Lege Artis Medicinae

[Systolic Hypertension in the Elderly Program]

MATOS Lajos

SEPTEMBER 30, 1992

Lege Artis Medicinae - 1992;2(09)

[Over the five-year study period, the incidence of stroke was 5.2% in the active treatment group and 8.2% in the palcebo group. The relative risk for the secondary endpoint (myocardial infarction, coronary mortality) was 0.73 and for all-cause mortality 0.87. Among patients with isolated systolic hypertension aged 60 years and older, low-dose chlorthalidone treatment as therapeutic step 1 reduced the incidence of stroke by 36%. In the active agent-treated group, the incidence of all coronary events was also reduced by 32%.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Echocardiography in the management of acute myocardial infarction]

LENGYEL Mária

[The author presents a detailed review of the role of echocardiography (echo) in the management of acute myocardial infarction (AMI). The echo diagnosis of AMI is based on segmental wall thinning and akinesia with a 90% accuracy. Echo has made a major impact on the immediate diagnosis of mechanical complications in the hemodynamically compromised patient with AMI. These mechanical complications which include myocardial rupture of the free wall or the septum or the papillary muscle, may be successfully treated by prompt surgical intervention. Echo diagnosis has an important role in the management of other complications of the acute, subacute and chronic phases of infarction as well, such as pericardial effusion, left ventricular thrombus, left ventricular aneurysm and pseudoaneurysm. Therapeutic strategies are thoroughly affected by systolic and diastolic function assessed by echo. Echo has a basic role in the algorithm of postinfarction anticoagulant treatment. Besides rest echo, early stress echo has a definite prognostic value in predicting multivessel disease and identifying viable myocardium which requires revascularisation procedures. The indications for echo in the acute phase and before discharge are summarized according to recent American recommendations. ]

Lege Artis Medicinae

[Clinical and immunological aspects of polymyositis and dermatomyositis]

DANKÓ Katalin, ZILAHI Zsolt, SZEGEDI Gyula

[Polymyositis and dermatomyositis are autoimmune diseases characterized by muscle weakness, tenderness, occasionally pain, and ultimately atrophy and fibrosis of the muscles. The extraskeletal manifestations, particularly the cardiopulmonary, oropharyngeal, gastrointestinal involvement, are described. Studies of autoantibodies and cellular immune function support a central role for disordered immunity in the pathogenesis. The myositis-specific autoantibodies, expecially those directed at certain enzymes important in protein synthesis are found in a clinically distinct subset of patients. ]

Lege Artis Medicinae

[Right ventricular infarction]

KISS Gabriella

[Right ventricular infarction (RVI) may occure as isolated or, more often, associated with left ventricular – inferior or occasionally anterior - infarction. The diagnosis of RVI is based first of all on the characteristic clinical symptoms, on the ECG pattern and on the results of 2D-echo-cardiography. The exact localisation of the infarction has vital significance in the therapy of the acute phase. The mortality can be substantially decreased with adequate therapeutic measures even in severe cases. The prospective prognosis of RVI is more favourable than that of left ventricular infarcti on. The author presents the most important diagnostic and therapeutic features related to RVI. ]

Lege Artis Medicinae

[Role of platelet function in the pathogenesis of alzheimer's disease]

HASITZ Mária, LIPCSEY Attila, RÁCZ Zoltán

[Dementias, especially those of Alzheimer type represent very serious types of disease in the elderly. Amounting evidence suggests that Alzheimer's disease is reflected in the platelets of the patients. Our results and the data of scientific literature have been summarized. In vitro parameters of platelet shape and aggregation were compared. Platelet shape, characterized by aggregometer oscillation amplitude, and the initial rate of 50 uM ADP-induced aggregation have been recommended for supporting the diagnosis of Alzheimer's disease or Alzheimer-type senile dementia. Our results and those of others revealed that the function of the Alzheimer platelet is influenced by two effects: the plasma medium and the genetic background resulting in the change of the platelets. The results suggest that both effects are involved in the vitro functions detected.]

Lege Artis Medicinae

[The role of ultrasound in the diagnosis of septic hip prosthesis loosening]

FÖLDES Károly, BÁLINT Péter, GAÁL Marianna, KISS Csaba, BÁLINT Géza

[The aim of the authors is the application of non-invasive ultrasound examination to the detection of complications after hip joint arthroplasty. Their recent work has been a trial to explore the kind of diagnostic assistance of ultrasound in case of suspected endoprosthetic infection. 39 patiens have been examined after hip joint arthroplasty. Out of this sample there was a suspected clinical infection in 20 cases. The rest 19 patients had no complaints and made the control group. Out of the patients with complaints effusion was detected around the neck of the prosthesis by means of US in 7 cases. Out of these in 10 cases reoperation in 6 cases US guided joint aspiration verified our US results. The authors made conclusion that as to patients having complaints of pain after hip joint arthroplasty very useful assistance in avoiding infection may be given by quided ultra sound aspiration.]

All articles in the issue

Related contents

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Lege Artis Medicinae

[RAAS inhibitors therapy – COVID-19 pandemic]

KÉKES Ede

[Acute respiratory syndrome with various signs and outcomes caused by the SARS-CoV-2 virus is the biggest challenge facing health systems worldwide today. The renin-angiotensin-aldosterone and kinin-kallikrein systems and within these two endopeptidases (ACE and ACE2) play a crucial role in the developing clinical feature of COVID-19. Adverse effects of the ACE-stimulated Ang II/AT1R axis (oxidant, pro-inflammatory effect, vasoconstriction) are counterbalanced by the ACE2-induced AT2R and MasR activities (antioxidant, anti-inflammatory effect, vasodilation). The severity of SARS-CoV-2 pneumonia and systemic inflammation explains the impairment of ACE2 (as an important defence factor of the lungs) caused by the biding spike protein of the SARS-CoV-2, which decreases the ACE2 levels. In parallel, bradykinin production also increases and intensifies the SARS-CoV-2-induced cytokine storm through the BKB1 and BKB2 receptors. Since the RAAS inhibitors (ACEI, ARB) affect the two regulatory systems and enzymes at different sites and to different degrees, their role must urgently have been clarified in the COVID-19 since their use is essential and general of many population-wide diseases (hypertension, cardiovascular, renal and metabolic conditions). Based on pathophysiological and experimental data, it is reasonable to hypothesize that in COVID-19 with comorbidities, especially in the elderly, the decreased ACE2 expression may be restored by RAAS inhibitors and the missed or reduced protective effect may be revitalised. This protective effect applies to both RAAS inhibitors. Clinical trials clearly support the declared opinion of many international societies that the use of RAAS inhibitors does not increase the risk of the occurrence of SARS-CoV-2 in itself let alone the severe and critical cases. Accordingly, initiated RAAS inhibitor therapy not only may rather must be continued during the development of COVID-19.]