Wiesbaden, Germany
Wiesbaden, Germany

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Reiff J.,HSK Wiesbaden | Jost W.H.,Deutsche Klinik fur Diagnostik
Journal of Neurology | Year: 2011

Dopamine replacement treatment with excessive or aberrant dopamine receptor stimulation can cause behavioral disturbances in Parkinson's disease, comprising dopamine dysregulation syndrome, punding, and impulse control disorders. Common impulse control disorders are compulsive buying, pathological gambling, binge eating, hypersexuality, and compulsive reckless driving. © Springer-Verlag 2011.

Jost W.H.,Deutsche Klinik fur Diagnostik
Journal of the Neurological Sciences | Year: 2010

Gastrointestinal (GI) motility is very frequently disturbed in Parkinson's disease (PD), manifesting chiefly as dysphagia, impaired gastric emptying and constipation. All these symptoms - constipation in particular - may precede the clinical diagnosis of PD for years. In the future, these symptoms might serve as useful early indicators in the premotor stage. Disturbed gastric emptying is an important factor in unpredictable fluctuations. The most likely causes are degenerations of the dorsal vagal nucleus and the intramural plexus of the whole intestine. These degenerations are likely to develop prior to the degeneration of dopaminergic neurons of the substantia nigra. Diagnosis includes history, clinical examination, barium meal, breath test, scintiscan of stomach, and colonic transit time. Therapeutic efforts are limited when it comes to disturbed motility of the upper GI-tract. Hypersalivation can be reduced by anticholinergics or botulinum toxin injections; motility of the upper gastrointestinal tract is only moderately impacted on by domperidone. In constipation, the conservative therapeutic option is administration of macrogol (polyethylene glycol), which leads to marked improvement. © 2009 Elsevier B.V. All rights reserved.

Eckardt A.J.,Deutsche Klinik fur Diagnostik | Eckardt V.F.,Deutsche Klinik fur Diagnostik
American Journal of Gastroenterology | Year: 2010

Patients with achalasia have an increased risk for the development of esophageal squamous cell cancer. Endoscopic surveillance in long-standing achalasia has been advocated by some, but the most recent American Society of Gastrointesinal Endoscopy guidelines regard current data as insufficient to support such an approach. In this issue of the American Journal of Gastroenterology, Leeuwenburgh and colleagues report on the results of a long-term prospective study with fixed surveillance intervals. The authors confirm earlier observations of an increased cancer risk after 10 years of symptomatic achalasia. Despite some limitations, this study and earlier data suggest that it might be worthwhile to consider endoscopic surveillance in patients with long-standing achalasia. © 2010 by the American College of Gastroenterology.

Eckardt A.J.,Deutsche Klinik fur Diagnostik | Eckardt V.F.,Deutsche Klinik fur Diagnostik
Nature Reviews Gastroenterology and Hepatology | Year: 2011

Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years. © 2011 Macmillan Publishers Limited. All rights reserved.

Background and study aims: Sphincter of Oddi dysfunction (SOD) is one important cause of idiopathic acute-recurrent pancreatitis (ARP). Several trials have documented complete remission from ARP after endoscopic sphincterotomy during a 2 - 3-year follow-up. Data with longer follow-up, however, are not available. Patients and methods: Between 1995 and 1998, endoscopic sphincterotomy was performed in 37 patients with manometrically documented SOD and ARP. Afterwards, all patients were prospectively re-evaluated over a period of at least 2 years. In 2008, all patients and their primary physicians were contacted and the patients were interviewed using a structured questionnaire. If a case or situation was unclear, the patients were clinically re-evaluated at our hospital. Results: During the initial prospective 2-year follow-up, relapsing pancreatitis was documented in 5 / 37 patients (14 %). At this point, dual endoscopic sphincterotomy was performed in four patients, and one patient underwent surgical pancreatico-jejunostomy. On retrospective re-evaluation (total follow-up, 11.5 ± 1.6 years) at least one episode of recurrent pancreatitis was found among 19 / 37 patients (51 %). The mean number of relapses that occurred during long-term follow-up (0.7 ± 0.7; range, 0 - 2) was lower than that recorded at the time of patient enrollment (2.5 ± 0.5; range, 2 - 4). The recurrence rate did not differ with respect to the patient's first clinical presentation, their demographic data or initial manometric findings. However, relapsing pancreatitis was documented more often in patients who, in the past, had undergone either biliary or pancreatic endoscopic sphincterotomy (12 / 13 patients) than among those who had undergone dual endoscopic sphincterotomy first (7 / 24 patients; P < 0.05). The median interval for relapsing pancreatitis was 3.5 years (range, 3 - 84 months). Conclusions: Follow-up after endoscopic therapy for SOD in patients with ARP should be considered for at least 5 years. For endoscopic treatment, dual endoscopic sphincterotomy may be preferred, although this will not completely prevent recurrence of pancreatitis. Endoscopic therapy nonetheless helped to decrease the frequency of relapse. © Georg Thieme Verlag KG Stuttgart - New York.

Jost W.H.,Deutsche Klinik fur Diagnostik
Journal of Neural Transmission | Year: 2013

Bladder dysfunctions are quite common in Parkinson's disease. They may occur at any stage of the illness and get worse with advancing and aggravating disease. The most prominent dysfunction is the so-called overactive bladder. Control of bladder function is part of a highly complex system subject to the interaction of predominantly the frontal and pontine micturition or continence center and the spinal cord. Besides there are some other anatomic structures involved in the complex control loop of bladder regulation. Regarding central regulation, dopamine is the essential neurotransmitter that inhibits bladder activity. All dopaminergic substances are capable of influencing automatic control systems. This also holds true for many other classes of other medications such as anticholinergics, antidepressants, and beta-blockers. The chief clinical problem of this patient consists in reduced inhibition with consequentially resulting overactivity of the detrusor muscle, meaning the urge to urinate in the absence of adequate bladder filling. The patients mostly complain of an imperative urge to urinate, of pollakisuria, nocturia and even incontinence of urine (urge incontinence). The objectives of diagnosis and therapy focus on controlled bladder evacuation and continence of urine. The most important diagnostic clues are provided by the patient's medical history. Only in rare cases urodynamic studies are indicated as well. For treatment we can avail ourselves of a number of anticholinergic drugs. We must watch out though that the medication ordered is not going to impact on cognition.We recommend tolteradine, not passing the blood brain barrier, or M3-specific antimuscarinics such as solifenacin and darifenacin. Positive therapeutic outcomes are limited. A new alternative at hand, albeit not approved for the time being, is the local injection of botulinum toxin into the detrusor muscle. © 2012 Springer-Verlag Wien.

Mettang M.,Deutsche Klinik fur Diagnostik | Weisshaar E.,Deutsche Klinik fur Diagnostik
Skin therapy letter | Year: 2010

Chronic kidney disease (CKD)-associated pruritus is a significant clinical symptom affecting more than 50% of patients on hemodialysis. Restricted by the availability of effective therapeutic options, the management of CKD-associated pruritus remains a treatment challenge. Evaluating research in this area is difficult, as most studies are not comparable due to differing methodologies and study designs, limited number of patients, and the lack of standardized measures. The most frequently used therapy is UVB phototherapy, eliciting favorable responses in most patients. Newer approaches, such as treatment with the m-opiod-receptor antagonist, naltrexone, have yielded conflicting results. The use of the k-opioid-receptor-agonist, nalfurafine, appears to be partially effective in relieving CKD-associated pruritus, as shown by a meta-analysis of 2 clinical trials. Promising results have been obtained by treatment with the anticonvulsant gabapentin. CKD-associated pruritus is thought to be mediated by a proinflammatory state, which explains why immunomodulating drugs (e.g., thalidomide, tacrolimus, and pentoxiphylline) are effective in some patients. Treatment of CKD-associated pruritus should be undertaken according to individual benefit-risk ratio assessments.

Eckardt A.J.,Deutsche Klinik fur Diagnostik | Baumgart D.C.,Humboldt University of Berlin
Recent Patents on Anti-Infective Drug Discovery | Year: 2011

Viral gastroenteritis presents a major public health concern worldwide. It is mostly a disease of young children. However, acquired immunity may wane and symptomatic infection can also occur in adults. Furthermore, asymptomatic adults may promote the spread of infections by shedding virus in their stools. This review covers the four most common causes of adult viral gastroenteritis, Calicivirirdae (predominantly noroviruses), astroviruses, enteric adenoviruses and rotaviruses focussing on their epidemiologic, structural, pathogenic and clinical aspects. In addition, current and future prevention and treatment options are discussed, including recent patents. While specific inhibitors of viral replication are currently not available, we summarized non-specific anti-viral agents and potential targets for the most important adult pathogen, Norovirus. Special emphasis is put on current and future vaccines. © 2011 Bentham Science Publishers Ltd.

Muller M.,Deutsche Klinik fur Diagnostik | Wehrmann T.,Deutsche Klinik fur Diagnostik
Nature Reviews Gastroenterology and Hepatology | Year: 2011

Sedation is the drug-induced reduction of a patient's consciousness. The aim of sedation in endoscopic procedures is to increase the patient's comfort and to improve endoscopic performance, especially in therapeutic procedures. The most commonly used sedation regimen for conscious sedation in gastrointestinal endoscopy is still the combination of benzodiazepines with opioids. However, the use of propofol has increased enormously in the past decade and several studies show advantages of propofol over the traditional regimes in terms of faster recovery time. It is important to be aware that the complication rate of endoscopies increases when sedation is used; therefore, a thorough risk evaluation before the procedure and monitoring during the procedure must be performed. In addition, properly trained staff and emergency equipment should be available. The best approach to sedation in endoscopy is to choose a sedation regimen for the individual patient, tailored according to the clinical risk assessment and the anxiety level of the patient, as well as to the type of planned endoscopic procedure. © 2011 Macmillan Publishers Limited. All rights reserved.

Mettang T.,Deutsche Klinik fur Diagnostik | Kremer A.E.,Friedrich - Alexander - University, Erlangen - Nuremberg
Kidney International | Year: 2015

Uremic pruritus or chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and compromising symptom in patients with advanced or end-stage renal disease, strongly reducing the patient's quality of life. More than 40% of patients undergoing hemodialysis suffer from chronic pruritus; half of them complain about generalized pruritus. The pathogenesis of CKD-aP remains obscure. Parathormone and histamine as well as calcium and magnesium salts have been suspected as pathogenetic factors. Newer hypotheses are focusing on opioid-receptor derangements and microinflammation as possible causes of CKD-aP, although until now this could not be proven. Pruritus may be extremely difficult to control, as therapeutic options are limited. The most consequential approaches to treatment are: topical treatment with or without anti-inflammatory compounds or systemic treatment with (a) gabapentin, (b) μ-opioid receptor antagonists and κ-agonists, (c) drugs with an anti-inflammatory action, (d) phototherapy, or (e) acupuncture. A stepwise approach is suggested starting with emollients and gabapentin or phototherapy as first-line treatments. In refractory cases, more experimental options as μ-opioid-receptor - antagonists (i.e., naltrexone) or κ-opioid-receptor agonist (nalfurafine) may be chosen. In desperate cases, patients suitable for transplantation might be set on 'high urgency'-status, as successful kidney transplantation will relieve patients from CKD-aP. © 2015 International Society of Nephrology.

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