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Neuerburg C.,Ludwig Maximilians University of Munich | Schmidmaier R.,Medizinische Klinik und Poliklinik IV | Schilling S.,Ludwig Maximilians University of Munich | Kammerlander C.,Ludwig Maximilians University of Munich | And 4 more authors.

Osteoporosis-associated fractures are of increasing importance in trauma surgery. The implementation of systematic diagnostics and treatment of osteoporosis during hospitalization, however, remains insufficient; therefore, a specific algorithm for the diagnosis and treatment of osteoporosis in trauma surgery patients was developed based on the German Osteology Society (Dachverband Osteologie, DVO) guidelines for osteoporosis from 2014. In a first step, the individual patient age and risk profile for osteoporosis are identified considering specific fractures indicative of osteoporosis. For these patients a questionnaire is completed which detects specific risk factors. In addition, the physical activity, risk of falls, dietary habits and the individual medication are collated as these can have a decisive influence on the subsequent therapy decisions. Prior to a specific treatment, laboratory osteoporosis tests, bone densitometry by dual energy X-ray absorptiometry (DXA) and if needed X-rays of the spine are carried out. For proximal femoral fractures the treatment of osteoporosis could already be indicated. With pre-existing glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted according to the table of T-scores detected by DXA. The treatment algorithm for diagnostics and treatment of osteoporosis in hospitalized trauma surgery patients can systematically and efficiently improve the identification of patients at risk. Thus, further fractures associated with osteoporosis or failure of internal fixation could be reduced in future. A prospective validation of the algorithm has already be initiated. © 2015, Springer-Verlag Berlin Heidelberg. Source

Neuerburg C.,Ludwig Maximilians University of Munich | Stumpf U.,Ludwig Maximilians University of Munich | Schmidmaier R.,Medizinische Klinik und Poliklinik IV | Kammerlander C.,Ludwig Maximilians University of Munich | And 4 more authors.

Osteoporosis-associated fractures represent a growing challenge in the treatment of orthopedic patients. In November 2014 a new revision of the guidelines on osteoporosis by the German Osteology Society (Dachverband Osteologie DVO) was adopted, in which additional risk factors for fractures and further treatment options have been included. On the one hand the existing model used to diagnose osteoporosis and estimate a high fracture risk as a guidance for the use of specific anti-osteoporotic therapy in patients without a fragility fracture was maintained and further refined. On the other hand the guideline includes the option to initiate a specific osteoporosis therapy without a prior bone densitometry in patients with typical radiographs of a proximal femur fracture and higher grade vertebral fractures, suspicious for osteoporosis, depending on the overall clinical context. This may reduce the treatment gap of osteoporosis in Germany. In this paper the changes in the DVO guidelines 2014 on osteoporosis are summarized, focusing on the most important changes with practical relevance for orthopedic surgeons. © 2015, Springer-Verlag Berlin Heidelberg. Source

Linkermann A.,University of Kiel | Stockwell B.R.,Howard Hughes Medical Institute | Krautwald S.,University of Kiel | Anders H.-J.,Medizinische Klinik und Poliklinik IV
Nature Reviews Immunology

Regulated cell death (RCD) is either immunologically silent or immunogenic. RCD in parenchymal cells may lead to the release of damage-associated molecular patterns that drive both tissue inflammation and the activation of further pathways of RCD. Following an initial event of regulated necrosis, RCD and inflammation can induce each other and drive a local auto-amplification loop that leads to exaggerated cell death and inflammation. In this Opinion article, we propose that such crosstalk between pro-inflammatory and RCD pathways has pathophysiological relevance in solid organ failure, transplantation and cancer. In our opinion, clinicians should not only prescribe immunosuppressive treatments to disrupt this circuit, but also implement the neglected therapeutic option of adding compounds that interfere with RCD. © 2014 Macmillan Publishers Limited. All rights reserved. Source

Monticone S.,University of Turin | Satoh F.,Tohoku University | Viola A.,University of Turin | Fischer E.,Medizinische Klinik und Poliklinik IV | And 23 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers.Setting: The study was carried out in eight different referral centers in Italy. Germany, and Japan.Patients: From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses.Objective: The objective of the study was to retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA.Results: Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared with basal procedures (90% vs 77%). The CL ratio was inversely correlated with the aldosterone level at diagnosis and, among AVS parameters, with the lateralization index (P= .02 and P= .01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters, and patients with CL suppression underwent a significantly larger reduction in the aldosterone levels after adrenalectomy.Conclusions: For patients with lateralizing indices of greater than 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy because it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery. Copyright © 2014 by the Endocrine Society. Source

Reisch N.,Medizinische Klinik und Poliklinik IV | Reincke M.,Medizinische Klinik und Poliklinik IV

Congenital adrenal hyperplasia (CAH) is one of the most common inherited metabolic diseases following an autosomal recessive trait. There are five different enzyme defects leading to CAH. Steroid 21-hydroxylase deficiency is the most common form of CAH accounting for more than 90%. Phenotypically, CAH due to 21-hydroxylase deficiency can be subclassified into the non-classic and classic form. The classic form can be divided into the simple virilising and the salt-wasting form. The non-classic form is characterised by an excess of adrenal androgens, but no permanent glucocorticoid or mineralocorticoid deficiency. All patients with the classic form suffer from glucocorticoid deficiency and the subgroup of patients with the salt-wasting form additionally from mineralocorticoid deficiency. Therapy of the non-classic form aims to treat the symptoms of hyperandrogenism. In the classic form therapy consists of the substitution of the missing hormones, the glucocorticoids, and in the salt-wasting form also mineralocorticoids. © 2012 Springer-Verlag. Source

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