Presse Med
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HEREDITARY DISEASE: Hereditary anomalies of homocysteine metabolism are quite uncommon and manifest by very high homocysteine levels (> 100 mumol/l) and associated homocysteinuria. The risk of premature cardiovascular disease is high. ⋯ These data show that moderately elevated homocysteine level is a powerful cardiovascular risk factor. Further information is however needed to ascertain its frequency in the population and determine whether it is a truly independent risk factor.
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BLOOD PRESSURE CONTROL: More than half of all diabetic patients have high blood pressure. Even more so than in the general population, hypertension compromises the cardiovascular and renal prognosis. ⋯ For the WHO, the goal is to control pressures < 130/85 mmHg. In this respect, there has been no demonstration of a J-curve relationship between pressure lowering with antihypertension drugs and incidence of cardiovascular events among patients with coronary artery disease included in the HOT study.
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RECOGNIZED EFFICACY: Platelet antiaggregats have been used with success for more than twenty years in industrialized countries, participating in reducing the number of complications of atherothrombosis. New compounds have appeared on the market over the last 3 years. CLOPIDOGREL: Clopidogrel is a thienopyridine similar to ticlopidine but with less toxicity, particularly hematological toxicity. ⋯ It provides a significant short-term and long-term reduction in severe events (myocardial infarction + death + revascularization). Oral formulations of GPIIbIIIa can be used to maintain and/or amplify the benefits obtained with injectable formulations. They are not currently available on the market.
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There is a need in the management of non-Hodgkin's lymphoma (NHL) for tumor-targeted therapy. Immunotherapy with monoclonal antibodies can be used to reach this goal. ⋯ Initial phase I/II trials of monoclonal antibodies for relapse or refractory NHL, especially with chimeric anti-CD20 rituximab, demonstrated encouraging results. FURTHER ASSESSMENT: Randomized trials are now necessary to compare these agents with standard regimens and to determine their optimal use.
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FALLS AND POST-FALL SYNDROME: Falls are a major health problem among the elderly because of the resulting psychological sequelae (sometimes termed "post-fall syndrome") and in a few cases serious injury, particularly hip fractures.