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Aachen, Germany

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. Source

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. Source

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. Source

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. Source

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. Source

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