Search

Copyright of Gynäkologische Endokrinologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Multimodal therapies comprising spa applications are widely used as non-pharmaceutical treatment options for musculoskeletal diseases. The purpose of this randomized, controlled, open pilot study was to elucidate the involvement of the endocannabinoid system in a multimodal therapy approach. Twenty-five elderly patients with knee osteoarthritis (OA) received a 2-week spa therapy with or without combination of low-dose radon therapy in the Bad Gastein radon gallery. A 10-point numerical rating scale (pain in motion and at rest), WOMAC questionnaire, and the EuroQol-5D (EQ-5D) questionnaire were recorded at baseline, and during treatment period at weeks one and two, and at 3-month and 6-month follow-ups. Plasma levels of the endocannabinoid anandamide (AEA) were determined at baseline and at 2 weeks, and serum levels of several cartilage metabolism markers at all five time-points. A significant and sustained reduction of self-reported knee pain was observed in the study population, but no further significant effect of the additional radon therapy up and above base therapy. This pain reduction was accompanied by a significant reduction of AEA plasma levels during treatment in both groups. No significant differences were seen in serum marker concentrations between the groups treated with or without radon, but a small reduction of serum cartilage degradation markers was observed during treatment in both groups. This is the first study investigating AEA levels in the context of a non-pharmacological OA treatment. Since the endocannabinoid system represents a potential target for the development of new therapeutics, further studies will have to elucidate its involvement in OA pain. [ABSTRACT FROM AUTHOR]

Copyright of Pädiatrie & Pädologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Somnologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The analysis of events such as apneas, hypopneas, and various types of arousals during sleep plays a central role when diagnosing and trying to understand sleep-related disorders and possible sequelae. Often, only the occurrence of these events is regarded instead of putting them into context with other cardiovascular variables and characterizing their mutual interactions. In this article, we present two new methods that allow for such an analysis: the coordigram and the ensemble symbolic-coupling traces. Through a case study of a subject with frequent arousals, the potential of the new tools for quantifying the autonomic response to sleep disturbances is shown. Furthermore, in a reanalysis of patients suffering from obstructive sleep apnea, the diagnostic relevance of cardiorespiratory coordination for risk stratification of an emerging hypertension is demonstrated. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess sexual function and quality of life (QoL) in patients after surgery for perianal Crohn's disease. Methods: Eighty-eight consecutive patients with perianal Crohn's disease, operated on at the Medical University of Vienna, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), Short Form-12 Health Survey (SF-12), and the Inflammatory Bowel Disease Questionnaire (IBDQ). Patients with a current stoma were excluded from further analysis. The median follow-up time was 104 months (range 3-186 months). Healthy subjects served as controls for each case and were matched by age (±6 years) and gender. Forty-seven (68 %) female and 22 male patients with a median age of 46.5 years (range 18-64 years) were analyzed. Eleven (16 %) patients had simple and 58 (84 %) complex anal fistulas. Results: The median SF-12 physical health score of the patients was significantly lower (47.9 (range 25.5-57.2)) than that of the controls (54.3 (range 34.6-61.8); p = 0.03). Not surprisingly, the median total sore of the IBDQ of the controls was significantly better than that of the patients (controls: 188.5 (range 125-206.5), patients: 157 (range 60-199.5); p < 0.0001). Analysis with the multiple logistic regression test showed that type of operation, >1 perianal fistula opening, and active Crohn's disease were independent risk factors for a worse IBDQ ( p = 0.03, p = 0.015 and p < 0.0001). Interestingly, the median FSFI and IIEF score were not found to be significant different in any domain. Conclusions: QoL but not sexual function is significantly influenced by surgery for perianal Crohn's disease. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: B-type natriuretic peptide (BNP) is a hormone released from cardiomyocytes in response to cell stretching and elevated in heart failure. Recent observations indicate a distinct connection between chronic heart failure and diabetes mellitus. This study investigated the role of BNP on glucose metabolism. Methods: Ten healthy volunteers (25 ± 1 years; BMI 23 ± 1 kg/m; fasting glucose 4.6 ± 0.1 mmol/l) were recruited to a participant-blinded investigator-open placebo-controlled cross-over study, performed at a university medical centre. They were randomly assigned (sequentially numbered opaque sealed envelopes) to receive either placebo or 3 pmol kg min BNP-32 intravenously during 4 h on study day 1 or 2. One hour after beginning the BNP/placebo infusion, a 3 h intravenous glucose tolerance test (0.33 g/kg glucose + 0.03 U/kg insulin at 20 min) was performed. Plasma glucose, insulin and C-peptide were frequently measured. Results: Ten volunteers per group were analysed. BNP increased the initial glucose distribution volume (13 ± 1% body weight vs 11 ± 1%, p < 0.002), leading to an overall reduction in glucose concentration ( p < 0.001), particularly during the initial 20 min of the test ( p = 0.001), accompanied by a reduction in the initial C-peptide levels (1.42 ± 0.13 vs 1.62 ± 0.10 nmol/l, p = 0.015). BNP had no impact on beta cell function, insulin clearance or insulin sensitivity and induced no adverse effects. Conclusions/interpretation: Intravenous administration of BNP increases glucose initial distribution volume and lowers plasma glucose concentrations following a glucose load, without affecting beta cell function or insulin sensitivity. These data support the theory that BNP has no diabetogenic properties, but improves metabolic status in men, and suggest new questions regarding BNP-induced differences in glucose availability and signalling in various organs/tissues. Trial registration:: ClinicalTrials.gov: NCT01324739 Funding:: The study was funded by Jubilée Fonds of the Austrian National Bank (OeNB-Fonds). [ABSTRACT FROM AUTHOR]

The analysis of effects from coupling within and between systems plays an important role in data-driven investigations as practiced in many scientific fields. It allows deeper insights into the mechanisms of interactions emerging between individual smaller systems when forming complex systems as in the human circulatory system. In this work, several existing coupling measures are briefly introduced and summarized. Special attention is paid to the application to cardiovascular and cardiorespiratory data measured during sleep. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are still controversial data about the impact of rectal resection for malignancies on overall pelvic organ function and quality of life. Our aim was to investigate whether these parameters differ compared to the general population without bowel resection. METHODS: One hundred eighteen patients (44%) operated for rectal cancer at a single institution between 1995 and 2005 completed a self-administering questionnaire including the International Index of Erectile Function, Female Sexual Function Index, Short Form-12 Health Survey, International Prostatic Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, and Vaizey Incontinence Score. Healthy subjects with no bowel resection served as controls for each case and were matched by age (±5 years) and gender. The median follow-up time was 7 years (range 2.8-14.2). RESULTS: The Vaizey incontinence score was significant higher in the patient group compared with the control group (patients: median 4 (range 0-24), controls: 0 (range 0-20); p<0.0001). Sexual and urinary function showed no significant difference between both groups. In regard to the SF-12 health survey the median physical health score of patients was 51.5 (range 22.0-58.2) compared to 53.6 (range 16.8-64.3) of the control subjects ( p = 0.1241). The median mental health score of the patient group was 55.1 (range 19.1-63.8) compared to 55.0 (range 28.7-63.8) of the control group ( p = 0.2222). CONCLUSIONS: Patients with rectal cancer resection have a significant impairment of fecal continence. Notably, urinary and sexual function and quality of life are comparable with healthy subjects without colorectal resection. [ABSTRACT FROM AUTHOR]

Copyright of Der Nephrologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bilateral, simultaneous quadriceps tendon rupture (QTR) represents a rare entity and delay in establishing the correct diagnosis is not uncommon. Another three cases are reported here and in all the correct diagnosis was missed initially. A review of the English and German literature retrieved 105 cases of bilateral, simultaneous QTR and in 32 patients (30.5%) the correct diagnosis was established with delay. In 28 cases—representing 25 men (89.3%) and 3 women (10.7%)—sufficient data was available for further analysis. In the majority of patients ( n = 19/28; 67.9%) rupture was associated with trauma, while no trauma was reported in 9/28 cases (32.1%). No direct correlation between age and the kind of rupture form (traumatic/spontaneous) could be detected ( P = 0.35). Most partients ( n = 18/28; 64.3%) presented risk factors associated with QTR and obesity ( n = 6/28; 21.4%) was most frequently encountered. A direct association between the rate of risk factors and the rupture form was not seen ( P = 0.5). Overall diagnostic delay lasted 64.7 days on an average (traumatic ruptures 67.7 days/spontaneous ruptures 58.7 days) with this period being longer than 2 weeks in 51.9% and longer than 3 months in 33.3% of patients. Delay varied distinctly in different medical institutions as this period lasted in hospital departments 93.9 days, in ambulances 24 days and in General Practitioners 7.6 days on an average. Initially 25 incorrect diagnoses were established in 21/28 (75%) patients, while 7/28 cases (25%) were discharged initially without any diagnosis. Clinical examination revealed most often palpable suprapatellar gaps ( n = 17/24) and effusions ( n = 13/24), while the classic trias of painful swelling, suprapatellar gap and loss of knee extension was found in only 58.3% of reported patients ( n = 14/24). The correct diagnosis of bilateral QTR was established in 60.7% ( n = 17/28) by history and clinical examination alone. In 10.7% ( n = 3/28) clinical suspect was supported by sonography and in 14.3% ( n = 4/28) by MRT; in 14.3% ( n = 4/28) the correct diagnosis represented a by chance finding during diagnostic or operative procedures of other indication. In 52 tendons detailed information about repair was provided and most often transosseous fixation ( n = 30/52; 57.7%) and direct repair ( n = 14/52; 26.9%) were used, while a tenoplasty was performed in only 15.4% ( n = 8/52). Only 34.6% of patients ( n = 9/26) with follow-up data ( n = 26/28) reported a full recovery with a trend that early surgical repair (limit 2 weeks) improves the final outcome. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims/hypothesis. Preproinsulin is a target T cell autoantigen in human Type 1 diabetes. This study analyses the phenotype and epitope recognition of preproinsulin reactive T cells in subjects with a high genetic risk of diabetes [HLA-DRB1*04, DQ8 with Ab+ (autoantibody-positive) or without islet autoantibodies (control subjects)], and in HLA-matched diabetic patients. Methods. A preproinsulin peptide library approach was used to screen for cytokine profiles and epitope specificities in human peripheral blood lymphocytes, and CD4+CD45RA- and CD4+CD45RA+ T cell subfractions, representing memory and naive and recently primed T cells respectively. Results. In CD4+ T cell subsets we identified immunodominant epitopes and cytokine production patterns that differed profoundly between patients, Ab+ subjects and non-diabetic HLA-matched control subjects. In Ab+ subjects, a C-peptide epitope C13–29 and insulin B-chain epitope B11–27 were preferentially recognised, whereas insulin-treated Type 1 diabetic patients reacted to native insulin and B-chain epitope B1–16. In peripheral blood lymphocytes of Ab+ subjects, an increase in T helper (Th) 1 (IFNγ, IL-2) and Th2 (IL-4) cytokines was detectable, wheras in CD45RA+ and CD45RA- subsets, IL-4 and IL-10 phenotypes dominated, compatible with the contribution of non-CD4 cells to IFNγ content. In insulin-treated Type 1 diabetic patients, naive and recently primed CD4+ cells were characterised by increasd IFNγ, TNFα, and IL-5. Conclusions/interpretation. Our data show that T cell reactivity to preproinsulin in CD45RA subsets is Th2-dominant in Ab+ subjects, challenging the Th1 paradigm in Type 1 diabetes. Characteristic immunodominant epitopes and cytokine patterns distinguish diabetic patients and Ab+ subjects from HLA-matched healthy individuals. This could prove useful in monitoring of T-cell immunity in clinical diabetes intervention trials. [ABSTRACT FROM AUTHOR]

Patienten mit Orbitafrakturen sind häufig schwer verletzt. Eine direkte, konventionelle koronale Computertomographie (CT) ist aufgrund der dafür nötigen Positionierung in Bauchlage mit überstreckten Nacken in der Regel nicht möglich. Die Diagnostik beruht demnach nur auf konventionellen axialen Schichten, da koronal rekonstruierte Bilder eine stark eingeschränkte Bildqualität besitzen. In einer Pilotstudie an sechs Patienten verglichen wir anhand von Orbitafrakturen die konventionelle Computertomographie in axialen und koronalen Schnittrichtungen mit der Spiral-CT in axialer Schnittebene und koronaler, aus dem Datensatz rekonstruierter Schnitte. Bildqualität und Beurteilbarkeit von Orbitafrakturen wurden von zwei Untersuchern anhand eines Scores konsensuell bewertet. Die axialen Schnitte in konventioneller und Spiral-CT-Technik zeigten keine wesentlichen Unterschiede bezüglich Bildqualität. Bei den koronalen Schichten aus Spiral-CT Datensätzen zeigten sich geringe Nachteile in der Beurteilbarkeit des Orbitabodens, jedoch eine deutlich verbesserte Beurteilbarkeit dieser, sowie auch horizontaler Strukturen bezüglich axialer Daten. Bei verletzten Patienten sollte die Untersuchung der Orbita in Spiral-CT-Technik erfolgen, da koronal rekonstruierte Bilder eine deutlich verbesserte Diagnostik gegenüber herkömmlichen axialen Schnitten ermöglichen und fast an die Bildqualität primär koronaler Schichten heranreichen. Patients with orbital fractures frequently suffer from concomitant severe trauma which makes the positioning needed (prone with hyperextended neck) for direct coronal computed tomography (CT) impossible. In this situation just axial scans are acquired directly with the possibility of reconstruction of coronal images from the axially acquired data. However, these reconstructed images show severe shortcomings of image quality making misdiagnosis more likely. In a pilot study with six patients we compared image quality and the ability to assess orbital bone fractures on axial and coronal scans of conventional- and spiral-CT. Evaluation criterion was a modified score which was used consensually by two reviewers to judge the hardcopies. Scores of image quality between spiral-CT and conventional CT were comparable on axial scans. In addition, spiral-CT generates coronal scans of diagnostic quality through multiplanar reconstruction. We recommend the use of spiral — CT technique for severely traumatized patients since reconstructed coronal images improve diagnostic accuracy significantly compared to axial images alone and come close to image quality of direct coronal scans. [ABSTRACT FROM AUTHOR]

Reduced bone mineral density (BMD) and the prevalence for osteoporotic vertebral fractures are symptoms of growth hormone deficiency (GHD) syndrome, and GH replacement therapy is now available for GH-deficient adults. We investigated the long-term effects of GH replacement therapy on bone mineral density (BMD) and bone metabolism in 19 adult patients with GHD over a period of 18 months. In response to GH treatment, the initially decreased IGF-I concentrations rose significantly during 18 months of therapy to levels within the normal range (matched for sex and age) (mean change 158.1 +/- 50.8 ng/ml, P < 0.001). Parameters of bone formation such as osteocalcin (OC) and procollagen I-C-Peptide (PICP) showed a significant increase in the first 6 months of therapy, followed by a slight decrease in the next months. Markers of bone resorption (CrosslapsR and deoxypyridinoline (D-Pyr) also increased significantly with a peak value after 6 months and all parameters except PICP remained above baseline values after 18 months. BMD of the femoral neck (FN) showed an increase after 18 months of therapy (mean change 0.01 +/- 0.03 g/cm2 after 18 months, n.s.). However, the increase in BMD was significant only in the lumbar spine (LS) (mean change 0.03 +/- 0.04 g/cm2, P < 0.05 after 18 months). We conclude that GH replacement therapy in adult patients with GHD over a period of 18 months causes a pronounced increase in bone turnover mainly during the first 12 months of therapy and increases BMD of the lumbar spine and the femoral neck after 18 months. [ABSTRACT FROM AUTHOR]

Single photon emission computerized tomography (SPECT) using the Iodine 123 labeled dopamine D receptor antagonist S (−)Iodobenzamide [S (−)IBZM] was performed in 15 patients with pituitary tumors. Among them there were five prolactinoma patients with macroadenoma and two acromegalic patients with macroadenoma. Specific binding in the area of the adenoma was only observed in one subject, a macroprolactinoma patient, who was responsive to dopaminergic treatment. None of the other patients, among them one macroprolactinoma patient responsive to dopaminergic treatment showed specific binding in the area of the tumor. IBZM-binding in the striatum was found to be significantly lower in the group of pituitary tumor patients as compared to controls. The results show that D2 receptors in pituitary adenomas can be visualized using SPECT. However, the sensitivity of IBZM-SPECT appears to be too poor to visualize PRL- and GH- secreting macroadenomas in general. [ABSTRACT FROM AUTHOR]

Penetrierende Verletzungen mit retinierten intraokularen, eisenhältigen Fremdkörpern sind in vielen Fällen schwere, das Auge stark beeinträchtigende Verletzungen. Aufgrund der Gefahr einer Infektion sowie einer Siderose wird der Fremdkörper in den meisten Fällen im Zuge der Versorgung der Verletzung oder auch sekundär entfernt. Es wird über einen Patienten berichtet, der als Beobachter während einer Operation ein solches Trauma erfährt. Durch die speziellen Umstände des sterilen sowie inerten Fremdkörpers als auch dem durch dieses Trauma unbeeinträchtigtem Virus wurde von einer Fremdkörperentfernung Abstand genommen. Über einen Beobachtungszeitraum von 2 Jahren kam es zu keiner Veränderung des Befundes, und ein Monitoring in Bezug auf Siderosis blieb unauffällig. Penetrating injuries with an intraocular ironcontaining foreign body represent in many instances severe injuries, threatening the integrity of the eye. Removal will be performed in most cases together with wound-closure or lensectomy or as an elective procedure. We present a patient who was inflicted such an injury while observing an operation. As a cause of the special circumstances — a steril and inert foreign body with no change in the patient’s visual acuity — the foreign material was left in place. During a follow-up period of two years there was no change of signs and symptoms and screening for signs of siderosis stayed negative. [ABSTRACT FROM AUTHOR]

Die heute übliche Behandlungsweise eines Molluscum Contagiosums am kindlichen Augenlid besteht, wegen möglicher okulärer Komplikationen, in der frühzeitigen chirurgischen Entfernung. Allerdings nimmt man dabei die Risiken einer Vollnarkose in Kauf, ohne gesicherte epidemiologische Daten über einerseits die Häufigkeit okulärer Komplikationen und andererseits die Häufigkeit von Spontanremissionen. Dieser Fall zeigt die rasche und komplikationslose Remission eines Molluscum Contagiosum bei einem 5-jährigen Kind und befürwortet nach kritischem Studium der Literatur eine abwartende Haltung ohne chirurgische Intervention bei diesen jungen Patienten. Because of possible ocular complications, POMC on children’s eyelid, is usually treated with early surgical removal. General anaesthisia, which is need in the case of pediatric patients, is however associated with the well known risks of this procedure and furthermore there are no valid epidemiological data regarding the frequency of ocular complications and/or spontaneous remission. We report a spontaneous and rapid remission, without any ocular complications, of a POMC in a five year old child. This case and critical interpretation of the literature regarding this topic, support the observation of such patient without surgical intervention. [ABSTRACT FROM AUTHOR]