RESUMEN
The vascular endothelium is a large organ that secretes numerous factors regulating vascular tone, cell growth, platelet and leukocyte interactions and thrombogenesis. Endothelial dysfunction is an early event in atherogenesis and is also important in establish coronary artery disease. Over the past decade a noninvasive technique has evolved to evaluate flow-mediated vasodilation, an endothelium-dependent function. Procedure is realised on the brachial artery. The stimulus provokes the endothelium to release nitric oxide with subsequent vasodilation that can be imaged and quantitated as the index of vasomotor function. (Fig. 1, Ref. 2.).
Asunto(s)
Arteria Braquial , Enfermedad de la Arteria Coronaria/diagnóstico , Endotelio Vascular/fisiopatología , Vasodilatación/fisiología , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Enfermedad de la Arteria Coronaria/fisiopatología , Humanos , Persona de Mediana EdadRESUMEN
Myelomatous bone disease affects about 90% patients with multiple myeloma and solitary myeloma as well. In initial stage it is manifested as osteopenia with osteoporosis or osteolytic foci, pathologic fractures followed by neurologic complications. Ethiopathogenitically a role is played by cytokine interactions with local chemokines produced by myeloma cells and activated stromal and hemopoietic cells (osteoblasts, monocytes, macrophages) resp. From the TNF-alpha family glycoprotein complexes are liberated (RANK-L), which support activation and proliferation or are inhibitory (osteoprotegerins). Similarly in the family TGF-beta several izotypes of antiinflammatory cytokines are known (the most important is TGF-beta 1 and the morphogenetic protein-2), which have a fibrotizing effect in bones, because the produced osteoid is insufficiently mineralized. The effect is a pathologic remodelation of the skeleton. In the diagnosis of multiple myeloma the immunological knowledge is used in the initial diagnosis (immunophenotypization, follow up of TNF-alpha, TGF-beta 1, IL-1, IL-6 etc). Important are also biochemistry values of increased osteoresorption (changes of calcium, parathormone, excretion of collagen fission products, osteocalcin, the bone alkaline phosphatase). In the following part the authors inform about favourable results of long-term treatment with bisphosphonates (Bonefos, Ibandronate) in combination with anti-tumor chemotherapy in 364 patients. During a 15 years observation period median survival of 94 months with a 35% probability of 10 year survival was achieved with a significant decrease of bone complications in 58% compared to 14% in the placebo group.
Asunto(s)
Enfermedades Óseas Metabólicas/etiología , Mieloma Múltiple/complicaciones , Enfermedades Óseas Metabólicas/tratamiento farmacológico , Enfermedades Óseas Metabólicas/fisiopatología , Huesos/fisiopatología , Difosfonatos/uso terapéutico , Humanos , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/fisiopatologíaRESUMEN
BACKGROUND: A survey of the pathogenesis, diagnostics and treatment of amyloidosis is presented, illustrated by long-term clinical experience with the treatment of 28 patients with primary amyloidosis, 4 patients with familial and 7 patients with secondary amyloidosis. METHODS AND RESULTS: To all patients combined treatment of glucocorticosteroids and cytostatics was administered. For primary amyloidosis methylprednisolone, vincristine (oncovine), cyclosphosphamide, alkeran, chlorethylnitrosourea (MOCCA), and in secondary amyloidosis cyclophosphamide, vincristine, prednisone (CVP). In all patients, this treatment was combined with dimethylsulphoxide treatment (DMSO) administered in intravenous infusion (5 g/100 ml saline) for 3-5 days before the start of cytostatic therapy. In primary amyloidosis the median of survival was 48 months, in secondary amyloidosis the median survival was 72 months. CONCLUSIONS: The authors emphasise the need of an early diagnosis and start of comprehensive therapy completed in recent years successfully with immunomodulatory therapy using hydrolytic enzymes (WOBE MUGOS).
Asunto(s)
Amiloidosis/complicaciones , Arteriosclerosis/complicaciones , Hemorragia/etiología , Adulto , Anciano , Amiloidosis/fisiopatología , Amiloidosis/terapia , Hemorragia Cerebral/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
During three-month therapy with small doses of guanfacine (Estulic Sandoz) that were sufficient to control blood pressure in patients with stage II essential hypertension and led to a decrease in excretion of noradrenaline and vanillylmandelic acid, the authors found a decrease in the level of blood cholesterol in patients with hyperlipidaemia. There was no adverse effect on the levels of triglycerides, beta, pre-beta and alpha lipoproteins. The authors conclude that Estulic therapy is indicated in patients who, in addition to essential hypertension, have hyperlipidaemia.