摘要:

Mycophenolate mofetil (MMF) is a new immunosuppressive agent with proven efficacy in the prevention of rejection in renal transplant recipients. Clinical studies in heart transplantation have suggested efficacy in patients with refractory and persistent rejection. A large multicenter randomized primary prevention trial in heart transplant patients has just been completed and suggests benefits of MMF in survival and treated rejection episodes. This drug appears to be well tolerated without significant increase in infection or other complications. MMF appears to be an important immunosuppressive agent in cardiac transplant recipients.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Despite advances in prophylaxis and treatment, cytomegalovirus (CMV) infection remains a significant problem in the solid-organ transplant recipient. In addition to the clinical manifestations of CMV infection, there is also the immunosuppressive effect of CMV, which confers increased risk for fungal and other opportunistic infections. In reference to heart transplant recipients, the possible connection between CMV infection and rejection or CMV infection and allograft vasculopathy are areas of active research. Recent diagnostic advances, such as the CMV antigenemia assay and CMV-DNA detection by polymerase chain reaction or direct hybrid capture, have enabled early detection and monitoring of CMV infection and have raised the question of the implications of asymptomatic viremia. A wide variety of prophylactic strategies have been evaluated in heart and other solid-organ transplant recipients, including antiviral agents, globulin preparations, combinations of these therapies, and pre-emptive treatment strategies based on early detection or identification of a high-risk subset of patients. Many of these regimens have demonstrated efficacy in certain groups of patients, but a consensus has yet to emerge in terms of a single preferable strategy. Future advances on the horizon include the development of newer antiviral agents and a vaccine.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Cardiovascular complications are a major cause of morbidity and mortality in patients with diabetes mellitus. Diabetes is a heterogeneous, complex metabolic disorder, and it is unlikely that control of hyperglycemia alone will eliminate the excess of cardiac, cerebral, and peripheral vascular diseases found in diabetic patients. In the care of the diabetic patient, glucose levels should be reduced to normal if possible. In addition, however, it is crucial to evaluate and, if necessary, to correct abnormalities in lipids, blood pressure, and hemostasis. The importance of reducing levels of insulin and insulin resistance is not yet clear. Although many questions remain to be answered, available data strongly suggest that patients with diabetes benefit from more aggressive and comprehensive treatment.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Many reports show a reduction in cardiovascular disease events in cohorts of women taking postmenopausal hormone replacement. Newer reports detail the possible mechanisms for reduction in cardiac events, including beneficial changes in arterial function and lipid metabolism. Clinical studies now show that combination estrogen and progestin therapy appears to also result in a reduction in cardiovascular risk, but women are receiving mixed messages about why they should or should not take hormones and many discontinue or never start therapy. Several organizations have provided guidelines for evaluating the individual risk-benefit ratio for hormone replacement therapy for a given woman. Until randomized clinical trials are reported, adherence to established guidelines for treatment is the recommended course of action.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID