Biomedical subjects
Publications and source records attributed to W Vetter.
Based on a clinical case we discuss the physiological changes in the lipid metabolism during pregnancy. The changes are characterised by a marked elevation of the total plasma cholesterol and the triglyceride levels. Usually there is no need for a specific therapy.
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To analyse drug therapy knowledge of prescribed drugs and self-administered medicinal products we interviewed 222 ambulatory cardiovascular patients. Spontaneous mentions of drugs (at least 3 preparations on average) were completed later on specific questioning. 40% of patients once interrupted their therapy due to adverse drug reactions. Most patients knew the labels of their medicaments but the effects and indications only in 50%. Nevertheless 70% were satisfied with the informations of the physician. Drugs available over the counter were consumed in many of the respondents: 50% consumed analgetics, and--mainly female patients--25% sedatives and 15% laxatives or diuretics. We conclude that specific questioning on self-administation of OTC preparations or formerly prescribed drugs results in an improved overview of medication and a better handling of polymedication and drug compliance.
We analyzed the diagnostical and therapeutical costs of 300 ambulatory patients over a two year period in a Swiss university policlinic of internal medicine. The calculations were based on the catalogue of hospital services (Spitalleistungskatalog) and the drugstore prices for pharmaceuticals (Apothekenpreise). The overall costs for the 300 patients were about 238,400 CHF. The refund by the health insurances represented 56% (excluding specific services such as radiological examinations). The main costs concerned analytical laboratory services (32%), physicians services (27%), technical services (26%), and pharmaceuticals (15%). Some analytical and technical services were prescribed unexpectedly frequently. Prevalent among the emitted pharmaceuticals were protone pump inhibitors, modern cardiovascular drugs and statins. Presumed reasons may be a minor cost awareness of the physicians and a trend towards modern but expensive therapies. An adequate cost awareness can only emerge from precise data of effective costs.
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Atherosclerosis is a chronic systemic inflammatory disease of the vasculature that accounts for the majority of morbidity and mortality in women. The incidence of atherosclerosis is low in premenopausal women and increases after ovariectomy. Experimental studies demonstrate inhibitory effects of natural estrogens on the progression of atherosclerosis. In contrast, results from recent hormone replacement trials using conjugated equine estrogens and medroxyprogesterone acetate in postmenopausal women showed no effects or even an increase in cardiovascular morbidity and mortality such as thrombosis or stroke. Therefore, conjugated equine estrogens alone or in combination with medroxyprogesterone acetate should not be recommended for the prevention or treatment of cardiovascular disease. Optimizing the risk factor profile such as cessation of smoking, normalizing body weight and blood pressure, regular physical activity, and statin treatment of patients with coronary artery disease remain important treatment options.
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