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Steinau an der Straße, Germany

Feuchtenberger M.,University of Wurzburg | Voll R.E.,Friedrich - Alexander - University, Erlangen - Nuremberg | Kneitz C.,Klinik fur Innere Medizin II
Zeitschrift fur Rheumatologie | Year: 2010

Patients with autoimmune or rheumatic diseases are at increased risk for infectious complications due to immunosuppressive therapy and/or the underlying immunological disease itself. To date, the consistent use of vaccinations in this patient group has been limited due to concerns about flair-ups or lack of efficacy. In prospective studies neither an increased risk of disease flair-ups nor of initiation of autoimmune disorders was found as yet; however, the data is still considered insufficient (small studies including only patients in remission). Vaccination with non-live vaccines can generally be regarded as safe and relatively effective, even in patients on immunosuppressive therapy. Since the immune response to vaccination may be markedly impaired depending on the medication used and the underlying autoimmune disease, monitoring of both serum titers and of patients' vaccination schedules should form an integral part of rheumatological care. © 2010 Springer-Verlag.

Stolzel U.,Klinik fur Innere Medizin II | Stauch T.,German Competence Center for Porphyria Diagnosis and Consultation | Doss M.O.,German Competence Center for Porphyria Diagnosis and Consultation
Internist | Year: 2010

Porphyrias are metabolic disorders of the heme biosynthesis. Clinically, they can be differentiated into acute and non-acute porphyrias. The symptomatic phase of acute hepatic porphyrias is characterized by overproduction of neurotoxic porphyrin precursors and porphyrins. Acute intermittent porphyria, Variegate porphyria, Hereditary coproporphyria and Doss porphyria belong to this group of metabolic disorders. The clinical presentation of the acute hepatic porphyria syndrome includes abdominal, psychiatric, neurological and cardiovascular symptoms. The diagnosis is based on a tenfold increased urinary excretion of porphobilinogen (apart from Doss porphyria). Besides symptomatic therapy with non-porphyrinogenic drugs, electrolyte compensation and intensive monitoring, intravenous administration of glucose and heme arginate is established for treatment.Among the non-acute types like Porphyria cutanea tarda, Erythropoietic protoporphyria and Congenital erythropoietic porphyria, the accumulated porphyrins cause photosensitivity of the skin up to severe liver damage. The location of the deficient enzyme within the heme biosynthesic pathway determines the pattern of the accumulated porphyrins. Besides light protection, there are different therapies depending on the type of non-acute porphyria. Ultimately, liver transplantation may be considered in therapy-resistant cases of acute hepatic porphyrias and bone marrow transplantation in severe cases of erythropoietic porphyrias. © 2010 Springer-Verlag.

Background and objectives: The compliance of CPAP therapy in patients with obstructive sleep apnea syndrome is variable. Many factors have a significant influence. The new bidding procedure of CPAP devices by insurance companies is a new factor in this area. The goal of this study was to investigate what influence this additional factor has on the compliance and drop-out rate.Patients and methods: All patients who received a CPAP device in our sleep laboratory in 2009 were included in the study. Two groups were formed: patients with bidding procedure (group A) and patients without (group B). All patients received a questionnaire and an appointment in the sleep laboratory. Patients were compared regarding epidemiological and sleep medicine aspects while using the device.Results: A total of 87 (group A) and 93 (group B) patients were included. The observation time required 622–966 days (mean 692.6 days). The data at the beginning of the study were comparable. The drop-out rate in group A was higher than in group B (29.9 % vs 22.6 %). Statistical significance was not accomplished (p = 0.072).Conclusions: The bidding procedure for CPAP devices might have negative effects for the drop-out rate of the therapy; however, further investigations are needed. © 2014, Springer-Verlag Berlin Heidelberg.

Comprehension of molecular principals of tumor biology is a requirement for understanding the efficacy of several substances which matter in treatment of lung cancer. Nevertheless these are only the principals that are considered to be likely because of pathophysiologic ideas. Each of them has to be proved in clinical trials because of the principal differences between laboratory results or animal tests and clinical routine. Anyhow during the last years research work has developed essential innovative substances for patients. In poor prognosis these substances distinctly extended the treatment options for at least some special groups of patients. © 2016 Dustri-Verlag Dr. Karl Feistle.

Konturek P.C.,Klinik fur Innere Medizin II
Internistische Praxis | Year: 2014

Irritable bowel syndrome (IBS) represents the most common gastrointestinal disorder in humans. This disease affects 15% of general population in Germany. IBS is characterized by the abdominal pain and/or alterations in bowel habits (diarrhea, obstipation) that last longer that 3 month and lack of organic abnormalities in the gut. The pathophysiology of IBS is multifactorial and includes visceral hypersensitivity, increased secretion of neurotransmitter (especially serotonin), increased expression of proinflammatory cytokines in the intestinal mucosa, alterations in gut motility, changes in bacterial gut flora (dysbiosis) and increased secretion of stress hormones. From clinical point of view, different subtypes of IBS have been defined including: constipation predominant IBS (IBS-C), diarrhea predominant IBS (IBS-D) and mixed IBS (IBS-M). The diagnostic testing for IBS patients includes routine blood tests, stool tests, celiac disease serology, abdominal sonography, breath testing to rule out carbohydrate intolerance (lactose, fructose, etc.) and small intestinal bacterial overgrowth. Colonoscopy is recommended if alarming symptoms (»red flags«) are present or to obtain colonic biopsies especially in patients with diarrhea predominant IBS. The management of IBS is based on a multifactorial approach and includes pharmacotherapy targeted against the predominant symptom, behavioural and psychological treatment, dietary alterations, education, reassurance and effective patient-physician relationship. The burden of illness associated with IBS in terms of quality of life, work productivity and health resource utilization is considerable.

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