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LAM Extra for General Practicioners

MARCH 20, 2013

[DABIGATRAN: A NEW ORAL ANTICOAGULANT AGENT FOR THE PREVENTION OF STROKE AND SYSTEMIC EMBOLISM IN NONVALVULAR ATRIAL FIBRILLATION]

KANCZ Sándor

[In this article, we summarise the available information on dabigatran, focusing on clinical practice, in particular on the prevention of stroke and systemic embolism, the critical aspects of anticoagulant treatment with dabigatran, potential drug-drug interactions and adverse reactions in nonvalvular atrial fibrillation. The most important molecular characteristics of dabigatran are also described. We highlight the implications of safety issues that have emerged during everyday clinical practice.]

Clinical Neuroscience

NOVEMBER 20, 2012

[Rivaroxaban in prevention of stroke in patients with atrial fibrillation]

SIMONYI Gábor, MEDVEGY Mihály

[Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group.]

Lege Artis Medicinae

SEPTEMBER 20, 2012

[Dabigatran: a new oral anticoagulant agent for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation]

KANCZ Sándor

[In this article, we summarise the available information on dabigatran, focusing on clinical practice, in particular on the prevention of stroke and systemic embolism, the critical aspects of anticoagulant treatment with dabigatran, potential drug-drug interactions and adverse reactions in nonvalvular atrial fibrillation. The most important molecular characteristics of dabigatran are also described. We highlight the implications of safety issues that have emerged during everyday clinical practice.]

LAM Extra for General Practicioners

APRIL 20, 2012

[THE DIAGNOSTIC VALUE OF A GLASS OF SODA WATER IN CASE OF A CARDIAC SPACE-OCCUPYING LESION]

PÁLINKÁS Attila, CZAKÓ László, CSÁSZÁR Ildikó, NAGY Edit, SZABÓ Marianna

[INTRODUCTION - Large hiatal hernias may result in cardiac space-occupying lesions. Our case study discusses the clinical aspects and the possible diagnostic approaches for such large hiatal hernias that cause cardiac compression. CASE REPORT - In an elderly patient with no cardiovascular symptoms, transthoracic echocardiography revealed a left atrial space-occupying mass. The diagnosis regarding the origin of the cardial mass was clarified by a glass of soda water drunk by the patient during echocardiography, as it resulted in a decrease in the inhomogenous echodensity of the mass and the appearance of “contrast bubbles” within it. This phenomenon suggested the presence of a large hiatal hernia compressing the heart, which was confirmed by gastroscopy and upper gastrointestinal barium examination. CONCLUSION - Drinking soda water during transthoracic echocardiography can help to diagnose lesions that look like intracardial tumours.]

Lege Artis Medicinae

FEBRUARY 20, 2012

[The diagnostic value of a glass of soda water in case of a cardiac space-occupying lesion]

PÁLINKÁS Attila, CZAKÓ László, CSÁSZÁR Ildikó, NAGY Edit, SZABÓ Marianna

[INTRODUCTION - Large hiatal hernias may result in cardiac space-occupying lesions. Our case study discusses the clinical aspects and the possible diagnostic approaches for such large hiatal hernias that cause cardiac compression. CASE REPORT - In an elderly patient with no cardiovascular symptoms, transthoracic echocardiography revealed a left atrial space-occupying mass. The diagnosis regarding the origin of the cardial mass was clarified by a glass of soda water drunk by the patient during echocardiography, as it resulted in a decrease in the inhomogenous echodensity of the mass and the appearance of “contrast bubbles” within it. This phenomenon suggested the presence of a large hiatal hernia compressing the heart, which was confirmed by gastroscopy and upper gastrointestinal barium examination. CONCLUSION - Drinking soda water during transthoracic echocardiography can help to diagnose lesions that look like intracardial tumours.]

Hungarian Radiology

APRIL 07, 2009

[Transjugular intrahepatic portosystemic shunt implantation in a patient with severe dilatative cardiomyopathy]

SZALÁNCZY Katalin, LÁZÁR István, STEFÁN János, KALÓ Emil

[INTRODUCTION - Indications for TIPS (transjugular intrahepatic portosystemic shunt) are usually portal hypertension induced by alcoholic or viral cirrhosis. Reported patient underwent TIPS because of a rare indication where his rapidly progressing heart failure lead to rapid deterioration of the splanchnic hypertension. CASE REPORT - A 51 years old male was admitted with severe dilatative cardiomyopathy and atrial fibrillation, generalized edema refractory to conservative treatment, and rapidly worsening hepatic laboratory test results. TIPS implantation achieved improvement of all clinical signs, decreased edema and the patient could finally be discharged. CONCLUSION - TIPS can result in improved quality of life not only in primary hepatic cirrhosis but in other clinical circumstances with portal hypertension.]

Clinical Neuroscience

NOVEMBER 30, 2006

[EPIDEMIOLOGY OF STROKE IN THE ELDERLY]

POZSEGOVITS Krisztián, KAZUO Suzuki, NAGY Zoltán

[Background - In the industrialized countries the very elderly stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very elderly can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the youngers' one. Subjects and methods - The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. Results - 8,046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged ≥85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of firstever stroke was 222/100,000/year, and 1,085/100,000/year in the very elderly, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the consciousness level at onset. The following in order of predicting value was the SAH stroke subtype. Conclusion - While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a procession, furthermore it raises the importance of prevention, more rather of the acute stroke care and rehabilitation in this high age group.]

Lege Artis Medicinae

NOVEMBER 30, 2006

[IVABRADINE - FROM IF INHIBITION TO THE TREATMENT OF PATIENTS WITH STABLE ANGINA]

KOLOZSVÁRI Rudolf, ÉDES István

[Ivabradine is a new agent that selectively inhibits the If channels of the sinus node. Electrophysiological studies have shown a significant heart rate lowering effect of ivabradine compared to placebo, while no significant changes have been observed in the frequency-corrected QT interval (QTc) or in the conductivity or refractoriness of the atrial muscle, AV node, His- Purkinje system or ventricular muscle. In a noninferiority study that compared ivabradine to atenolol, the same efficacy was shown in terms of increasing effort tolerance and reducing anginal events, with less reduction in heart rate. The same results were obtained with the comparison to amlodipine - the two drugs were equally efficient. The longest trial investigated the efficacy and safety of ivabradine for 12 month; both heart rate and the number of anginal episodes significantly decreased during the entire study period. The ongoing BEAUTIFUL trial tests ivabradine in patients with heart failure. The only important side effect of ivabradine is phosphenes, but this rarely requires the treatment to be discontinued. No other side effects such as symptomatic bradycardia or conduction abnormalities have been observed. Ivabradine is currently indicated as an alternative treatment of stable angina pectoris.]