Klinik II fur Innere Medizin

Köln, Germany

Klinik II fur Innere Medizin

Köln, Germany
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Olschewski A.,Ludwig Boltzmann Research Institute | Olschewski A.,Medical University of Graz | Berghausen E.M.,Klinik II fur Innere Medizin | Berghausen E.M.,University of Cologne | And 18 more authors.
Deutsche Medizinische Wochenschrift | Year: 2016

The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension (PH) are also valid for Germany. While the guidelines contain detailed recommendations regarding clinical aspects of pulmonary arterial hypertension (PAH) and other forms of PH, they contain only a relatively short paragraph on novel findings on the pathobiology, pathology, and genetics. However, these are of great importance for our understanding of this complex disease both from a clinical and scientific point of view, and they are essential for the development of novel treatment strategies. To this end, a number of current data are relevant, prompting a detailed commentary to the guidelines, and the consideration of new scientific data. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the pathobiology, pathology and genetics of PH. This article summarizes the results and recommendations of this working group. © Georg Thieme Verlag KG Stuttgart . New York.


Kisner T.,Klinik II fur Innere Medizin | Pfister R.,University of Cologne | Engels M.,Institute For Pathologie | Benzing T.,Klinik II fur Innere Medizin | Michels G.,University of Cologne
Deutsche Medizinische Wochenschrift | Year: 2012

History and clinical findings: A 39-year-old man complained of unspecific chest pains four years after kidney transplantation. Investigations: Laboratory tests revealed a slow increase of retentions values; the value of soluble IL-2 receptor was slightly elevated. Computed tomography of the chest confirmed mediastinal and bilateral hilar masses. The broncho-alveolar lavage (BAL) showed a marked increase of the CD4/CD8 T-lymphocyte ratio and the aspiration cytology of these lymphadenopathies revealed the cytopathological characteristics of sarcoidosis. Treatment and clinical course: An asymptomatic stage I sarcoidosis was diagnosed, and the immunosuppressive treatment with cyclosporine, mycophenolatmofetil and prednisone was retained. The patient has remained asymptomatic for now six months. Conclusion: When bilateral hilar / mediastinal lymphadenopathies occur after organ transplantation with immunosuppression de novo sarcoidosis should be taken into account. © Georg Thieme Verlag KG Stuttgart New York.


Hopker K.,Klinik II fur Innere Medizin | Reinhardt H.C.,Klinik i fur Innere Medizin | Reinhardt H.C.,University of Cologne | Reinhardt H.C.,Collab Research Center 832 Molec Basis And Modulation Of Cell Interaction In The Tumor Microenvironment | Reinhardt H.C.,Universitatsklinik Cologne
Deutsche Medizinische Wochenschrift | Year: 2013

The tumor suppressor p53 acts as a transcription factor downstream of many different stress-induced signaling pathways. Two major groups of p53-controlled genes can be distinguished. Those that mediate the initiation and maintenance of cell cycle checkpoints, and those driving apoptosis. An important determinant of the cellular reaction to DNA damage is the degree of genotoxic stress. The type of cellular response, which ranges from cell cycle arrest to apoptosis depends to a large extend on the severity of the genotoxic lesion. It remains largely unclear which molecular mechanisms govern the cellular decision between p53-driven cell cycle arrest and apoptosis. From a therapeutic perspective, this cellular decision is of utmost importance, as p53-driven apoptosis is therapeutically desired, when treating a malignant disease with DNA-damaging chemotherapy. However, a p53-driven cell cycle arrest might promote chemotherapy resistance, as it allows the tumor cells time to repair genotoxic lesions prior to the next cell division. Here, we summarize recent advances in our understanding of the molecular mechanisms controlling the functional outcome of p53 signaling. We further provide an outlook on the potential development of pharmacological interventions targeting the p53-regulating machinery to promote p53-driven apoptosis, while repressing p53-dependent cell cycle checkpoints. © 2012 Georg Thieme Verlag KG Stuttgart New York.


Hopker K.,Klinik II fur Innere Medizin | Reinhardt H.C.,Klinik i fur Innere Medizin | Reinhardt H.C.,Universitatsklinik Cologne | Reinhardt H.C.,Collaborative Research Center 832
Tumor Diagnostik und Therapie | Year: 2013

The tumor suppressor p53 acts as a transcription factor downstream of many different stress-induced signaling pathways. Two major groups of p53-controlled genes can be distinguished. Those that mediate the initiation and maintenance of cell cycle checkpoints, and those driving apoptosis. An important determinant of the cellular reaction to DNA damage is the degree of genotoxic stress. The type of cellular response, which ranges from cell cycle arrest to apoptosis depends to a large extend on the severity of the genotoxic lesion. It remains largely unclear which molecular mechanisms govern the cellular decision between p53-driven cell cycle arrest and apoptosis. From a therapeutic perspective, this cellular decision is of utmost importance, as p53-driven apoptosis is therapeutically desired, when treating a malignant disease with DNA-damaging chemotherapy. However, a p53-driven cell cycle arrest might promote chemotherapy resistance, as it allows the tumor cells time to repair genotoxic lesions prior to the next cell division. Here, we summarize recent advances in our understanding of the molecular mechanisms controlling the functional outcome of p53 signaling. We further provide an outlook on the potential development of pharmacological interventions targeting the p53-regulating machinery to promote p53-driven apoptosis, while repressing p53-dependent cell cycle checkpoints.© Georg Thieme Verlag KG Stuttgart . New York.


von Gersdorff G.,Klinik II fur Innere Medizin
Nephrologe | Year: 2016

Patients not only want to survive on dialysis but also to have as good a life as possible despite dialysis. The quality of life on dialysis is multidimensional and is not only determined by the state of physical health but also by psychosocial factors. Shared decision-making helps patients determine the balance between the burden associated with dialysis treatment and its perceived beneficial effects. Low health-related quality of life is associated with low adherence as well as increased morbidity and mortality. Efforts to improve the quality of life on dialysis need to be individualized using a multidimensional approach. The emphasis of dialysis therapy should be allowed to shift during the course of treatment from a “curative” approach aiming for maximum survival to a supportive and geriatric palliative approach, depending on patient preferences and health status. Important aspects of the quality of life relate to symptom burden and social support, which are therefore starting points for interventions aimed at improvement. Individualized programs of intradialytic sport and exercise were shown in randomized trials to be safe and widely effective for improving the quality of life as well as physical symptoms. This approach is, however, currently underused. © 2016, Springer-Verlag Berlin Heidelberg.


Kurschat C.,Klinik II fur Innere Medizin
Zeitschrift fur Gerontologie und Geriatrie | Year: 2016

Older patients clearly benefit from a kidney transplantation despite multiple comorbidities and complications, particularly with respect to life expectancy. Older patients remaining on dialysis on average die earlier compared to patients who underwent a kidney transplantation. In addition, patients experience a significant increase in the quality of life after renal transplantation. However, every patient has to be thoroughly evaluated to assess the individual benefits of a renal transplantation. Geriatric tools are particularly helpful to evaluate the suitability of older individuals. In 1999 the Eurotransplant senior program (ESP or “old for old”) was initiated, aiming at shortening waiting time and cold ischemia time for patients on the waiting list. In this program, kidneys of donors aged 65 years and older are locally allocated to recipients also of 65 years and older. The results in ESP are promising, to the effect that this program helps older patients to receive a kidney transplant earlier than by the normal procedure; however, a better alternative to the ESP program is living donor transplantation, provided that a suitable donor is available. There is no age limit for the evaluation of potential donors. Compared to deceased donor kidney transplantation a living donor kidney will most likely function with a higher spontaneous rate and for a longer period of time and therefore provides a clear advantage for older recipients. © 2016, Springer-Verlag Berlin Heidelberg.


Grundmann F.,Klinik II fur Innere Medizin
Zeitschrift fur Gerontologie und Geriatrie | Year: 2016

Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia. Hypernatremia often only results in unspecific symptoms but the condition is associated with a clearly increased mortality. As electrolyte disturbances have a high prevalence in the geriatric population and can contribute to geriatric syndromes and frailty, relevant electrolyte alterations should be excluded in all geriatric patients, in particular after a change in medication schedules. © 2016, Springer-Verlag Berlin Heidelberg.


PubMed | Klinik II fur Innere Medizin
Type: Case Reports | Journal: Deutsche medizinische Wochenschrift (1946) | Year: 2012

A 39-year-old man complained of unspecific chest pains four years after kidney transplantation.Laboratory tests revealed a slow increase of retentions values; the value of soluble IL-2 receptor was slightly elevated. Computed tomography of the chest confirmed mediastinal and bilateral hilar masses. The broncho-alveolar lavage (BAL) showed a marked increase of the CD4/CD8 T-lymphocyte ratio and the aspiration cytology of these lymphadenopathies revealed the cytopathological characteristics of sarcoidosis.An asymptomatic stage I sarcoidosis was diagnosed, and the immunosuppressive treatment with cyclosporine, mycophenolatmofetil and prednisone was retained. The patient has remained asymptomatic for now six months.When bilateral hilar / mediastinal lymphadenopathies occur after organ transplantation with immunosuppression de novo sarcoidosis should be taken into account.


PubMed | Klinik II fur Innere Medizin
Type: Journal Article | Journal: Zeitschrift fur Gerontologie und Geriatrie | Year: 2016

Disturbances of water and electrolyte balance are commonly encountered in older patients due to a multitude of physiological changes and preexisting morbidities with hyponatremia being the most common disorder. Even mild chronic hyponatremia can lead to cognitive deficits and gait instability and is associated with an increased rate of falls and fractures. Additionally, experimental and epidemiological data suggest that hyponatremia promotes bone resorption and therefore increases the risk of osteoporosis. Furthermore, osteoporosis and sarcopenia can be stimulated by hypomagnesemia. Hypernatremia often only results in unspecific symptoms but the condition is associated with a clearly increased mortality. As electrolyte disturbances have a high prevalence in the geriatric population and can contribute to geriatric syndromes and frailty, relevant electrolyte alterations should be excluded in all geriatric patients, in particular after a change in medication schedules.


PubMed | Klinik II fur Innere Medizin
Type: Journal Article | Journal: Zeitschrift fur Gerontologie und Geriatrie | Year: 2016

Older patients clearly benefit from a kidney transplantation despite multiple comorbidities and complications, particularly with respect to life expectancy. Older patients remaining on dialysis on average die earlier compared to patients who underwent a kidney transplantation. In addition, patients experience a significant increase in the quality of life after renal transplantation. However, every patient has to be thoroughly evaluated to assess the individual benefits of a renal transplantation. Geriatric tools are particularly helpful to evaluate the suitability of older individuals. In 1999 the Eurotransplant senior program (ESP or old for old) was initiated, aiming at shortening waiting time and cold ischemia time for patients on the waiting list. In this program, kidneys of donors aged 65years and older are locally allocated to recipients also of 65years and older. The results in ESP are promising, to the effect that this program helps older patients to receive a kidney transplant earlier than by the normal procedure; however, a better alternative to the ESP program is living donor transplantation, provided that a suitable donor is available. There is no age limit for the evaluation of potential donors. Compared to deceased donor kidney transplantation a living donor kidney will most likely function with a higher spontaneous rate and for a longer period of time and therefore provides a clear advantage for older recipients.

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