Sander D.,Benedictus Krankenhaus |
Sander D.,TU Munich |
Poppert H.,TU Munich |
Sander K.,TU Munich |
And 2 more authors.
European Journal of Neurology | Year: 2012
Background: Despite important advances in therapeutic approaches in stroke, the options of acute treatment are still limited. Primary prevention represents another potentially highly efficient strategy. For effective prevention the early detection of subjects at risk is of utmost importance. Coinciding with a change in current understanding of atherosclerosis as an inflammatory, cross-organ disease, new parameters to assess the individual risk are emerging. Methods: Systematic review of the potential of selected parameters for prediction of cerebrovascular events beyond detection of traditional risk factors that might expand the repertoire of primary prevention programs in stroke. Results: An absolute carotid intima-media thickness difference of 0.1mm increases the future risk of stroke by 13-18%. An ankle-brachial index <0.9 was associated with a relative risk of 2.33 (95% CI 2.02-2.68) for stroke. In patients with acute stroke and ABI values < 0.9 the risk for a new vascular event is significantly increased (HR 2.1; 95% CI 1.6-2.8). Measurements of several molecular biomarkers may be used to predict future vascular events independently of traditional risk factors. Conclusions: Based on the data presented, there is clear evidence that measurement of the ankle-brachial index identifies subjects of increased stroke risk in primary and secondary care settings as well as of stroke recurrence in acute stroke. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
Muehlmeier G.,German Armed Forces Hospital Ulm |
Biesinger E.,Klinikum Traunstein |
Maier H.,German Armed Forces Hospital Ulm
Audiology and Neurotology | Year: 2011
Effective pharmacological treatments for tinnitus have proven elusive. Emerging evidence suggests that dysregulation of cochlear N-methyl-D-aspartate (NMDA) receptors may underlie aberrant excitation of the auditory nerve, which in turn is perceived as tinnitus. The blocking of these receptors thus represents a promising therapeutic approach. In a recent phase I/II clinical trial, the safety and local tolerance of intratympanic injections of the NMDA receptor antagonist AM-101 was evaluated for the first time in humans. The results from the double-blind, randomized, placebo-controlled study show that intratympanically injected AM-101 was well tolerated by study participants, and provided the first indications of therapeutic efficacy. © 2011 S. Karger AG, Basel.
Pscherer S.,Klinikum Traunstein |
Dietrich E.S.,HealthEcon AG |
Dippel F.-W.,Sanofi S.A. |
Neilson A.R.,HealthEcon AG
International Journal of Clinical Pharmacology and Therapeutics | Year: 2010
Objective: A one-year cost analysis comparing basal insulin analogues glargine (IG, Lantus®) versus detemir (ID, Levemir ®) in combination with oral antidiabetic drugs (basal supported oral therapy; BOT) in insulin naive Type 2 diabetes patients in Germany based on the results of a randomized controlled clinical trial (RCT). The trial demonstrated equivalent treatment efficacy.Materials and methods: Total direct diabetes treatment costs were estimated from the perspective of the German statutory health insurance (SHI) for the time horizon of one-year. Simulated resources included medication (insulin, oral antidiabetic drugs) and consumable items (needles, blood glucose test strips and lancets). Initial and final insulin doses per kg body weight and proportion of patients with once/twice daily insulin injection were taken from the above mentioned RCT. Unit costs were taken fromofficialGerman price lists and sources. Deterministic-(DTA) and probabilistic sensitivity analyses (PSA) on resource use and unit costs were performed to test robustness of the results. Results: Average annual treatment costs per patient (base case) were € 849 for glargine and € 1,334 for detemir resulting in cost savings of € 486 per patient per year (36%). Costs of insulins were € 469 (IG) and € 746 (ID). Costs of consumable items amounted at € 380 (IG) and € 588 (ID) respectively. Sensitivity analyses confirmed the findings in favor of insulin glargine. PSA results found cost savings ranging from € 429 to € 608 (5th/95th percentiles). Conclusions: The current model estimated that insulin glargine was associated with lower annual treatment costs of € 486 (36%) compared to the use of insulin detemirwhile the same glycemic control is expected to be achieved. ©2010 Dustri-Verlag Dr. K. Feistle.
Freude T.,University of Tübingen |
Braun K.F.,TU Munich |
Haug A.,TU Munich |
Pscherer S.,Klinikum Traunstein |
And 4 more authors.
Journal of Molecular Medicine | Year: 2012
Affecting more than 230,000,000 patients, diabetes mellitus is one of the most frequent metabolic disorders in developed countries. Among other complications, diabetic patients have an increased fracture risk and show delayed fracture healing. During the disease progression, these patients' blood glucose and insulin levels vary significantly. Thus, the aim of this study was to analyze the effects of glucose and insulin on primary human osteoblasts. Although, in the presence of insulin and glucose, proliferation of osteoblasts was increased (1.2- to 1.7-fold), their alkaline phosphatase activity and, consequently, production of mineralized matrix were significantly reduced down to 55 % as compared to control cells (p < 0.001). Interestingly, the observed effects were mainly due to stimulation with insulin. Increase in glucose did not alter osteoblasts' function significantly but further enhanced the effects of insulin. Expression of active and total transforming growth factor beta (TGF-β) was increased by glucose and insulin. Stimulation with both glucose and insulin induced gene expression changes (e.g., osteocalcin, Runx2, Satb2, or Stat1) comparable to treatment with recombinant TGF-β1, further indicating osteoblasts' dysfunction. Inhibition of TGF-β signaling completely abolished the negative effects of glucose and insulin. In summary, glucose and insulin treatment causes osteoblast dysfunction, which is accompanied by an increased TGF-β expression. Blocking TGF-β signaling abrogates the functional loss observed in glucose- and insulin-treated osteoblasts, thus identifying TGF-β as a key regulator. Therefore, increased TGF-β expression during diabetes may be a feasible pathogenic mechanism underlying poor bone formation in uncontrolled diabetes mellitus. © 2012 Springer-Verlag.
Hilberath J.M.,Klinikum Traunstein |
Schmidt H.,Ludwig Maximilians University of Munich |
Wolf G.K.,Klinikum Traunstein |
Wolf G.K.,Harvard University
European Journal of Pediatrics | Year: 2014
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also termed Hashimoto’s encephalopathy (HE), is a rare immune-mediated disorder and is also affecting children and adolescents. It is characterized by altered mental status, seizures, and cognitive dysfunction. Therapeutic options include steroid treatment and prognosis range from complete recovery, a relapsing course to long-term cognitive sequelae. We describe a previously healthy 13-year-old girl presenting to the emergency room with coma and refractory status epilepticus. Generalized tonic-clonic seizures persisted after pre-hospital infusion of antiepileptic medication. She was found to have highly elevated levels of thyroid-stimulating hormone and anti-thyroid peroxidase antibodies not only in blood but also in cerebrospinal fluid while showing negative results for traumatic, infectious, metabolic, toxic, neoplastic, or other known specific autoimmune diseases. Cranial neuroimaging revealed no abnormality. A diagnosis of SREAT was established, and the patient improved rapidly on corticosteroids and levothyroxine therapy. However, 3 months after the discontinuation of steroid treatment, the girl relapsed. The current literature regarding SREAT is reviewed and summarized. Conclusion: In children with SREAT, early diagnosis and treatment with corticosteroids is crucial and can lead to rapid clinical improvement. Clinicians should be aware of this uncommon but treatable condition, especially in female adolescents with unexplained seizures or an encephalopathic state. © 2014, Springer-Verlag Berlin Heidelberg.
Pscherer S.,Klinikum Traunstein |
Freude T.,Trauma Center Tubingen |
Forst T.,Ikfe Mainz University Mainz |
Nussler A.K.,Trauma Center Tubingen |
And 2 more authors.
Diabetology and Metabolic Syndrome | Year: 2013
Background: The single-center, open-label, four-arm, exploratory study investigates the relation of different anti-diabetics to serum levels of active TGF-β, a known pro-fibrotic stimulus, before and after a defined test meal. Findings. We investigated sera of patients with type 2 diabetes mellitus (T2DM) treated with metformin and sulfonylurea, insulin glargine or a DPP-4 inhibitor (DPP4i). Patients' sera were analyzed before and 5 h after a defined test meal at intervals of 30 min.The sulfonylurea/metformin group exhibited the highest basal levels of active TGF-β (31.50 ± 3.58 ng/ml). The glargine/metformin group had active TGF-β levels (24.98 ± 1.90 ng/ml) that were comparable to those of the healthy participants (22.12 ± 2.34 ng/ml). The lowest basal levels of active TGF-β were detected in the DPP-4i/metformin group (12.28 ± 0.84 ng/ml). Following the intake of a standardized meal, active TGF-β levels decreased (approx. 30%) in healthy subjects as well as in the sulfonylurea/metformin group and in the glargine/metformin group. After 5 h, the active TGF-β levels were normalized to basal levels. Active TGF-β levels in the DPP-4i/metformin group did not change significantly after the test meal. Overall plasma levels of insulin and proinsulin were comparable between healthy participants, and T2DM patients in the glargin/metformin group and in the DPP4i/metformin group. However, no correlation between active TGF-β levels, glucose, insulin or pro-insulin levels was detected. Conclusions: T2DM patients often exhibit elevated levels of pro-fibrotic active TGF-β. Our results suggest that glargine/metformin and DPP4i/metformin treatment may more effectively reduce active TGF-β serum levels than the sulfonylurea/metformin treatment. © 2013 Pscherer et al.; licensee BioMed Central Ltd.
Schindlbeck C.,Klinikum Traunstein |
Dziura D.,Klinikum Traunstein |
Mylonas I.,Ludwig Maximilians University of Munich
Archives of Gynecology and Obstetrics | Year: 2014
Introduction: Pelvic inflammatory disease (PID) is frequent in adolescents and younger women. Diagnosis is usually based on the clinical findings, and the threshold for empiric antibiotic therapy should be low. However, at least in cases of resistance toward therapy or deterioration of symptoms, laparoscopic evaluation can be helpful. Methods: We searched the hospital charts for in-house patients who were treated for PID or tubo-ovarian abscess between 2007 and 2010. In cases with both vaginal and intraabdominal bacterial cultures, results of those were compared. Results 73 patients with suspected PID or tubo-ovarian abscess were included. Median patients' age was 40 years (18-88), 18 of 73 (24.7%) patients had an IUD at the time of consultation. 58 patients underwent laparoscopy or laparotomy. In 41 patients (70.7%) tubo-ovarian abscess could be confirmed, four patients had differential gynecologic diagnoses, and two patients appendicitis. In vaginal swabs, most frequent bacteria were Streptococcus sp. (28.5%), Escherichia coli (22.2%), Enterococcus faecalis (15.9%), and Staphylococcus sp. (9.5%). In eight patients (11%) Chlamydia trachomatis could be found, there was no case of Neisseria gonorrhea. In 33 patients both vaginal and abdominal cultures were available. In nine cases (27.3%), identical bacteria could be found, however, 11 cases (33.3%) showed different results. Conclusion: In severe cases of PID, laparoscopic evaluation and taking an intra-abdominal bacterial culture are helpful for the confirmation of diagnosis, accurate microbiologic testing and specific therapy. © Springer-Verlag 2014.
Pscherer S.,Klinikum Traunstein |
Heemann U.,TU Munich |
Frank H.,TU Munich
Diabetes Care | Year: 2010
OBJECTIVE - The study investigated the effect of angiotensin receptor blockers (ARB) on glucose homeostasis and inflammatory parameters in patients with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS - We prospectively studied the insulin sensitivity index (ISI) and homeostasis model assessment-insulin resistance (HOMA-IR) in 13 obese males with IGT and in 13 matched control subjects with normal glucose tolerance (NGT) during hyperglycemic testing over 90 min. Adiponectin, retinol-binding protein 4 (RBP4), and highsensitive C-reactive protein (hsCRP) were analyzed. Measurements were performed at baseline and after a 4-week treatment with 160 mg/day valsartan. The results of the IGT and NGT groups were compared. RESULTS - At baseline, HOMA-IR (IGT 4.1± 3 vs. NGT 2.3 ± 1.0, P ± 0.01), hsCRP (IGT 3.9 ± 1.9 vs. NGT 1.8 ± 1 mg/l, P ± 0.05), and RBP4 (IGT 27.1 ± 2.1 vs. NGT 24.0 ± 2.0 ng/ml, P < 0.05) were significantly higher, whereas ISI (IGT 1.5 ± 0.9 vs. NGT 1.8 ± 1.2, P < 0.05) and plasma adiponectin (IGT 3.2 ± 0.9, NGT 5.2 ± 2.4 μg/ml, P < 0.05) were significantly lower in the IGT group compared with the NGT group. Under ARB, there was an increase in both groups of adiponectin (IGT 4.1 ± 1.9 μg/ml, NGT 6.3 ± 2.9 μg/ml, P < 0.05) and an increase in ISI (IGT 1.5 ± 0.9 to 2.3 ± 1 μg/ml, NGT 1.8 ± 1 to 2.5 ± 2 μg/ml, P < 0.05). HOMA-IR (4.1±3 to 2.6 ± 2; P<0.01), hsCRP (3.9 ± 1.9 to 1.8 ± 1 mg/l, P < 0.05), and RBP4 (27.1 ± 2.1 to 22.1 ± 1.8 ng/ml, P < 0.01) decreased significantly in the IGT group. CONCLUSIONS - Insulin sensitivity and associated inflammatory factors improve under ARB in IGT patients. © 2010 by the American Diabetes Association.
Can the outcome of proximal humeral fractures be improved using a minimally invasive surgical technique for fixed-angle plate osteosynthesis? [Wird das Outcome durch den Einsatz einer minimalinvasiven Operationstechnik mit winkelstabiler Plattenosteosynthese bei proximalen Humerusfrakturen verbessert?]
Ketterl R.,Klinikum Traunstein
Obere Extremitat | Year: 2013
Question: Is it possible to improve the outcome of proximal humeral fractures using minimally invasive fixed-angle plate osteosynthesis with the help of an insertion handle? Methods: A total of 100 patients treated with fixed-angle plate osteosynthesis after humeral head fractures using an insertion handle and deltoid split approach were examined prospectively over a 3-year period. The results were compared with a group of 100 patients with similar fractures and the same implant but who were treated by osteosynthetic open surgery using a deltoideopectoral access. These data were also collected prospectively over a 3-year period Results: The use of a minimally invasive surgical technique could significantly shorten surgery time and inpatient stay. Furthermore, a reduction of pain and the rate of complications, as well as an improvement of mobility and functional outcome was found The results could be seen soon after the surgical intervention and remained significant over the first few months and the differences were still detectable later on but no longer in the primary specification. Conclusions: The use of fixed-angle plates is an effective method for stabilization of proximal humeral fractures. The short-term outcome of proximal humeral head fractures with plate osteosynthesis can be improved by the minimally invasive surgical technique. With this technique there are significant advantages in the perioperative phase as well as in the first few postoperative months; however these benefits can no longer be seen in long-term follow-up. © 2013 Springer-Verlag Berlin Heidelberg.
Pscherer S.,Klinikum Traunstein
German medical science : GMS e-journal | Year: 2010
OBJECTIVE: To compare the treatment costs of insulin glargine (IG; Lantus) to detemir (ID; Levemir), both combined with bolus insulin aspart (NovoRapid) in type 2 diabetes (T2D) in Germany. METHODS: Cost comparison was based on data of a 1-year randomised controlled trial. IG was administered once daily and ID once (57% of patients) or twice daily (43%) according to treatment response. At the end of the trial, mean daily basal insulin doses were 0.59 U/kg (IG) and 0.82 U/kg (ID). Aspart doses were 0.32 U/kg (IG) and 0.36 U/kg (ID). Costs were calculated from the German statutory health insurance (SHI) perspective using official 2008 prices. Sensitivity analyses were performed to test robustness of the results. RESULTS: Annual basal and bolus insulin costs per patient were euro 1,473 (IG) and euro 1,940 (ID). The cost of lancets and blood glucose test strips were euro 1,125 (IG) and euro 1,286 (ID). Annual costs for needles were euro 393 (IG) and euro 449 (ID). The total annual cost per patient of administering IG was euro 2,991 compared with euro 3,675 for ID, translating into a 19% annual cost difference of euro 684/patient. Base case results were robust to varying assumptions for insulin dose, insulin price, change in weight and proportion of ID once daily administrations. CONCLUSION: IG and ID basal-bolus regimes have comparative safety and efficacy, based on the Hollander study, IG however may represent a significantly more cost saving option for T2D patients in Germany requiring basal-bolus insulin analogue therapy with potential annual cost savings of euro 684/patient compared to ID.