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Giel K.,Medizinische Universitatsklinik Tubingen | Leehr E.,Medizinische Universitatsklinik Tubingen | Becker S.,Medizinische Universitatsklinik Tubingen | Startup H.,King's College London | And 2 more authors.
PPmP Psychotherapie Psychosomatik Medizinische Psychologie | Year: 2013

Anorexia nervosa is characterised by high relapse rates and thus there is a need for strategies that reduce reoccurrence of illness. One way of achieving this is to integrate relapse prevention into treatment, but clearly this requires identification of risk and maintenance factors. The Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA) by Schmidt & Treasure has 5 major treatment stages. These include an initial stage of motivation and dialogue about change, an individual relapse formulation, improvement of cognitive and socio-emotional skills, work on the patient's identity and eventually a final stage of ending and parting. These treatment stages are derived from a maintenance model of AN by Schmidt & Treasure and on evidence from recovered patients and part of their objective is to prevent relapse. © 2013 Georg Thieme Verlag KG Stuttgart New York.


Haen S.P.,Medizinische Universitatsklinik Tubingen | Haen S.P.,Interfakultares Institute For Zellbiologie | Rammensee H.-G.,Interfakultares Institute For Zellbiologie
Current Opinion in Immunology | Year: 2013

In cancer patients, active immunotherapy has gained significant importance in recent years by implementation of novel substances into standard clinical care. These new drugs represent strategies which either use defined cancer associated antigens as vaccines or induce tumor-directed immune responses through generation of a general inflammatory state which has extensive autoinflammatory side effects by induction of autoreactive immune cells. Hence, the definition of suitable target antigens for immunotherapy remains a major challenge. These antigens should ideally be specific markers for individual tumors or should be at least structures overexpressed on the tumor as compared to normal cells. Recent approaches have defined algorithms and refined analytical methods for antigen identification and immunological validation that have already been evaluated in clinical studies. This article summarizes recent developments in tissue analysis on genome, transcriptome and HLA-ligandome levels and of antigen application in recent clinical vaccination trials. © 2013 Elsevier Ltd.


A 48-year-old patient presented with an insufficient control of his diabetes mellitus which was known since 3 years. The antidiabetic medication comprised metformin and exenatide. Physical examination revealed, beside elevated blood pressure, abdominal purple striae. Endocrine testing was consistent with ectopic Cushing's syndrome. Abdominal CT showed a 5 cm measuring, inhomogeneous, contrast-enhanced mass in the right suprarenal area which was positive on iodine-131 MIBG SPECT. Furthermore, urinary catecholamines were markedly increased. Diagnosis of an ACTH-producing pheochromocytoma was made and an open adrenalectomy was performed. Histology confirmed a pheochromocytoma with potential aggressive clinical behaviour according to the Pheocromocytoma of the Adrenal gland Scaled Score. 6 months after the intervention, glucose control was significantly improved with an HbA1c of 5.5%. An ACTH-producing pheochromocytoma is a very rare cause of deterioration of glucose control. However, in presence of typical clinical findings an endocrine work-up is warranted.


Sauer-Schulz A.,Medizinische Universitatsklinik Tubingen
Deutsche medizinische Wochenschrift (1946) | Year: 2011

A 51-year-old woman was admitted from a mental institution for evaluation of hypercalcemia. She was treated with lithium for a bipolar disorder since 25 years. She complained of polydypsia and polyuria. The physical examination findings were unremarkable up to manic symptoms. Laboratory values showed elevated serum calcium and parathormone. Serum phosporus was within the normal range. Neck ultrasound revealed a goiter with one nodule in the right thyroid lobe and a suspected enlarged lower left parathyroid gland. The sesta-MIBI-scan failed to detect an adenoma. In light of long-term treatment with lithium and negative MIBI-scan, lithium-associated- hyperparathyreoidism (LAH) was suspected. The patient refused further preoperative imaging studies, such as c-11 methionine positron emission tomography and thyroid scan. Until surgery after stabilization of the psychiatric condition, treatment with the calcimimetic cinacalcet was initiated. Long-term lithium therapy is frequently associated with LAH. The criteria of diagnosis and therapy are similar to those of primary hyperparathyroidism. Lithium alters the set-point of the calcium-sensing-receptor and results in elevation of parathormone und hyperplasia of the parathyroid glands. Patient with LAH have a higher prevalence of multiglandular disease compared with sporadic hyperparathyreoidism. Thus, the preoperative localization is challenging. After surgery recurrent or resistant disease is more frequent. The calcimimetic cinacalcet is a potential alternative for patients who have contraindications to surgery, refuse surgery, or experience recurrent disease after surgery. © Georg Thieme Verlag KG Stuttgart · New York.


A 33-year-old female patient with chronic anorexia nervosa was admitted for inpatient psychosomatic treatment after a recent severe weight loss. In addition, an inflammatory bowel disease had been suspected in the past 4 years. The patient was convinced that the weight loss had purely organic reasons. She reported frequent diarrhea after meals. Also laxative abuse was suspected because of melanosis coli. An MR Sellink showed no evidence for actual intestinal inflammation. No increased inflammation parameters were found in blood tests. Diarrhea could not be proved by investigation of excrements or a symptom diary. Treatment consisted of a multimodal approach with focus on cognitive behavioural therapy. Treatment revealed eating disorder specific cognitions, fears and behaviour. A partial acceptance of gastrointestinal symptoms and weight loss as eating disorder symptomatology could be achieved. Diagnostics and treatment of chronic anorexia nervosa are complicated by a coincidental (or suspected) organic intestinal disease. Gastrointestinal problems are common in eating disorders. Organic symptoms are often difficult to distinguish from psychosomatic symptoms. Somatic fixation complicates treatment of eating disorders. © Georg Thieme Verlag KG Stuttgart · New York.


We report on a 41-year-old female patient suffering from obesity, binge eating more than twice a week with loss of control, eating rapidly and feeling guilty after eating, dyspnoea and chronic pain in the whole body, especially in her arms, legs and in both ankles. Furthermore, subdued mood, loss of interest and pleasure, fatigue and impaired concentration could be recognized. In the past, weight increase had been observed when corticosteroids were given against exacerbations of sarcoidosis. In the case of our patient, the beginning of sarcoidosis and increase of weight and pain correlated with augmentation of depression and psychosocial stress. Dysfunctional behavioral features and multiple interactions between diseases could be observed. We diagnosed obesity, binge eating disorder, major depression, chronic pain disease with somatic and psychical components and sarcoidosis. The patient was treated in a multimodal therapy program including psychotherapy, pharmacotherapy and psychopharmacotherapy, nutritionist advice and therapeutic exercise. A weight loss of 7.9 kg (5.9 %), well-balanced diet, reduction of binge eating and of pain intensity, mood stabilization as well as perception and expression of emotions and coping strategies in chronic diseases were achieved. Interdisciplinary treatment of patients suffering from psychosomatic, somatic and mental diseases is crucial for a good outcome. © Georg Thieme Verlag KG Stuttgart · New York.


A 65-year-old female patient presented with increasing vertigo, tendency to fall, dry cough and, in addition, numerous psychic and somatic symptoms since 6 years. Former diagnostic attempts did not yield clarifying results. In part, the patient had not followed up on former recommendations for further diagnostic procedures. With a suspected somatization disorder the patient was admitted to the Department of Psychosomatic Medicine. The neurological examination at admission revealed vertical oculomotor palsy and tendency to fall backwards indicating an affection of the brain stem. A magnetic resonance imaging of the head showed atrophy of the mesencephalon. In light of these findings the patient was diagnosed Steele-Richardson-Olszewksi syndrome. The therapy which comprises training measures and medication with a cholinesterase inhibitor aims to retain neuropsychological and motional abilities. Besides, psychotherapy is offered alongside to help the patient to cope with the disease. Treating patients with somatic and psychological symptoms calls for careful anamnestic exploration and clinical examination. Psychological alterations following neurological affection of the brain can imitate somatization disorder. © Georg Thieme Verlag KG Stuttgart · New York.


Schmohl J.,Medizinische Universitatsklinik Tubingen
Deutsche medizinische Wochenschrift (1946) | Year: 2012

We report on a patient with relapse of Graves' disease and immune thrombocytopenia (ITP). In the light of thrombocytopenia, thyroidectomy could not be performed. Cytologic examinations of the peripheral blood count showed a distinctive thrombocytopenia and giant platelets. In the bone marrow smear, a huge amount of megacaryocytes was seen. Examinations including platelet antibodies, virology studies, helicobacter pylori, and whole body computed tomography showed no pathological results. DIAGNOSIS, TREATMENT UND COURSE: The results were interpreted as ITP. The patient received an intervall of two month several cycles of glucocorticoid treatment and immunglobulines. There was no significant improvement after this therapy. As second-line treatment the patient received rituximab, with no change in the platelet count. In contrast, treatment with a thrombopoietin-receptor-agonist was successful. Finally, normalisation of thyroid function was associated with a normalisation of the platelet count also after discontinuation of ITP treatment. In recent studies, thrombopoetin-receptor-agonists were established for the treatment of recurrent or refractory ITP. In our case, successful management of Graves' disease including efficient thyreostatic therapy may also have contributed to normalisation of the platelet count. Splenectomy should be deferred in these patients. © Georg Thieme Verlag KG Stuttgart · New York.


Grunebach F.,Medizinische Universitatsklinik Tubingen | Klein R.,Medizinische Universitatsklinik Tubingen
BioSpektrum | Year: 2015

The success of allogeneic stem cell transplantation depends upon the degree of human leukocyte antigen (HLA) compatibility between the donor and patient since T-cell responses to foreign HLA molecules can result in aggressive immune responses. The human HLA locus on chromosome 6 is highly polymorphic within the population. Due to the large number of allels, the exact determination of the individual HLA polymorphisms (HLA typing) is a technically challenging task requiring different molecular biological procedures. © 2015, Springer-Verlag Berlin Heidelberg.


Overweight and obesity count among the most significant disorders in Germany. The etiology, persistence, and therapy of obesity are associated with psychosocial and behavioral dimensions, among others. The first revised version of the German 'Interdisciplinary Guideline of S3 Quality for the Prevention and Therapy of Obesity' was published in April 2014. This updated version contains important innovations especially with regard to aspects of behavioral intervention pertaining to the etiology of obesity and the treatment of the people affected. Against this background, this article explains the innovative issues of the guideline concerning the psychosocial aspects and discusses the implications for the clinical practice. In addition, a number of propositions are derived for the future clinical obesity research.

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