Gahr M.,Universitatsklinikum Ulm |
Hiemke C.,Universitatsklinikum Mainz |
Connemann B.J.,Universitatsklinikum Ulm
Fortschritte der Neurologie Psychiatrie | Year: 2017
Opipramol was developed in the 1960s as an antidepressant and has chemical similarities with tricyclic antidepressants. Pharmacodynamic properties with absent reuptake inhibition of serotonin and noradrenaline and agonism at sigma receptors distinguish opipramol from tricyclics. Furthermore, antidepressive effects are smaller than the anxiolytic ones. The mechanism of action of opipramol is currently not sufficiently understood. Agonistic effects at sigma receptors have been linked with therapeutic effects. Excessive hepatic metabolism (primarily via CYP2D6) should be considered, particularly in patients with impaired hepatic function and polypharmacy. The available clinical data suggest good tolerability and safety within the approved dose range. Mild disturbances of vigilance and anticholinergic adverse events are the predominant side effects. In Germany, opipramol is approved for the treatment of somatoform disorders and generalized anxiety disorder, and there is sufficient evidence for the efficacy of opipramol in these disorders. The agent is still prescribed very often in Germany, yet plays a minor role in the clinical as well as scientific setting. In view of the limited availability of (pharmacologic) treatment options for generalized anxiety disorder and particularly somatoform disorders, opipramol should be considered in the treatment of these entities.
Lutz J.,Universitatsklinikum Mainz
Nephrology Dialysis Transplantation | Year: 2013
Chronic rejection is a poorly understood entity albeit a frequent cause of graft failure. Despite the advent of new immunosuppressive agents, neither the slope of graft destruction nor the frequency is ameliorated. There are a number of hypothesis which try to explain the conundrum of chronic graft destruction: ongoing rejection, antibody-mediated rejection, poor choice of organs, hyperfiltration, calcineurin inhibitors (CNI) nephrotoxicity and non-compliance among them. None of these hypotheses can explain all features of the process, thus, it is likely that they act in combination. What seems to be clear is a beneficial effect of early angiotensin-converting enzyme (ACE)/AT1 blocker treatment. It is less clear, however, whether a reduction or a switch from CNIs to other immunosuppressants prolongs graft survival. This review highlights the pathophysiological aspects that are important for the development of chronic allograft damage in the context of possible treatment options. © 2013 The Author. All rights reserved.
PubMed | University of Tübingen, Universitatsklinikum Bonn, Universitatsklinikum Mainz, University Mainz and 4 more.
Type: Journal Article | Journal: Der Urologe. Ausg. A | Year: 2016
The PREFERE study, which compares the treatment options for prostate cancer with low and early intermediate risk, has recorded a noticeable upswing in recruitment since mid-2015. Responsible for this are the revised inclusion criteria and the wide support for this study in Germany. The inclusion criteria opened the study to the use of imaging techniques (MRI, CTrus / Anna) and the inclusion of all Gleason 3+3=6 cancers, regardless of tumor extent. In addition, patients can now be included who, for example due to the size of the prostate or existing obstructive micturition disorders, had a contraindication to percutaneous radiotherapy or brachytherapy - these can now be randomized between active surveillance and radical prostatectomy. With the increased recruitment numbers, it seems realistic that the required milestones in recruiting will be achieved.
Schladt T.D.,Johannes Gutenberg University Mainz |
Shukoor M.I.,Johannes Gutenberg University Mainz |
Schneider K.,Johannes Gutenberg University Mainz |
Tahir M.N.,Johannes Gutenberg University Mainz |
And 12 more authors.
Angewandte Chemie - International Edition | Year: 2010
Flower power: A convenient strategy for preparing core-tunable multicomponent Au@MnO nanocrystals has been developed. The magnetic nanoflowers are not only efficient as cargo-specific carriers but also have excellent fluorescent properties resulting from fluorophors bound to the Au and MnO domains. (Figure Equotion Present) © 2010 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.
Hermann M.,University of Zürich |
Fischer D.,Medizinische Hochschule Hanover |
Hoffmann M.M.,Albert Ludwigs University of Freiburg |
Gasser T.,University of Zürich |
And 4 more authors.
Atherosclerosis | Year: 2012
Background: Several proinflammatory single-nucleotide polymorphisms (SNPs) have been linked to the progression of atherosclerosis and coronary artery disease (CAD). Plaque size and its destabilization by inflammatory processes are major determinants of ischemia and acute coronary syndromes. Intravascular ultrasound (IVUS) allows for quantification of plaque size in vivo. We therefore investigated the relation of plaque size with mutations of proinflammatory genes in patients with CAD. Methods: In 196 patients with stable CAD enrolled in the ENCORE trials coronary plaque and vessel volume was assessed by IVUS. 173 patients were successfully genotyped for polymorphisms of proinflammatory genes CD14 C(-260)T and CRP C(+1444)T using the single-nucleotide polymorphism polymerase chain reaction (SNP PCR) approach. Results: Baseline characteristics were comparable for all genotype groups. Higher ratios of plaque volume/vessel volume were observed in patients with the CRP 1444TT (n= 11) and CD14 260TT (n= 33) genotypes (p= 0.016 and p= 0.026, respectively). Conclusion: In patients with stable coronary artery disease the CRP 1444TT and CD14 260TT variants are associated with larger coronary plaque volume independently of concomitant cardiovascular risk factors. © 2011 Elsevier Ireland Ltd.
N-terminal pro brain natriuretic peptide in the management of patients in the medical emergency department (PROMPT): Correlation with disease severity, utilization of hospital resources, and prognosis in a large, prospective, randomized multicentre trial
Luchner A.,University of Regensburg |
Mockel M.,Charite Berlin Campus Virchow Klinikum |
Spanuth E.,Roche Holding AG |
Spanuth E.,DIAneering Diagnostics Engineering and Research GmbH |
And 11 more authors.
European Journal of Heart Failure | Year: 2012
Aims: N-terminal pro brain natriuretic peptide (NT-proBNP) is a potent marker of heart failure and other cardiac diseases. The value of NT-proBNP testing in the medical emergency department (ED) was assessed in patients >65 years old. Methods and results: This large, prospective, randomized, controlled, multicentre trial was conducted in six medical EDs. Data for evaluation of the primary endpoint of hospitalization were available for 1086 patients. Median NT-proBNP was 582 pg/mL. A total of 16% of patients presented with NT-proBNP <150 pg/mL (low), 55% with NT-proBNP between 150 and 1800 pg/mL (intermediate), and 29 with NT-proBNP >1800 pg/mL (high). NT-proBNP was positively correlated with hospital admission [odds ratio (OR) for high vs. low 2.9, P < 0.0001], length of stay (8.5 days vs. 3.5 days for high vs. low, P < 0.01), in-hospital death (3.9% vs. 0% for high vs. low, P < 0.01), 6 months re-hospitalization (OR for high vs. low 5.1, P < 0.0001), and 6 months death or re-hospitalization (OR for high vs. low 5.7, P < 0.0001). Knowledge of NT-proBNP had no significant effect on the primary endpoint hospital admission and the secondary endpoints intermediate/intensive care unit (IMC/ICU) admission, length of stay, re-hospitalization and death, or re-hospitalization in the total cohort. However, patients with high open NT-proBNP (>1800 pg/mL) were more likely to be admitted to the hospital (P < 0.05) and IMC/ICU (P < 0.05), whereas patients with low open NT-proBNP (<150 pg/mL) were less likely to be admitted (P < 0.05) compared with patients with blinded NT-proBNP. Conclusion: Although NT-proBNP does not affect overall hospitalization, it is associated with better stratification of patient care and is strongly correlated with subsequent utilization of hospital resources and prognosis. © The Author 2012.
Schillinger W.,Universitatsmedizin Gottingen |
Hunlich M.,Universitatsmedizin Gottingen |
Baldus S.,Universitares Herzzentrum Hamburg |
Ouarrak T.,University of Heidelberg |
And 10 more authors.
EuroIntervention | Year: 2013
Aims: The influence of age on baseline demographics and outcomes of patients selected for MitraClip® has not been previously investigated. Methods and results: Baseline demographics and acute outcomes in 1,064 patients from the German TRAMI registry were stratified by age (525 patients ≥76 years and 539 patients <76 years). In elderly patients, logistic EuroSCORE was higher (25[15-40]% vs. 18[10-31]%, p<0.0001) and the proportion of women was greater (47.2% vs. 29.3%, p<0.0001). Elderly patients were more likely to have preserved left ventricular ejection fraction >50% (40.1% vs. 21.8%, p<0.0001) and degenerative mitral regurgitation (DMR, 35.3% vs. 25.6%, p<0.01). Age was the most frequent reason for non-surgical treatment in the elderly (69.4% vs. 36.1%, p<0.0001). The intrahospital MACCE (death, myocardial infarction, stroke) was low in both groups (3.5% vs. 3.4%, p=0.93) and the proportion of non-severe mitral regurgitation at discharge was similar (95.8% vs. 96.4%, p=0.73). A logistic regression model did not reveal any significant impact of age on acute efficacy and safety of MitraClip therapy. In both groups, the majority of patients were discharged home (81.8% vs. 86.2%, p=0.06). Conclusions: Elderly and younger patients have similar benefits from MitraClip therapy. Age was the most frequent cause for denying surgery in elderly patients. © Europa Digital & Publishing 2013. All rights reserved.
Burkhart K.J.,Universitatsklinikum Cologne |
Dietz S.O.,Universitatsklinikum Mainz |
Bastian L.,Klinik fur Orthopadie |
Thelen U.,Universitatsklinikum Cologne |
And 2 more authors.
Deutsches Arzteblatt International | Year: 2013
Background: The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Around the world, this type of fracture remains a major challenge for treating surgeons. While non-displaced fractures can be managed conservatively, displaced ones are often treated surgically. Methods: Selective literature review Results: There are still no evidence-based schemes or guidelines for the treatment of proximal humeral fractures, and very few prospective randomized trials are available. The few that have been published recently show a trend in favor of conservative treatment, but they were carried out on small groups of patients and their findings are not directly generalizable. For younger patients, the goal of treatment is generally anatomical repositioning and osteosynthetic stabilization; for older patients, primary treatment with a prosthesis is a further option. Depending on the mode of treatment, complications can arise such as shoulder stiffness, necrosis of the humeral head, pain, infection, loss of reposition, and "cutting out." Conclusion: Current evidence supports the individualized treatment of proximal humeral fractures. Treatment decisions must always be made jointly with the patient in consideration of his or her individual needs and characteristics. Particularly for elderly patients, the possibility of conservative treatment should be carefully considered. If conservative treatment is not possible, then the type of operation performed should also be a function of the surgeon's individual skills and experience with particular types of implant.
Factoranalytic structure of a short version of the eating attitudes test (EAT-13) and prevalences of disordered eating in a representative german sample [Faktoranalyse einer Kurzversion des Eating Attitudes Tests (EAT-13) und Prävalenzen gestörten Essverhaltens in einer repräsentativen deutschen Bevölkerungsstichprobe]
Richter F.,Friedrich - Schiller University of Jena |
Brahler E.,Universitatsklinikum Mainz |
Strau B.,Friedrich - Schiller University of Jena |
Berger U.,Friedrich - Schiller University of Jena
PPmP Psychotherapie Psychosomatik Medizinische Psychologie | Year: 2014
Early detection of disordered eating behavior is a first hint to prevent clinically relevant eating disorders. Screening instruments are aimed at detecting disordered eating behavior at an early stage, to identify risk groups and as necessary initiate treatment. The EAT-13 is an economic screening instrument (13 items), that allows identification of risk groups in big unselected samples with help of determination of sum score. Factorial validity of the EAT-13 and the suitability for different ages were determined in a representative sample of the German population (N=2 508). Furthermore prevalence of disordered eating behavior was assessed in the sample. Results show that the EAT-13 is a reliable and economic screening instrument that is eligible to select risk groups. An inspection of criterion validity shall be conducted in further studies. © Georg Thieme Verlag KGStuttgart New York.
Hellmann M.,Universitatsklinikum Cologne |
Hallek M.,Universitatsklinikum Cologne |
Scharrer I.,Universitatsklinikum Mainz
Internist | Year: 2010
Thrombotic-thrombocytopenic purpura (TTP) is a microangiopathic disorder characterized by multiple von Willebrand-Factor (vWF) rich microthrombi affecting the arterioles and capillary vessels of several organs. Ultra large von Willebrand multimers cause the blood clotting process by linking to platelets due to a lack of a plasma metalloprotease named ADAMTS13. Deficiency of this vWF-cleaving enzyme is caused by an inborn mutation in the gene coding or, more often, by acquired autoantibodies that inhibit ADAMTS13. TTP is a life-threatening disease which requires urgent admission to a hematological centre. Plasmapheresis therapy should be started immediately when diagnosis of primary TTP is likely. Patients typically present with schistozytes, hemolysis, thrombocytopenia and neurological abnormalities such as headache, focal deficits or coma. The monoclonal CD20 antibody rituximab targets ADAMTS13 antibody production and has the potential to be an effective therapy for relapsed TTP or initial treatment to shorten duration of plasma exchange. © 2010 Springer-Verlag.