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Dreher M.,Universitatsklinikum Aachen | Kluge S.,Universitatsklinikum Hamburg Eppendorf
Pneumologie | Year: 2014

This review presents the potential indications for different airway devices in the intensive care unit (ICU). Since the interface during noninvasive ventilation is located outside the body, sedation is not regularly needed. Therefore, selection of a fitting mask is essential to avoid mask intolerance which is one of the biggest problems during noninvasive ventilation. Full-face masks are the interfaces mostly used for noninvasive ventilation to treat acute respiratory failure; here, mouth breathing is possible which is often necessary during acute respiratory failure. Good alternatives are total face masks and the helmet, whereas nasal masks and mouthpieces are not regularly used on the ICU. Extraglottic airway devices and coniotomy are used for the management of difficult airway situations on the ICU. Endotracheal intubation remains the gold standard procedure for airway management. However, this procedure is associated with a number of complications. Tracheostomy is the airway access of choice when long-term mechanical ventilation is necessary. © Georg Thieme Verlag KG. Stuttgart. New York.

Placental-mediated pregnancy complications (PmC) like preeclampsia, intrauterine growth restriction and placental abruption are common causes of fetal and maternal morbidity and mortality. The high prevalence of hereditary thrombophilias in case-control studies associated with pathological morphological findings of the placenta in these cases gave evidence for the association between hereditary thrombophilias and PmC. However, data from the literature are inconsistent, since subsequent prospective cohort studies could not demonstrate significant associations between inherited thrombophilia and PmC. Because of the multifactorial aetiology of PmC it may be difficult to prove, that hereditary thrombophilias are independent risk factors for PmC. Current guidelines do not recommend screening for inherited thrombophilias in patients with previous PmC. Evidence from current in vitro studies have shown, that heparin has beneficial non-anticoagulatory effects on trophoblast invasion. Retrospective casecontrol studies and recently published randomised controlled cohort studies have shown, that prophylactic administration of lowmolecular-weight heparin (LWH), started in early pregnancy, may lead to a significant reduction in the incidence of PmC in subsequent pregnancies in patients with and without hereditary thrombophilias and previous PmC. Conclusion: Large, well-designed multicenter studies are needed to elucidate the role of hereditary thrombophilias in cases of PmC and to confirm the benefit of LWH for subsequent pregnancy outcomes. © Schattauer 2013.

Rath W.H.,Universitatsklinikum Aachen | Hofer S.,Universitatsklinikum Heidelberg | Sinicina I.,Ludwig Maximilians University of Munich
Deutsches Arzteblatt International | Year: 2014

Background: Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 of every 100 000 deliveries. With a mortality of 11% to 44%, it is among the leading direct causes of maternal death. This entity is an interdisciplinary challenge because of its presentation with sudden cardiac arrest without any immediately obvious cause, the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, including cardio-pulmonary resuscitation. Methods: We selectively reviewed pertinent literature published from 2000 to May 2013 that was retrieved by a PubMed search. Results: The identified risk factors for AFE are maternal age 35 and above (odds ratio [OR] 1.86), Cesarean section (OR 12.4), placenta previa (OR 10.5), and multiple pregnancy (OR 8.5). AFE is diagnosed on clinical grounds after the exclusion of other causes of acute cardiovascular decompensation during delivery, such as pulmonary thromboembolism or myocardial infarction. Its main clinical features are severe hypotension, arrhythmia, cardiac arrest, pulmonary and neurological manifestations, and profuse bleeding because of disseminated intravascular coagulation and/or hyperfibrinolysis. Its treatment requires immediate, optimal interdisciplinary cooperation. Low-level evidence favors treating women suffering from AFE by securing the airway, adequate oxygenation, circulatory support, and correction of hemostatic disturbances. The sudden, unexplained death of a pregnant woman necessitates a forensic autopsy. The histological or immunohistochemical demonstration of formed amniotic fluid components in the pulmonary bloodflow establishes the diagnosis of AFE. Conclusion: AFE has become more common in recent years, for unclear reasons. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. Establishing evidence-based recommendations for intervention is an important goal for the near future.

Lenski M.,Universitatsklinikum des Saarlandes | Kazakov A.,Universitatsklinikum des Saarlandes | Marx N.,Universitatsklinikum Aachen | Bohm M.,Universitatsklinikum des Saarlandes | Laufs U.,Universitatsklinikum des Saarlandes
Journal of Molecular and Cellular Cardiology | Year: 2011

Type 2 diabetes is associated with an increased risk of cardiac complications. Inhibitors of dipeptidylpeptidase 4 (DPP-4) are novel drugs for the treatment of patients with type 2 diabetes. The effect of DPP-4 inhibitors on myocardial metabolism has not been studied in detail. In wild-type C57Bl6-mice, 3. weeks of treatment with sitagliptin had no effect on body weight and glucose tolerance nor on phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoAcarboxylase (ACC), phosphofructokinase-2 (PFK2) or tuberin-2 (TSC2) in the left ventricular myocardium. However, in 10 week old db/db-/- mice, a model of diabetes and obesity, sitagliptin potently reduced plasma glucose rise in peritoneal glucose tolerance tests and reduced weight increase. The myocardium of untreated db/db-/- mice exhibited a marked increase of the phosphorylation of AMPK, ACC, TSC2, expression of p53 and fatty acid translocase (FAT/CD36) membrane expression. These changes were reduced by DPP-4 inhibition. Sitagliptin showed no effect on cardiomyocyte size but prevented myocardial fibrosis in the 10. week old db/db-/- mice and reduced expression of TGF-β1, markers of oxidative stress and the accumulation of advanced glycation end products in cardiomyocytes. Working heart analyses did not show an effect of sitagliptin on parameters of systolic cardiac function. In animals with diabetes and obesity, sitagliptin improved glucose tolerance, reduced weight gain, myocardial fibrosis and oxidative stress. Furthermore the study provides evidence that treatment with sitagliptin decreases elevated myocardial fatty acid uptake and oxidation in the diabetic heart. These observations show beneficial myocardial metabolic effect of DPP-4 inhibition in this mouse model of diabetes and obesity. © 2011 Elsevier Ltd.

Schwinges-Lymberopoulos M.,Universitatsklinikum Aachen
Urologe - Ausgabe A | Year: 2010

Psychosomatics is a branch of medical science dealing with biopsychosocial interactions in the origin, course and treatment of human illnesses. In the biopsychosocial model the patient is considered in its entirety. In the practice of urologists the proportion of patients with psychosomatic clinical symptoms varies between 15 and 50%. The main focus is on somatoform autonomous dysfunctions. The main symptom involves the fact that often persisting complaints cannot be explained by suitable physical findings. The anatomical characteristics of the urogenital tract and the resultant three functional levels, production, reproduction and desire, explain the susceptibility to psychological participation. Besides the exclusion of inflammatory, obstructive or malignant illnesses, the diagnostics relies on an anamnesis interview in terms of the basic psychosomatic therapy. The treatment is individual and multimodal in cooperation with physiotherapists and psychotherapists. © Springer-Verlag 2010.

Heidenreich A.,Universitatsklinikum Aachen
Urologe - Ausgabe A | Year: 2011

Renal cell carcinoma represents the fifth most frequent malignant tumor in humans. At the time of diagnosis, 20% of the patients already manifest metastases. A further 20-30% of the patients develop systemic metastases in the postoperative course. Despite continued advances in pharmacological treatment options, cancer surgery tailored to the individual tumor findings constitutes the only curative treatment option. © 2011 Springer-Verlag.

In recent years, neurobiological markers of antisocial behavior have frequently been identified in children of the early-starter subtype of conduct disorder (CD, according DSM-IV). Some studies, however, produced inconsistent findings. The present review argues that, given the existing methodological opportunities, we need a more detailed phenotyping of children with CD. In particular, establishing comorbid anxiety in neuroendocrinological studies might constitute an important factor. There also seem to be associations between trait anxiety and alterations of brain function and brain structure. Finally, the impact of trait anxiety on different subtypes of aggressive behavior as well as on prognosis is emphasized. In sum, a more detailed characterization of children with CD might help to improve our understanding of antisocial development and enhance therapeutic options. © 2011 Verlag Hans Huber, Hogrefe AG, Bern.

In recent years type 2 diabetes mellitus has been associated with increased cancer risk and mortality. Hyperinsulinemia is believed to be the central factor, promoting cancer incidence and progression by direct and indirect mechanisms. Antidiabetic therapies can either reduce or promote those effects by anti-insulinogenic or proinsulinogenic actions. In this article the pathophysiological mechanisms and current epidemiological evidence of available antidiabetic drugs will be reviewed. Metformin has received much attention as a promising drug that can reduce both cancer incidence and mortality. Prospective randomized trials are currently underway to evaluate the potential of metformin as a preventive and therapeutic drug in oncology. Depending on the outcome the antidiabetic profile of metformin will be complemented by its anticancer properties and expand the therapeutic spectrum of metformin use. © Springer-Verlag 2012.

Lehrke M.,Universitatsklinikum Aachen
Diabetologe | Year: 2016

Background: Diabetes remains a leading risk factor for cardiovascular events. Current diabetes therapies: For the therapy of type 2 diabetes mellitus metformin is available as the first choice treatment. The decision which anti-diabetic drug should be used for second line therapy is left up to the treating physician. The decision-making process is largely influenced by the results of new cardiovascular outcome trials, which are carried for newly introduced diabetes medications. Diabetes therapy and cardiovascular risk: Outcome studies for three classes of drugs were presented in the previous year, which are discussed in this article. Furthermore, this article presents recent advances in the possibilities for coronary interventions in patients with diabetes and mechanisms of diabetic cardiomyopathy are discussed. © 2016, Springer-Verlag Berlin Heidelberg.

Lebherz C.,Universitatsklinikum Aachen
Diabetologe | Year: 2016

Background: Patients with type 2 diabetes are at increased risk of developing cardiovascular diseases and have been shown to greatly benefit from tight control not only of the blood glucose but also of LDL (low density lipoprotein) cholesterol levels. Cardiovascular risk reduction: So far an aggressive treatment regimen with potent statins has been recommended. The IMPROVE IT study caused a paradigm shift in that it showed additional cardiovascular risk reduction if LDL cholesterol was reduced below target levels independent of the pleiotropic statin actions. These effects were even more significant in patients with type 2 diabetes. Conclusions: Therefore even though statins are still first choice, a combination with ezetimibe or the novel PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors is warranted to further reduce cardiovascular risk. As secondary targets, non-HDL (high density lipoprotein) cholesterol or ApoB (apolipoprotein B) levels serve as surrogate markers for atherogenic lipid particles. Depending on the individual lipid levels, combination therapy with fibrates or ω‑3 fatty acids might be of benefit. © 2016, Springer-Verlag Berlin Heidelberg.

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