Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Aug 2002
Multicenter Study Clinical Trial[Treatment of hypertension in diabetics with trandolapril, an angiotensin converting enzyme inhibitor--a multicenter study].
Subjects with diabetes mellitus (DM) are high-risk patients because of the cardiovascular morbidity and mortality. A one-year open clinical prospective study took place in 7 centres in the Czech and Slovak Republic in 1996-1997. Aim of the study was treatment of hypertension in patients with DM of both types by the ACE inhibitor trandolapril in dose of 2-4 mg, possibly in combination with the calcium channel blocker verapamil--240 mg. ⋯ On comparison of other risk factors in groups of patients with a BP below 130/85 mm Hg and higher than this borderlimit line it was revealed that one-year treatment of hypertension with trandolapril--4 mg alone or combined with verapamil 240 mg led to a greater reduction of the pulse rate, fasting insulin level, hematicrit and triglycerides and to an increase of HDL-cholesterol. This study revealed that systematic treatment of hypertension by the above mentioned drugs in patients with DM is effective and well tolerated. In addition to reduction of the blood pressure the activity of the sympathetic nervous system was reduced and some metabolic parameters improved.
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Vnitr̆ní lékar̆ství · Aug 2002
Review[Role of cytokines in the development of local and systemic inflammation and septic shock].
A central position in the development of systemic inflammation is played by activation of the vascular endothelium and monocyte- macrophage system. Both are associated with the formation of inflammatory cytokines, the primary mission of which is mobilization of the organism to cope with the infection. The so-called acute stage response develops with typical clinical manifestations and laboratory values. ⋯ The compensatory antagonistic mechanism which develops due to the formation of anti-inflammatory cytokines leads sometimes to the development of a balanced state of immunity which is most favourable from the prognostic aspect. In case of their excess however immunodepression develops which is equally dangerous for the patient as excessive cytokine activity. From what has been said ensues the need of regular monitoring of patients with sepsis and thus also detailed investigation of their immune system.