia, BODROGI József

[Reference pricing is one of the potential cost containment methods for pharmaceuticals. Authors describe its main types and the international examples of reference pricing together with technical details of its introduction. Consequences of the system are grouped into 5 categories: pharmaceutical expenditure, other health care expenditure, medical implications, consequences on patients and their health status, and political effects. They propose that reference pricing should be introduced only gradually based upon recommendations by multiprofessional teams. The system should be evidence based which includes clinical effectiveness, safety, compliance and cost-effectiveness. ”Real” active substance based reference pricing is justifiable for broad ranges of pharmaceuticals. General introduction of therapeutic reference pricing in Hungary, however, may result in serious negative consequences.]

Lege Artis Medicinae

[Cytological and genetic background of senescence]

LÁSZLÓ Valéria, FALUS ANDRÁS

Lege Artis Medicinae

[Oral clodronate for the prevention and therapy of bone metastasis of breast cancer]

NAGYKÁLNAI Tamás

[1600 mg/d oral clodronate has been shown to reduce the incidence of skeletal complications significantly in advanced breast cancer cases with lytic bone metastases. Analysis of clinical trials revealed that the adjuvant, prophylactic administration of clodronate possibly decreases the number of non-skeletal metastases and might prolong survival.]

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