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Garmisch-Partenkirchen, Germany

The increase in prevalence of diabetes mellitus and in life expectancy cause the growing number of diabetic patients with peripheral artery disease (PAD). Patients with long standing diabetes suffer frequently (about 70%) from peripheral sensory neuropathy. Therefore these patients miss the symptoms of claudication. Patients with silent ischemia will be classified to Stadium I (Fontaine) instead to stadium II or III or their diagnosis will be missed at all. The clinical investigation of the food pulses should be done at least once per year in all patients with diabetes mellitus. When one or more pulses are not detectable the further diagnostic procedures should start with the measurement of the ABI (Ancle Brachial Index). In patients with mediasclerosis the measurement will give false high numbers. After early diagnosis conventional treatment may be effective. With late diagnosis in the stadium IV (Fontaine) always and especially before any amputation revascularisation should be done. Guidelines give the right choise of katheter-based or open vascular-surgical procedures. © Springer-Verlag 2011. Source


Hartmann B.,Zentrum fur Innere Medizin
Clinica Chimica Acta | Year: 2012

Inhibitors of the mammalian target of rapamycin (mTOR) are administered as immunosuppressant as well as antineoplastic agents. Because of the narrow therapeutic index of mTOR inhibitors, drug monitoring is required, and this is usually done by measuring blood drug levels. Increasing knowledge of the signaling pathways of the mTOR protein kinase provides an opportunity for pharmacodynamic drug monitoring.With the different laboratory methods it is becoming possible to measure new biomarkers to control the influence of mTOR activity. One of these biomarkers is phospho-S6 kinase, with its isoform p70S6K. © 2012. Source


In the course of several gastroenterological diseases rheumatological symptoms can occur which in some cases are even the main symptoms. Important examples are Crohn's disease, ulcerative colitis, Whipple's disease and gluten-sensitive enteropathy. Arthralgia and also arthritis with or without joint destruction are possible in the context of chronic inflammatory bowel diseases. Pathogenetically, the bowels are of central importance. The interrelation of hepatological and rheumatological diseases is also complex. Viral hepatitis can present a clinical picture resembling classical rheumatoid arthritis but also show symptoms of collagenosis and vasculitis. In addition to the differential diagnostic demarcation, in most cases therapy of the underlying gastroenterological disease is the determining factor regarding the development of rheumatological symptoms. © 2011 Springer-Verlag. Source


Allescher H.D.,Zentrum fur Innere Medizin
Gastroenterologe | Year: 2012

Aging causes typical changes in several regions of the human body which lead to altered function. These changes can also be observed in the gastrointestinal tract, despite the fact that food and fluid intake is a well preserved function of the human body and changes are less prominent than those in the skeletal regions. In general a clear distinction has to be made between primary "physiological" aging changes of the laryngo-pharynx, esophagus or stomach and changes of swallowing function which are due to secondary effects of other diseases which have an increased incidence with rising age. The latter include cerebro-vascular and neurodegenerative disorders and malignant disease of the oropharynx, esophagus and cardia. © Springer-Verlag 2012. Source


During laboratory monitoring of patients with rheumatic diseases it is not uncommon to notice elevated liver transaminase levels. From a rheumatological perspective there are multiple causes for this. Liver dysfunction can be the result of certain rheumatological diseases, such as systemic lupus erythematosus. Primary biliary cirrhosis and primary sclerosing cholangitis are associated with rheumatic diseases. On the other hand, hepatological diseases, such as hepatitis C and autoimmune hepatitis show rheumatological symptoms. The most common cause of elevation of liver transaminase levels in rheumatic patients is without doubt the anti-rheumatic therapy. © 2015, Springer-Verlag Berlin Heidelberg. Source

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