The link between hypertension and peripheral artery disease (PAD) is complex, , because atherosclerosis can be both a cause and an effect of hypertension. Hypertension as a known risk factor for atherosclerosis cause endothelial dysfunction through increased oxydative stress, which initiates the progress of vascular remodelling. Alterations of the mechanical properties of the arteries can cause already in the early stages of atherosclerosis vascular dysfunction and hypertension. In consequence endothelial dysfunction can play a role in the pathogenesis of arterial hypertension, but it can be also the result of the increased shear stress due to hypertension. Essential hypertension and also renovascular disease occure more often in PAD patients and together with other risk factors increase the mortality of the disease. In hypertensive PAD patients the coronary, carotis and renal conditions should be monitored carefully.

Summary

Elevated plasma homocysteine level is a new independent risk factor for peripheral arterial disease.(arteriosclerosis obliterans). By the relevant literature the author gives a brief summary of the metabolism of homocysteine, dicusses the epidemiology and the causes of hyperhomocysteinemia and its pathological effects to the vascular system. Dietary considerations and the questions of medical treatment are also mentioned.

A pilot study was initiated to evaluate the use of antimicrobials and medical outcome for patients with community-acquired pneumonia whose therapy was either consistent or inconsistent with the Hungarian guidelines in the outpatients setting. A total of 238 adult patients with confirmed CAP, attending the Pulmonary Outpatient Clinic Network was involved in the study. The non-compliance to the guidelines for treatment of CAP resulted in lower cure rates in ambulatory treatments (79 versus 91%), higher rote in of changes of antibiotics (60 versus 33%) and more hospital admission (25 versus 9%) than in those whose treatment was consistent with the recommendations.

The incidence of the malignant diseases in childhood is much less, than in adults; it was 13,6/100.000 in 2000. The cure rate of paediatric malignancies would be much higher during the last few decades; the 5 yrs. overall survival rate is 75,5% in acut lymphoid leukaemia and 72,5% in solid tumors. Early diagnose and treatment in paediatric oncologic centers with good experience is needed to achieve favorable results. Because of the several late side effects the rehabilitation, care and socialisation of the cured patients made by both the paediatric oncologic centers and the family doctors is necessary. In the future a less toxic, targeted therapy based on the molecular biology of the tumor cells is warranted to further improve the therapeutic results with less early and side effects.

Recently, a fast development of the preventive paediatrics has been detected, because of both the decrease of the number of deliveries and the increase of diagnostic possibilities. The prevention of allergic and other dermatologic illnesses and that of malignancies seem to be most interesting new fields. Possible Statin treatment of serious childhood familial hypercholesterolaemia without serious side effects was found. Routes of the metabolic syndrome in children and adolescents were detected. Decrease of the body mass index followed by the decrease of the blood pressure and normalized glucose tolerance test courve after the dietotherapy applied together with a physical exercise program were observed.

In ischaemic heart disease, if the medically treated patient’s anginal complaints and/or ischaemic symptoms are persistent, coronary angiography, and, accord on its result, coronary intervention (surgery or dilatation) may necessary. The intervention is required in critical, >70% diameter stenosis of the main vessels, the emergency depending on the clinical situation. Basic method of coronary angioplasty is the balloon dilatation, other tools (stent, rotablator, laser wire, atherectomy device, etc.) are also available. Periprocedural anticoagulant (heparin) and platelet aggregation inhibitor (aspirin, ticlopidine, GP IIb/III/a receptor blocker, clopidogrel) treatment is required, the latter after the procedure as well. After stent implantation the lumen of the vessel is bigger and the ratio of the major adverse cardiac events (acute myocardial infarction, repeated intervention, fatal outcome) is diminished. Decrease of serum lipid level improves the outcome of coronary angioplasty. It is applicable successfully for multiple lesions, occluded vessels, stable and unstable angina, in the early phase of myocardial infarction, in patients underwent coronary surgery, and in old age too. Risk factors of the intervention are: tortuous vessel, significant calcification, stenosis in angle or ostium, intraluminal thrombus, urgent intervention, old age, female gender, congestive heart failure, unstable condition and acute myocardial infarction. By indication, besides the probable results, it is necessary to consider the possibility of complications (myocardial infarction, malignant rhythm disorders, acute heart failure, bleeding, etc.). In left main stem stenosis, three vessel disease and in the case of one functioning coronary artery rather surgery would be preferable. Having the actual opportunities the ratio of urgent surgical intervention as well as the mortality is below 1%.