Lege Artis Medicinae

[THE ROLE OF ORAL ANTIDIABETIC AGENTS AND ACE INHIBITORS IN THE PREVENTION OF TYPE 2 DIABETES MELLITUS]

KEMPLER Péter

NOVEMBER 21, 2004

Lege Artis Medicinae - 2004;14(11)

[Nowadays Type 2 diabetes is considered as a cardiovascular disease,. The cause of death among 80% of people with Type 2 diabetes is of cardiovascular origin, with the most common cause of death of myocardial infarction. Optimal solution would be the prevention of the disease and there are also some possibilities for intervention. The present paper summarises the role of antidiabetic agents and ACE inhibitors in the prevention of Type 2 diabetes mellitus. The incidence rate of Type 2 diabetes decreased by 36% using acarbose in the STOP NIDDM Trial and by 31% using metformin in the Diabetes Prevention Program. The rate of risk reduction regarding the incidence of Type 2 diabetes during the ALLHAT Study compared the subjects treated with thiazid diuretics among those treated with amlodipine was 25% by the end of the second year and 16% by the end of the fourth year, while the corresponding data for patients treated with lisinopril were 40% and 30%, respectively. The action of lisinopril on the better bioavailability of Insulin like growth factor I. (IGF-I) probably contributes to the beneficial effect of lisinopril on insulin sensitivity.]

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BOHÁCS Anikó, TAMÁSI Lilla, SOMOSKÖVI Ákos, MÉSZÁROS Zsolt, SÁPI Zoltán, BÁRTFAI Zoltán

[INTRODUCTION - Rare asymptomatic pleuropulmonary neoplasms can represent serious differencial diagnostic difficulties both for clinicans and pathologists. Immunohistochemical tests are essential tools for the diagnosis of soliter fibrotic tumor of the pleura. These tests are also of diagnostic and prognostic importance. CASE REPORT - The report summarizes the case of an asymptomatic 63 years old man. The patient was admitted to hospital with a parahilar infiltrate of the right lung. Based on this chest X-ray abnormality pulmonary malignancy was suspected. The patient was referred to surgical intervention and the diagnosis of was based on post-surgical histology. These fibrotic tumors have typical immunohistochemical features. Although the histomorphology of the tumor suggested the presence of a benign tumor the p53 positivity and focal CD34 positivity indicated the possibility of malignant transformation as well. The patient is alive 17 months after surgery and there is no relapse of the disease. CONCLUSION - Although histologically benign, soliter fibrotic tumors of the pleura may occasionally transform into malignant variants. Therefore complete surgical resection and longterm clinical and close radiological follow-up is recommended for these patients. Clinician can plan well ahead the frequency and time of the follow-up with the help of the prognostic factors of hystology.]

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[Diverticulosis of the colon is frequent in developed countries. Decreased intake of dietary fibre have been implicated as an important pathogenetic factor. Most of the affected patients are asymptomatic but 10-20% of them have abdominal problems. Clinical manifestations range from simple, non-complicated form (abdominal pain, distension, constipation, urgency etc.) to severe complications (diverticulitis, abscess, peritonitis, perforation, haemorrhage etc.) The diagnosis and therapy of different forms of diverticular disease can be very simple but in several cases differential diagnostical problems and therapeutical difficulties may arise. The gold standard for establishment of uncomplicated diverticulosis is the barium enema or colonoscopy. In case of complicated forms non-invasive methods (US, CT scan, CT-colonography, MRI) have to be preferred. These examinations have no risk for perforation and extraintestinal pathology (air, fluid, abscess) can be detected. Colonoscopy or angiography are the methods of choice in case of haematochesia. The choice of therapy is based on clinical presentation, symptoms and pathology. Fibre supplementation is recommended for patients with diverticulosis without symptoms. In case of noncomplicated symptomatic diverticular disease fiber supplementation or cyclic administration of broad spectrum, poorly absorbable antibiotic can be effective in the prevention of inflammatory episodes and complications. If some of the severe or recurrent complications can not be treated conservatively, surgery is necessary. Prevention of diverticulosis and diverticular disease has to be emphasized. While fibre supplementation in the diet is recommended, other efficacious preventive strategies remain to be identified.]

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Image challenge

What do you see on the feet of the diabetic patient?