Lege Artis Medicinae

[Reform or pseudo-reform? Points and codes]

FRENKL Róbert

JUNE 30, 1993

Lege Artis Medicinae - 1993;3(06)

[The question is not really a theoretical one: is there real reform in health care, or are we witnessing a pseudo-reform that, at best, does not add to decades of contradictions, does not further distort the system, but does not bring closer the resolution of tensions that have been felt for quite some time. ]

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Lege Artis Medicinae

[The role of angiotenzin converting enzyme inhibitors in the treatment of hypertension]

FARSANG Csaba

[The role of the renin-angiotensin system in the regulation of blood pressure is outlined. The mechanism of action as well as the role of angiotensin converting enzyme inhibitors (ACEI) in the treatment of various forms (primary, secondary, uncomplicated, complicated) of hypertension is discussed. The individualized , stepped care" approach is detailed, therefore the advantages of the therapeutic combinations of ACEi-s are emphasized. Interactions with other antihypertensive agents and with other drugs are also described, and side effects are also briefly addressed]

Lege Artis Medicinae

[Postmenopausal hormone replacement therapy]

H S Jacobs, F E Loeffler

[Over the past year, a number of summary publications on postmenopausal hormone replacement therapy have been published in the UK (1-3). Therefore, in this review we focus on areas that, although often controversial, may be of interest to practitioners. We will discuss the effects of postmenopausal hormone therapy on the risk of ischaemic heart disease, osteoporosis and cancer and present some observations on the concept of oestrogen tachifilaxis and dependence. Our conclusions are summarised in our recommendations on hormone therapy in menopause.]

Lege Artis Medicinae

[Immunohistochemistry of atherosclerotic lesions]

ILLYÉS Gyula, KÁDÁR Anna

[Cellular interactions within the arterial wall are considered to be essential in the development and progression of atherosclerotic lesions. This paper is a review of the actual knowledge about the role of the macrophages in the process of atherogenesis. The cellular composition of atherosclerotic changes – aligned in a possible consecutive order in which they may progress – are presented and discussed from the author's own immunohistochemical investigation. 108 aortic specimens obtained at autopsy performed within 12 hours following death from young people (20–34 ages) were examined. The Factor VIII positive endothelial lining was well preserved, no desmin content could be demonstrated. In contrary the presence of vimentin was noted in almost all the cells of the aortic wall. The foam cells reacted with different anti-macrophage antibodies, and most of the non-reacting cells of the different lesions proved to be smooth muscle cells. A considerable part of the intimal cells showed HLA-DR positivity as well. The quantity of the T helper lymphocytes in the lesions did not bear any significance. There was relationship between clinical data and types of (early) atherosclerotic lesions in the aorta. It is suggested, that the atherogenetic process starts in the intima with the appearance of smooth muscle cells and an increase in the lipid content. Thereafter macrophages accumulate and lead to the development of foam cells and at the same time they cause tissue damages leading to further smooth muscle proliferation and to classic atherosclerotic changes within the arterial wall.]

Lege Artis Medicinae

[Genetic counselling service at the congenital diaphragmatic defect]

GÖRBE Éva, FEKETE Zoltán, JEAGER Judit, TÓTH-PÁL Ernő, PAPP Csaba

[Recurrence risk of congenital diaphragmatic defect in a genetic counselling service has been investigated. Based on the investigation of 78 cases the risk of recurrence proved not significant. The families who have already had a newborn with congenital diaphragmatic defect may be suggested to bear subsequent pregnancies with the support of genetic counselling and intermittent ultrasonography. ]

Lege Artis Medicinae

[Studies of left ventricular dysfunction]

MATOS Lajos

[510 patients (39.7%) in the placebo group and 452 patients (35.2%) in the enalapril group died. The reduction in cardiac mortality was mainly due to a reduction in progressive heart failure (placebo: 251, enalapril: 209; risk reduced by 22%). There was no appreciable reduction in mortality from arrhythmias without pump failure. However, fewer patients died or were hospitalised due to worsening of circulatory failure (placebo: 736, enalapril: 613; risk reduction 26%; p<0.001).]

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