HIPPOCRATES Vol. IV.  No. 4  July  August 2002

 

HIPPOCRATES   July  August 2002  Vol. IV.  No. 4   Page:   227

Dr. Fazakas László:

Let's avoid nephrotoxic drugs!

Summary

It is not too rare that doctors give drugs in a nephrotoxic dosis and transitorical or chronic renal failure will be occur. We have to think it over our prescriptions to prevent toxic nephropathies: Is the medicine nephrotoxic or not, the dosis must be reducted or the dosis intervalls must be prolonged. We have to consider the age of the patient because of elderly patient’s renal function is altered. It has been also considered nephrotoxic interactions between drugs. If we have to give nephrotoxic drugs we can prevent the toxic effect with good hydration of the patient and diuretics such as mannisol or furosemid and the dosage has to be considered.

 

 

 

 

 

 

 

 

 

HIPPOCRATES   July  August  2002  Vol. IV.  No. 4.  Page: 234.  

Dr. Berta Gyula:  

Possibilities to reduce the corticosteroid dose in the modern asthma treatment

Summary

Drugs currently available for the treatment of asthma can deliver near-normal quality of life for patients, provided that the pharmacological therapy is based on the pathogenesis of the disease. This simply means that the first choice drug should effectively suppress airway inflammation which is the cornerstone of the disease. Once inflammation is adequately suppressed, airway obstruction caused by airway hyperreactivity and the symptoms of obstruction will diminish. Inhaled corticosteroids are best suited currently for this role. In the majority of cases inhaled corticosteroids delivered by dry powder inhalers provide adequate base therapy. In more severe cases or in case of exacerbations it might be necessary to increase the dose of inhaled corticosteroids, however it is not the ideal solution. Clinical improvement is not proportional with the increased dose, and, on the other hand the probability of clinically significant systemic steroid exposure increases. High dose of inhaled corticosteroids can be reduced if the therapy is combined with long acting β2 agonists formoterol or salmeterol. This combination is more effective than doubling the dose of inhaled corticosteroids. Combination therapy significantly reduces the frequency of mild and severe exacerbations, increases the exercise tolerance and quality of life of patients. Formoterol with its fast onset of action could also be viable an alternative for currently used p.r.n. short acting β2 agonists. Combining inhaled corticosteroids with other therapeutic options such as sustained release theophyllines or leukotriene antagonists is definitely less effective than the inhaled corticosteroid/long acting β2 agonist combination.

 

 

   

 

 

 

HIPPOCRATES  July  August  2002  Vol. IV.  No. 4.  Page: 241

Dr. Mezei Mónika, Prof. Dr. Pénzes István:

Preemptív analgesia

Summary:„Sedare dolorem opus divinum est" was cited Hippocrates. The most important exercise of physicians in every age is to fight versus the pain. International surveys show that the treatment of acut pain is often insufficient, especially in the postoperative period. Allan Gottschalk és David S. Smith wrote: "Pain, which is often inadequately treated, accompanies more than 23 million surgical procedures performed each year and may persist long after the tissue heals. The inadequat treated pain imprints indelibly on the nervous system, has an effect on the postoperatve period, and by the development of chronic pain impair the quality of life with months after surgery. Chronic pain is that kind of pain, wich persist more than 6 months. The central nervous system has an active role in the perception of pain. The noxious stimuli change the sensitivity of peripheral nociceptors and spinal neuron. It is known as peripheral and central sensitisation. The goal of preemptive analgesia is to prevent the establishment of central sensitization, wich then amplifies postoperative pain. This process can be blocked with various analgesic techniques and with different analgesic drugs. The most effective preemptive analgesic method may stop the sensitization of the nervous system during the whole perioperative period. In the end there is a question: does preemptive analgesia have any influence on chronic pain and daily living months after surgery.

Keywords: acut pain, chronic pain, noxious stimulus, peripheral sensitization, central sensitization, preemptive analgesia

 

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HIPPOCRATES    July  August  2002 Vol. IV.  No. 4.  Page:    260

Dr. Czuriga István:

 Prevention of ischemic heart disease

Summary

This article summarizes the current knowledge and most important work to do of the primary and secondary prevention of ischaemic heart disease, based on european and national guidelines and data from randomized clinical trial. There is an overview about risk factors and lifestyle changes, prophylactic drug therapies and screening of high risk persons.

 

 

 

 

 

 

 

 

 

 

HIPPOCRATES   July  August    2002  Vol. IV.  No. 4. Page: 269.  

Dr. Blaskovits Erzsébet:

The cardiological treatment of the elderly

Summary

This study presents the main physiologic events of the last phase of human life focusing on the structural, morphological and functional agedependent modifications of the heart and the vascular system. Without the knowledge of these, it is impossible to separate the real pathological processes from the consequences of the natural reduction due to ageing. The study also contains the risk-factors which hasten the pathological ageing, and the curing-caring tasks and possibilities which slow down the process, regarding the elderly written particularly to the attention of the specialists.