Statin Intolerance in Clinical Practice.

PURPOSE OF REVIEW: In our pilot study, we aimed to determine how many patients with the statin intolerance history referred to the specialized center for the diagnostics and treatment of lipoprotein metabolism disorders really suffer from a complete statin intolerance. The purpose of the study was to prove that complete statin intolerance is overestimated and overdiagnosed, and with the detailed knowledge of the issue and patient approach, it is possible to find an appropriate statin treatment for the most of patients. RECENT FINDINGS: With the increasing number of statin users worldwide, the issue of statin intolerance has been a frequently discussed topic in recent years. There are many factors that play a role in the manifestation of statin intolerance (predisposing factors as age, sex, and some diseases), genetic factors leading to a different metabolism, drug-drug interactions, psychological reasons, and the negative influence of the mass media. However, it is estimated that true complete statin intolerance, defined by an intolerance of at least three statins at their usual lowest daily doses, occurs in approximately 3-6% of all statin users. In our pilot study, we conducted a retrospective analysis of 300 patients who were referred to the Center of Preventive Cardiology with a history of statin intolerance. During the follow-up treatment, 222 patients (74%) were able to use some statin (rosu-, atorva-, simva-, fluvastatin), and in 21% of the cases (63 patient), the target values according their CV risk level were even achieved. Only 78 patients (26%) were confirmed as being complete statin intolerant following a thorough therapeutic effort. The most tolerated statin was rosuvastatin.

[Tumors of the inner angle of the eye]. / Problematika tumoru vnitrního koutku oka.

The authors present an account of their longstanding experience with treatment of tumours affections of the inner angle of the eye. Careful preoperative examination incl. assessment of possible obstruction of the lacrimal pathways and CT examination of the affected area, which was the only method which did not produce falsely negative results, is essential. In this area they recommend radical surgery of tumours infiltrating into deep layers, i.e. extensive excision, incl. some sound tissue, and covering of the defect by a frontal flap. With regard to the danger of inadequate freezing they do not recommend in this area cryodestruction in deep tumours. The authors draw attention to the necessity of close collaboration of the ophthalmologist and otorhinolaryngologist which makes it possible to supplement the operation, when the paranasal sinuses are affected, which was essential in the great majority of the authors' patients.