[THE HISTORY OF FLUOROQUINOLONES]
LUDWIG Endre
FEBRUARY 21, 2004
Lege Artis Medicinae - 2004;14(02)
LUDWIG Endre
FEBRUARY 21, 2004
Lege Artis Medicinae - 2004;14(02)
[During the 40 year history of quinolones, from the first compounds (nalidixic acid, oxolinic acid, norfloxacin) suitable only for the treatment of mild urinary tract infections, an important group of antimicrobials was developed that can be used for the treatment of serious Gramnegative (ciprofloxacin, ofloxacin) and Grampositive (levofloxacin, moxifloxacin) infections. With the changes in the antimicrobial spectrum of the new derivatives it seems, that the clinical indications of the mainly anti-Gram-positive and the mainly anti-Gram-negative fluoroquinolones can be separated. We also learned the characteristics of their antibacterial activity that makes the optimal administration possible assuring the maximum clinical efficacy and the minimal development of bacterial resistance. The activity of fluoroquinolones can also be compromised by bacterial resistance so to preserve their clinical value it is important to follow the above mentioned principles in their use.]
Lege Artis Medicinae
[Primary tubulointerstitial nephritis is characterised by an inflammatory infiltrate of tubulointerstitial space. The infiltrate consists of T and B lymphocytes, monocytes, macrophages, neutrophyl and eosinophyl granulocytes in varying degree. It is associated with interstitial oedema and different level of tubular damage. The disease exists in acute and chronic form. The main causes of this condition are: drugs, infection, systemic diseases, malignancy and in some cases the disease is idiopathic. The pathogenesis in most cases is immune-mediated. The secondary form of tubulointerstitial nephritis can occur in primary glomerular and vascular disease and is characterised by tubulointerstitial fibrosis and tubulus atrophy. The morphological alterations are major determinants of the progression of chronic renal disease. In both forms of tubulointerstitial nephritis the development of renal insufficiency is often observed.]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[The diagnosis of giant-cell arteritis is a real challenge for clinicians. There are several reasons for the difficulties in establishing the diagnosis. This disease is associated to rare conditions, therefore most physicians lack clinical experience. This condition shows very heterogeneous manifestation, the intensity of the symptoms vary in time. Early diagnosis is of great importance in order to prevent ischemic complications. Among these complications one should emphasise the role of anterior ischemic optic neuropathy that may result in abrupt blindness. In this case report, we show a rare socalled large vessel manifestation of giant-cell arteritis. This form of the disease needs different approach in diagnosis where color duplex ultrasonography may have distinguished importance. The final verification of the diagnosis is based on histology. However the lack of all histological criteria do not exclude the presence of giant-cell arteritis.]
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Hypertension and nephrology
[The possible mechanisms of therapeutic plasma mexchange: 1. the removal of circulatory plasma factor (anti Gbm disease, myasthenia gravis, Guillain Barré syndrome), 2. monoclonal antibody (Waldenström macroglobulinemia, myeloma protein), 3. circulatory immuncomplexes cryoglobulinaemia, myeloma protein, SLE), 4. alloantibody, 5. toxic factor, 6. replacement of a specific plasma factor, 7. a repear of the function of reticulo-endothelial system, 8. the removal of the inflammatory mediators, 9. the changes of the ratio of antigen-antibody which makes immuncomplexes more soluble, 10 stimulation of lymphocyte clones for supporting the cytotoxic therapy. Indications of emergency plasmapheresis: 1. Goodpasture syndrome with rapidly progressive glomerulonephritis and hemoptoe, 2. hyperviscosity syndrome, 3. TTP/HUS, 4. High level of factor VIII inhibitor, 5. respiratory insufficiency Guillain-Barré syndrome, 6. myasthenia gravis, 7. acute mushroom intoxication, or protein bound toxins. Further indications for plasmapheresis: 8. cryoglobulinemia, 9. other cases of rapidly progressive glomerulonephritis (when steroid+ cyclophosphamide are ineffective), 10. Wegener granulomatosis, 11. polyarteritis nodosa, 12. systemic lupus erythematosus (when steroid and cyclophosphamid therapy is not effective or associated with cerebral vasculitis, antiphospholipid syndrome combined with bleeding and thrombosis), 13. focal segmental glomerulosclerosis (resistant for therapy), 14. acute tubulointerstitial nephritis, 15. acute vascular rejection, 16. rheumatoid arthritis systemic type, 17. hypertrigliceridemia (≥25 mM), 18. thyreotoxic crisis, 19. acute necrotizing pancreatitis, 20. acute fulminant hepatitis, 21. paraquat intoxication, 22. snake bite (when antiserum is unavailable), 23. drug intoxication.]
Lege Artis Medicinae
[Coumarin oral anticoagulants are highly effective antithrombotic agents with relatively low risks of serious bleeding. Clinical uses and applications have evolved over the years. Recent changes include a, lower doses are used to treat most patients with thromboses, b, laboratory monitoring has been standardised thus intensities of anticoagulation are equivalent around the world, C, new indications for treatment have emerged from prospoective controlled clinical trials, for example profilaxis of embolic stroke in patients with chronic nonrheumatic atrial fibrillation. Coumarins inhibit the factors II, VII, IX, X and protein C and S. Traditionally the prothrombin time has been used to monitor the antithrombotic effects of the coumarins. The test is performed by the addition of a thromboplastin to recalcified plasma. The sensitivity of the thromboplastin to coumarin induced reduction in clotting factor activity is variable in the assay. Some thromboplastins are very sensitive, others are insensitive. Consequently, patients can receive different doses of coumarin depending on the thromboplastin used. To address this important clinical problem, the prothrombin time ratio is now modified by a factor (ISI) that reflects the „sensitivity" of the thromboplastin used and the result is termed International Normalised Ratio (INR). The main coumarin adverse effects (hae morrhage, teratogenicity and coumarin skin necroses and some special problems of coumarin therapy (diet, coumarin resistance, drug-drug interactions, the problem of over lapping heparin and coumarin, the problem of interval surgery) are also discussed.]
Lege Artis Medicinae
[Coumarins have been widely used for the prevention of arterial and venous thromboembolism. The importance of oral anticoagulants has steadily increased in internal medicine and cardiology in the past 20 years. Coumarins are vitamin K antagonists by inhibiting the synthesis of vitamin K-dependent coagulation factors in liver cells. Since the average half-life of hydroxycoumarin is longer than that of aceno-coumarin, the INR of patients treated with hydroxy-coumarin is more stable, thus making it especially suitable for long-term anticoagulant treatment. The main indications of coumarin therapy include secondary prophylaxis of venous thromboembolism, and primary and secondary prevention of arterial thromboembolism, particularly embolic stoke, in patients with cardiovascular disorders. This review summarizes the most important clinical issues of long-term oral anticoagulant therapy including indications, contraindications, dosing, therapeutic range, and laboratory monitoring. Special emphasis is placed on the role of hydroxy-coumarin in longterm oral anticoagulant therapy.]
Clinical Oncology
[Positron emission tomography (PET) has earned an important role in clinical imaging, where it is used almost exclusively as hybrid modality such as PET/CT and PET/MR. The driving force behind the development of the method and the increasing clinical penetration of PET in the past two decades was clearly its use in Oncology. The most used tracer in PET is the 18 F-labeled fl uoro-deoxy-glucose (FDG). With the help of this molecule malignant tumors and their metastases, in which anaerobic glycolysis is typically increased, can be identifi ed with high sensitivity in the total body volume. However, FDG is not a tumor specifi c tracer, thus both false positivity and false negativity may occure which reduces the diagnostic accuracy. Indications of FDG PET studies in Oncology continuously evolved, owing to scientifi c publications, large scale national programs and even health-economic considerations. This publication describes the well-established indications of FDG PET/CT(MR) tests in cancer diagnostics and furthermore discusses more recent new PET tracers already being applied as well as those expected to be used in the future.]
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