Universitatsklinikum Rostock

St. Georg, Germany

Universitatsklinikum Rostock

St. Georg, Germany
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National and international guidelines have been very cautious in their recommendations regarding allergen immunotherapy (AIT) in asthma. AIT has only been recommended for patients with mild disease, good asthma control, and a clear link between (typically seasonal) allergen exposure und asthma symptoms. However, current studies demonstrated that AIT can also be safe and effective in patients with not well-controlled asthma and perennial allergies (such as house dust mite allergy). Thus, there are new horizons in AIT suggesting that AIT could represent a sustained disease-modifying intervention in patients with not well-controlled asthma. © 2017 Springer Medizin Verlag GmbH

A precise phenotyping of asthma has become an essential factor in the treatment of patients with asthma who are not well-controlled despite treatment with inhaled corticosteroids (ICS). In this regard, there is an increasing role for immunologic biomarkers such as eosinophils, total and specific IgE in serum and exhaled nitric oxide (FeNO). In the future, additional markers such as the type 2 marker periostin may become available in clinical practice. Of note, there are several unanswered questions regarding the clinical relevance of biomarkers in severe asthma. However, as a consequence of the increasing use of biologicals in clinical practice, we will gain new insights into the different phenotypes of asthma and the role of biomarkers in asthma management. © 2017 Springer Medizin Verlag GmbH

Calderon M.A.,Imperial College London | Linneberg A.,Glostrup University Hospital | Linneberg A.,Copenhagen University | Kleine-Tebbe J.,Allergy and Asthma Center Westend Outpatient Clinic Hanf | And 4 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015

The house dust mite (HDM) is a major perennial allergen source and a significant cause of allergic rhinitis and allergic asthma. However, awareness of the condition remains generally low. This review assesses the links between exposure to HDM, development of the allergic response, and pathologic consequences in patients with respiratory allergic diseases. We investigate the epidemiology of HDM allergy to explore the interaction between mites and human subjects at the population, individual, and molecular levels. Core and recent publications were identified by using "house dust mite" as a key search term to evaluate the current knowledge of HDM epidemiology and pathophysiology. Prevalence data for HDM allergen sensitization vary from 65 to 130 million persons in the general population worldwide to as many as 50% among asthmatic patients. Heterogeneity of populations, terminology, and end points in the literature confound estimates, indicating the need for greater standardization in epidemiologic research. Exposure to allergens depends on multiple ecological strata, including climate and mite microhabitats within the domestic environment, with the latter providing opportunity for intervention measures to reduce allergen load. Inhaled mite aeroallergens are unusually virulent: they are able to activate both the adaptive and innate immune responses, potentially offering new avenues for intervention. The role of HDM allergens is crucial in the development of allergic rhinitis and asthma, but the translation of silent sensitization into symptomatic disease is still incompletely understood. Improved understanding of HDMs, their allergens, and their microhabitats will enable development of more effective outcomes for patients with HDM allergy. © 2014 The Authors.

Bahlmann E.,Asklepios Clinic St. Georg | Gerdts E.,University of Bergen | Cramariuc D.,University of Bergen | Gohlke-Baerwolf C.,Herz Zentrum Bad Krozingen | And 6 more authors.
Circulation | Year: 2013

Background-: Aortic valve area index adjusted for pressure recovery (energy loss index [ELI]) has been suggested as a more accurate measure of aortic stenosis (AS) severity, but its prognostic value has not been determined in a prospective study. Methods and Results-: The relation between baseline ELI and rate of aortic valve events and combined total mortality and hospitalization for heart failure resulting from the progression of AS was assessed by multivariate Cox regression and reclassification analysis in 1563 patients with initial asymptomatic AS in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. During 4.3 years follow-up, a total of 498 aortic valve events and 181 combined total mortalities and hospitalizations for heart failure caused by the progression of AS occurred. In Cox regression analyses, 1-cm2/m 2 lower baseline ELI predicted a 2-fold higher risk both for aortic valve events and for combined total mortality and hospitalization for heart failure independently of baseline peak aortic jet velocity or mean aortic gradient and independently of aortic root size (all P<0.05). In reclassification analysis, ELI improved the prediction of aortic valve events by 13% (95% confidence interval, 5-19), whereas the prediction of combined total mortality and hospitalization for heart failure resulting from the progression of AS did not improve significantly. Conclusions-: In asymptomatic AS patients without known atherosclerotic disease or diabetes mellitus, ELI provides independent and additional prognostic information to that derived from conventional measures of AS severity, suggesting that ELI should be measured in such patients. Clinical Trial Registration Information-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677. © 2013 American Heart Association, Inc.

Surgery is the mainstay of treatment of oral squamous epithelial carcinomas for resectable tumors in conjunction with stage-dependent radiotherapy and (radio)chemotherapy. Although many questions are still unanswered a lot of data are available on the effectiveness of surgical resection of the primary tumor as well as on treatment of the efferent lymphatic channels. Besides the lymph nodal status, the safety margins achieved and resection status are the crucial prognostic parameters, which underlines the high significance of the quality of surgical resection. Data are also available for the problem of mandibular resection; however, conclusions on a higher evidential level are more difficult to draw. For lower and middle stage oral carcinomas surgical treatment at present sets the benchmark for therapy also concerning functionality and quality of life. © 2010 Springer-Verlag.

Protzel C.,Universitatsklinikum Rostock | Hakenberg O.W.,Universitatsklinikum Rostock
Urologe - Ausgabe A | Year: 2013

Penile carcinoma is fortunately a relatively rare disease in central Europe because advanced tumor stages are incurable. However, this rarity results in disadvantages for those affected because data from large series as an evidence basis are rare, the formulation of guidelines is often correspondingly vague and research funding for therapy studies is limited. Penile carcinoma is an orphan disease. Despite these disadvantageous characteristics research on the molecular biological basis of penile carcinoma has made some progress in recent years. This article gives a current review of all relevant aspects of this disease. © 2013 Springer-Verlag Berlin Heidelberg.

Lommatzsch M.,Universitatsklinikum Rostock
Deutsche Medizinische Wochenschrift | Year: 2016

Current guidelines of the global initiative for asthma (GINA) recommend the addition of biologics in step 5 of the stepwise asthma treatment approach. This review gives an overview on the effects and the clinical role of antibodies targeting immunoglobulin E, IgE (Omalizumab), Interleukin-5, IL-5 (Mepolizumab, Reslizumab) or the IL-5 receptor (Benralizumab). In addition, potential future treatment options of refractory asthma with antibodies (for instance Dupilumab) are discussed.

Hakenberg O.W.,Universitatsklinikum Rostock
Urologe | Year: 2016

Pelvic lipomatosis is a rare benign disease characterized by increased pelvic fatty tissue of unknown origin, which leads to encroachment on the pelvic organs. This can lead to symptoms due to narrowing of the bladder and in some cases also of the rectum as well as distal obstruction of the ureter. Symptomatic disease seems to occur more commonly in men with unspecific lower urinary tract symptoms, constipation and hydronephrosis. Obstruction of the upper urinary tract necessitates operative treatment. As the etiology is unclear an appropriate causal treatment is not available. © 2016, Springer-Verlag Berlin Heidelberg.

Asthma is not a new disease. It is one of the most common chronic disorders affecting approximately 45% of adults and more than 10% of children in Germany. This turns asthma into one of the most prevalent chronic disorders. Over the last century ideas about its pathogenesis have changed many times. While around one hundred years ago asthma was often considered a neurotic disease, changes in airway smooth muscle, mast cell accumulation and activation or specific mediators such as platelet-activating factor have since been incriminated in its pathogenesis. Eosinophils, cytokines and T-lymphocytes were favourites some time later. Nowadays, and this is unlikely to be the end of the story asthma is considered as a complex disorder of the adaptive immune system. Therapeutic approaches have changed dramatically, too. While until about 30 years ago asthma was still considered a Smooth muscle disorder, recurrent attacks of asthma which required frequent, mostly nocturnal interventions, status asthmaticus, or the necessity of mechanical, invasive ventilation have markedly decreased. In view of the asthma epidemic in recent years, this development suggests that current treatments are at least partially effective. In spite of this patients with asthma are often only moderately well controlled with considerable morbidity from the disease as well as its treatment. Thus, despite recent advances in diagnosis and treatment, asthma is still not a trivial disease and future attempts at improving the care of those affected are warranted. The developments of the past 100 years as well as a careful look into the future are presented in this review. © 2010 Georg Thieme Verlag KG Stuttgart · New York.

Krause B.J.,Universitatsklinikum Rostock | Schwarzenbock S.,Universitatsklinikum Rostock | Souvatzoglou M.,TU Munich
Recent Results in Cancer Research | Year: 2013

Molecular imaging with positron emission tomography (PET) using tumour-seeking radiopharmaceuticals has gained wide acceptance in oncology with many clinical applications. The hybrid imaging modality PET/CT allows assessing molecular as well as morphologic information at the same time. Therefore, PET/CT represents an efficient tool for whole body staging and re-staging within one imaging modality. In oncology the glucose analogue 18F- fluorodeoxyglucose (FDG) is the most widely used PET and PET/CT radiopharmaceutical in clinical routine. FDG PET and PET/CT have been used for staging and re-staging tumour patients in numerous studies. This chapter will discuss the use and the main indications of FDG PET and PET/CT in oncology with special emphasis on lung cancer, oesophageal cancer, colorectal cancer, head and neck cancer, lymphoma and breast cancer (among other tumour entities). A review of the current literature will be given with respect to primary diagnosis, staging and diagnosis of recurrent disease (local, lymph node and distant metastases). Besides its integral role in diagnosis, staging and re-staging of disease in oncology, there is increasing evidence that FDG PET and PET/CT can significantly contribute to therapy response assessment possibly influencing therapeutic management and treatment planning, to therapy tumour control and prediction of prognosis in oncologic patients, which will also be discussed in this chapter. © 2013 Springer-Verlag Berlin Heidelberg.

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