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Kornmann J, Scherl C, Lammert A, Rotter N, Huber L. Rare Case of Tularemia With Preauricular Lymphadenopathy and Conjunctivitis in a 27-Year-Old Male Patient in Germany. Ear Nose Throat J 2024:1455613231226046. [PMID: 38247118 DOI: 10.1177/01455613231226046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Tularemia is a rare disease but shows an approximately 10-fold increase in reported cases over the last 15 years in Germany. Clinical symptoms of acute tularemia infection are various, which often delays diagnosis. This case report gives an overview of the clinical manifestations of acute tularemia and shows the importance of interdisciplinary work to shorten the time from the onset of symptoms to effective treatment in infection with Francisella tularensis. Since some cases of tularemia are life-threatening, early diagnosis is vital. This case report serves as a reminder that rare diseases need to be considered in cervical lymphadenopathy.
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Affiliation(s)
- J Kornmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Germany
| | - C Scherl
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Germany
| | - A Lammert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Germany
| | - N Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Germany
| | - L Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Germany
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Kohmer N, Rabenau HF, Ciesek S, Krämer BK, Göttmann U, Keller C, Rose D, Blume C, Thomas M, Lammert A, Lammert A. Heterologous immunization with BNT162b2 followed by mRNA-1273 in dialysis patients: seroconversion and presence of neutralizing antibodies. Nephrol Dial Transplant 2022; 37:1132-1139. [PMID: 35099023 PMCID: PMC9383412 DOI: 10.1093/ndt/gfac018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The vital renal replacement therapy makes it impossible for dialysis patients to distance themselves socially. This results in a high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and developing coronavuris disease 2019, with excess mortality due to disease burden and immunosuppression. We determined the efficacy of a 100-µg booster of mRNA-1273 (Moderna, Cambridge, MA, USA) 6 months after two doses of BNT162b2 (BioNTech/Pfizer, Mainz, Germany/New York, USA) in 194 SARS-CoV-2-naïve dialysis patients. METHODS Anti-SARS-CoV-2 spike antibodies were measured with the Elecsys Anti-SARS-CoV-2 S assay (Roche Diagnostics, Mannheim, Germany) 4 and 10-12 weeks after two doses of BNT162b2 as well as 4 weeks after the mRNA-1273 booster. The presence of neutralizing antibodies was measured by the SARS-CoV-2 Surrogate Virus Neutralization Test (GenScript Biotech, Piscataway, NJ, USA). Two different cut-offs for positivity were used, one according to the manufacturer's specifications and one correlating with positivity in a plaque reduction neutralization test (PRNT). Receiver operating characteristics analyses were performed to match the anti-SARS-CoV-2 spike antibody cut-offs with the cut-offs in the surrogate neutralization assay accordingly. RESULTS Any level of immunoreactivity determined by the anti-SARS-CoV-2 spike antibody assay was found in 87.3% (n = 144/165) and 90.6% (n = 164/181) of patients 4 and 10-12 weeks, respectively, after two doses of BNT162b2. This was reduced to 68.5% or 60.6% 4 weeks and 51.7% or 35.4% 10-12 weeks, respectively, when using the ROC cut-offs for neutralizing antibodies in the surrogate neutralization test (manufacturer's cut-off ≥103 U/mL and cut-off correlating with PRNT ≥196 U/mL). Four weeks after the mRNA-1273 booster, the concentration of anti-SARS-CoV-2 spike antibodies increased to 23 119.9 U/mL and to 97.3% for both cut-offs of neutralizing antibodies. CONCLUSION Two doses of BNT162b2 followed by one dose of mRNA-1273 within 6 months in patients receiving maintenance dialysis resulted in significant titres of SARS-CoV-2 spike antibodies. While two doses of mRNA vaccine achieved adequate humoral immunity in a minority, the third vaccination boosts the development of virus-neutralizing quantities of SARS-CoV-2 spike antibodies (against wild-type SARS-CoV-2) in almost all patients.
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Affiliation(s)
- Niko Kohmer
- Institute for Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Holger F Rabenau
- Institute for Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
- German Centre for Infection Research, External Partner Site, Frankfurt, Germany
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Branch Translational Medicine and Pharmacology, Frankfurt, Germany
| | - Bernhard K Krämer
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Uwe Göttmann
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Nierenzentrum Worms, Germany
| | - Christine Keller
- Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Daniela Rose
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Carsten Blume
- Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Michael Thomas
- Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Alexander Lammert
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Anne Lammert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Delgado GE, Kleber ME, Moissl AP, Yazdani B, Kusnik A, Ebert MP, März W, Krämer BK, Lammert A, Teufel A. Surrogate scores of advanced fibrosis in NAFLD/NASH do not predict mortality in patients with medium-to-high cardiovascular risk. Am J Physiol Gastrointest Liver Physiol 2021; 321:G252-G261. [PMID: 34132110 DOI: 10.1152/ajpgi.00058.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Untreated non-alcoholic fatty liver disease (NAFLD) may have significant consequences including an increase in mortality and cardiovascular injury. Thus, early detection of NAFLD is currently believed not only to prevent liver-related but also cardiovascular mortality. However, almost nothing is known about coexisting NAFLD in patients with coronary artery disease (CAD). We investigated the impact of surrogate scores of fibrosis in NAFLD in a large cohort of patients referred to coronary angiography. Modeling the common NALFD and fibrosis scores, fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS), as splines revealed significant associations with all-cause and cardiovascular mortality when Cox regression models were only adjusted for cardiovascular risk factors that were not already included in the calculation of the scores. Stratifying the scores into quartiles yielded hazard ratios [95% confidence interval (CI)] for all-cause and cardiovascular mortality for the 4th quartile versus the 1st quartile of 2.28 (1.90-2.75) and 2.11 (1.67-2.67) for FIB-4 and of 3.21 (2.61-3.94) and 3.12 (2.41-4.04) for NFS. However, we did not observe an independent association of FIB-4 or NFS with overall or cardiovascular mortality in our prospective CAD cohort after full adjustment for all cardiovascular risk factors [all-cause mortality: HR 1.13 (0.904-1.41) and 1.17 (0.903-1.52); cardiovascular mortality: HR 1.06 (0.8-1.41) and 1.02 (0.738-1.41)]. Thus, neither FIB-4 nor NFS, as surrogate markers for NAFLD/NASH, were independent risk factors for overall or cardiovascular mortality in patients with CAD. Our data show that surrogate risk scores for NAFLD-related fibrosis do not add information in assessing the CVD events in patients with CAD proven by angiography.NEW & NOTEWORTHY We investigated the impact of NAFLD surrogate markers in a large cohort of patients that had been referred to coronary angiography. In contrast to a repeatedly demonstrated increased link of cardiovascular events in patients with NALFD, we demonstrated that NAFLD surrogate markers were not independent risk factors for overall or cardiovascular mortality in patients with CAD. Thus, these markers may not be useful for primary prevention of cardiovascular events in patients with CAD.
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Affiliation(s)
- Graciela E Delgado
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcus E Kleber
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,SYNLAB MVZ Humangenetik Mannheim GmbH, Mannheim, Germany
| | - Angela P Moissl
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany.,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
| | - Babak Yazdani
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Kusnik
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Winfried März
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Synlab Academy, SYNLAB Holding Deutschland GmbH, Mannheim and Augsburg, Germany
| | - Bernhard K Krämer
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Lammert
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Praxis für Stoffwechsel- und Nierenerkrankungen, Zentrum für Dialyse und Apherese, Grünstadt, Germany
| | - Andreas Teufel
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lammert A, Lezhenina S, Shuvalova N, Andreeva N, Guryanova E. AB0869-HPR HOW TO IMPROVE THE QUALITY-OF-LIFE IN PATIENTS WITH OSTEOPOROSIS? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:This paper is an assessment of quality-of-life for patients living with osteoporosis. It employs special questionnaires and scales to allow for more detailed observation of the patient both during initial treatment and in dynamics. This allows us to establish the effectiveness of the therapy, to assess the need to correct the treatment and rehabilitation program, and to compare the effectiveness of various treatment methods and determine disease prognosis.Objectives:to assess quality-of-life in patients with osteoporosis for further development of treatment and rehabilitation programs.Methods:To assess the quality-of-life in patients with osteoporosis, HRQOL and SF-36 scale were used. The study was conducted from January to December 2019, at the Republican Clinical Hospital of the Chuvash Republic. The study involved 70 patients (n = 70) with a diagnosis of osteoporosis with a pathological fracture. Of the 70 patients included in the study, 35 women aged 67 ± 1.2 years and 35 men aged 60 ± 1.2 years. The results were statistically processed using MS Office Excel programs.Results:According to the analysis carried out by the HRQOL method, more than half of the patients (52.13%) experienced daily back pain, which worsens their mood and well-being. When assessing the degree of pain, almost half of the patients (48.73%) rated their pain by VAS as moderate. Moreover, most of the respondents experienced a “significant” (46.51%) or “moderate” (34.29%) decrease in social activity due to pain syndrome associated with osteoporosis. In connection with this, 44.51% rated their satisfaction with their lives as “average degree of satisfaction”.When analyzing the quality-of-life indicators according to the SF-36 scales, we determined that the mental component of health predominates for women (The Short Form-36: MH=68,6±3,45 (Men: MH=48,5±2,85)). In men, high quantitative values of the scales “physical” and “role physical functioning” (The Short Form-36: PF=62,5±3,33; RP=58,4±3,81) indicate a more pronounced nature of changes in somatic status, which has a significant impact on the quality-of-life. The intensity of pain was perceived to be higher by men (The Short Form-36: BP=75,6±4,06) than by women (The Short Form-36: BP=35,7±1,86). This confirms that osteoporosis and its complications negatively affect the human psyche and can significantly worsen the quality-of-life.Conclusion:Analysis of quality-of-life indicators using the SF-36, HRQOL method contributes to a more correct choice of effective strategy for specialized medical care and rehabilitation for patients with osteoporosis. This choice should be developed individually, taking into account the age, gender characteristics, the severity of structural and functional disorders and the psychological state of the patient. It must also take into account the presence and severity of concomitant diseases, which will require additional research and discussion at different levels of the organization of medical care.Disclosure of Interests:None declared
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Lezhenina S, Lammert A, Shuvalova N, Guryanova E. AB0922-PARE OSTEOPOROSIS AWARENESS LEVEL AS A METHOD FOR IMPROVING PRIMARY PREVENTION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Having complete information about osteoporosis is a prerequisite for preventive behavior, which determines the conscious adherence to the principles of a healthy lifestyle.Objectives:To assess the level of awareness of osteoporosis among women.Methods:A survey was conducted of 750 female respondents aged 15 to 55 years in the Chuvash Republic. The survey was conducted from January to December 2019. The questionnaire consisted of 30 questions. One point was awarded for each correct answer. The minimum score for passing the test was 75% correct answers. The questions addressed both general knowledge about osteoporosis and the relationship between disease onset and diet, physical activity, vitamin D, cigarette smoking, excessive alcohol consumption, and being overweight. The respondents were divided into two groups: group A (n = 375) - females from 15 to 35 years old and group B (n = 375) - females from 36 to 55 years old. Survey data was processed in Statistical Analysis Software 15.0. Statistical significance was calculated using Analysis of Variation.Results:We obtained the following results for the Main Aspects of the survey: 1. Osteoporosis is a rare condition that occurs primarily in women (Awareness level: Group A - 47%; Group B - 67,5%; Analysis of Variation > 0,05). 2. Postmenopausal women are more at risk of osteoporosis (Awareness level: Group A - 73,5%; Group B - 70,4%; Analysis of Variation > 0,05). 3. Prevention of osteoporosis is impossible (Awareness level: Group A - 78,8%; Group B - 89%; Analysis of Variation > 0,05). 4. Vitamin D is synthesized by direct exposure to UV radiation on the skin (Awareness level: Group A - 53,1 %; Group B - 69,1%; Analysis of Variation > 0,05). 5. Effective prevention of osteoporosis are: I. Balanced diet; II. Absence of bad habits; III. Occupation with health-improving physical culture. IV. Reduction of excess body weight (Awareness level: Group A - 69,2%; Group B - 47,1%; Analysis of Variation > 0,05). 6. Increased consumption of table salt, sugar and excessive consumption of protein foods, vegetarianism negatively affects the quality of bone tissue (Awareness level: Group A - 56,7%; Group B - 70,4%; Analysis of Variation > 0,05).Conclusion:The conducted survey shows that the level of awareness of osteoporosis and its prevention is low among women in different age groups. In some cases, it is even a cause for concern. We believe that respondents’ statements that osteoporosis cannot be effectively prevented are the most important findings of our study. Starting from adolescence, women should be well aware of the main risk factors for the development of osteoporosis, the mechanisms of its development and its consequences. This knowledge will help substantiate why it is necessary to lead a healthy lifestyle, which will help to prevent the development of this disease in the future. The concept of prevention of osteoporosis should include the following recommendations for the general population: to maintain a physically active lifestyle and to spend sufficient time under the influence of sunlight, avoid smoking and drinking large amounts of alcohol, ensure that dietary calcium intake is in line with the recommended level in the area, and maintain an appropriate body weight.Disclosure of Interests:None declared
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Lammert A, Nowak K, Weber R, Rotter N, Schölch S, Krämer BK, Lammert A. [Postoperative hypocalcemia - the most common complication of endocrine head and neck surgery: acute management]. Laryngorhinootologie 2021; 100:610-617. [PMID: 33652494 DOI: 10.1055/a-1381-8286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Germany, 8000 patients are affected by postoperative hypoparathyroidism per year following surgery of the thyroid gland, parathyroidal glands and the larynx. Patients do not only suffer from paresthesia in the acute phase of this complication, but are also adversely affected by the fear of loss of control following episodes of tetany even years after the first episode. OBJECTIVES Discussion of a diagnostic pathway and presentation of a management pathway for postoperative hypocalcemia. METHODS Narrative review, analysis and discussion of current literature and expert recommendations. RESULTS Early determination of calcium and parathyroid hormone allows timely diagnosis and treatment of postoperative hypoparathyroidism. Active vitamin D is pivotal for the resorption of calcium. Only the combined treatment with active vitamin D and calcium can mitigate or prevent the postoperative drop of calcium levels. CONCLUSIONS A standard operating procedure (SOP) for postoperative hypoparathyroidism should be implemented in every surgical department. An SOP for diagnosis and treatment of postoperative hypoparathyroidism is proposed for institutional individualization and implementation.
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Affiliation(s)
- Anne Lammert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Kai Nowak
- Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, RoMed Klinikum, Rosenheim, Germany
| | - Roland Weber
- Medizinische Klinik II, RoMed Kliniken, Rosenheim, Germany
| | - Nicole Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Sebastian Schölch
- Chirurgische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Bernhard K Krämer
- V. Medizinische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Alexander Lammert
- V. Medizinische Klinik, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Germany.,Apherese- und Dialysezentrum Grünstadt, Praxis für Diabetes, Stoffwechsel und Nierenerkrankungen, Grünstadt, Germany
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Abstract
Exosomes, virus-sized nanovesicles, are utilized as messenger systems of our body to communicate with other body cells and regulate immune functions. Almost all cells produce exosomes and are able to interact with immune cells in the blood stream and peripheral body areas. Different markers on the surface of exosomes are necessary for immune cell adhesion and interaction. Furthermore, many types of exosome-immune cell interaction, such as surface receptor contact and phagocytosis, are known. As carriers of different cargos, exosomes affect different immune cell types in head and neck cancers: So far, T cells, natural killer cells, macrophages, and dendritic cells have been described in this context. For diagnostic purposes, a combined analysis of different parameters including protein amount, nucleic acid/protein expression, and the immunosuppressive impact of exosomes could empower exosomes as useful tools for evaluation of tumor promotion and progression in the future.
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Affiliation(s)
- S Ludwig
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M-N Theodoraki
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - J Jablonska
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - A Lammert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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Abstract
Background:The neuropathic component is present in the mechanism of pain in RA in 36% of cases. The presence of anxiety-depressive disorders and a decrease in the quality of life in patients with RA are shown.Objectives:The study of the clinical features of pain in RA in men and women.Methods:The group consisted of 134 patients with RA (94 women and 40 men), aged 36 to 60 years (average age 48.6 ± 7.1 years) and disease duration from 1 year to 10 years (4.03 ± 1.6 years) hospitalized in the rheumatology department of the Republican Clinical Hospital (Cheboksary). At the time of inclusion in the study, all patients were in the active stage of the disease.An assessment of rheumatological and neurological status was carried out. Pain assessment was performed using: Visual Analog Scale (VAS); Ritchie articular index (RAI). The severity of neuropathic pain was determined using the diagnostic neuropathic pain questionnaire DN4 and PainDetect (sensitivity - 82.9%; specificity - 89.9%). To determine the psycho-emotional deviations used: general health questionnaire (anxiety and depression) - General Health Questionnaire (form GHQ – 28); HADS; Spilberger-Hanin situational and personal anxiety scale. Patient mobility limitations were assessed using the Rivermead mobility index score scale, and quality of life was quantified using the EQ-5D visual analogue scale.To assess the activity of the disease, the level of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and the DAS index - 28-CRP were used. To assess mental and physical functioning, a standardized questionnaire The Short Form-36 was used.To visualize the stage, survey radiographs were used in the direct projection of the metacarpophalangeal and metatarsophalangeal joints, wrist joints, proximal interphalangeal joints of the hands; distal parts of the feet.Results:An analysis of chronic pain syndrome in 36% of patients revealed a neuropathic component of pain (DN4: 5.7 ± 1.1 points, PainDetect: 16.3 ± 4.2).In the group of patients with neuropathic pain (n = 78) aged 55.1 ± 7.9 years, the duration of the disease was 3.4 ± 0.9 years, the more advanced and late clinical stages of the disease, III – IV radiological stages of RA were more common, were present neurological disorders and complaints characteristic of peripheral polyneuropathy. Rivermead mobility index in patients with neuropathic disorders, (n = 78) was 9.1 ± 0.8 points, in the absence of neuropathic disorders (n = 56), 11.2 ± 1.1 points. There were no significant differences in process activity (DAS index - 28 - CRP) and quality of life.According to the questionnaire of situational and personal anxiety, Spilberger-Khanin revealed moderate anxiety and mild - depressive disorders. Quality of life was reduced in all patients with RA.Pain syndrome in patients with neuropathic pain with symptomatic (NSAIDs, GC) and basic cytostatic therapy (methotrexate) showed that, despite the decrease in the severity of the inflammatory process, the positive dynamics was partial (VAS before therapy 6.4 ± 0, 7; VAS in the presence of therapy 4.3 ± 0.5 (p> 0.05); PainDetect = 14.9 ± 4.4; DN4 = 4.3 ± 1.5).In men, statistically significant factors associated with pain were clinical parameters that accounted for 37% and 18% of pain variation (Ritchie articular index (CIR): Fsmc = 4.107, p <0.001; SF-36: Fsmc = 2.107, p <0.001) In women, the main significant factors associated with pain were the subjective feeling of pain and psychological characteristics that accounted for 12% of the pain variation (SF-36: Fsmc = 11.118, p <0.001).Conclusion:A dynamic study of patients with RA in accordance with gender and age will further develop additional criteria for evaluating the effectiveness of complex therapy used to treat chronic pain, and will also increase the overall effectiveness of treatment.Disclosure of Interests:None declared
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Elbelt U, Schlaffer SM, Buchfelder M, Knappe UJ, Vila G, Micko A, Deutschbein T, Unger N, Lammert A, Topuzoglu-Müller T, Bojunga J, Droste M, Johanssen S, Kolenda H, Ritzel K, Buslei R, Strasburger CJ, Petersenn S, Honegger J. Efficacy of Temozolomide Therapy in Patients With Aggressive Pituitary Adenomas and Carcinomas-A German Survey. J Clin Endocrinol Metab 2020; 105:5634134. [PMID: 31746334 DOI: 10.1210/clinem/dgz211] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite growing evidence that temozolomide (TMZ) therapy is effective for the treatment of aggressive pituitary tumors (APTs) or carcinomas (PCs), individual therapy decisions remain challenging. OBJECTIVE We therefore aimed to report on clinical characteristics leading to initiation of TMZ therapy and to add evidence on TMZ long-term effectiveness. DESIGN AND SUBJECTS Retrospective survey on TMZ treatment in patients with APTs or PCs. TMZ therapy was initiated in 47 patients (22 females) with APTs (n = 34) or PCs (n = 13). Mean age at diagnosis was 45 ± 15 years. The immunohistochemical subtypes were corticotroph (n = 20), lactotroph (n = 18), and nonfunctioning (n = 9) tumors. TMZ therapy started 8 years after initial diagnosis using a standard regimen (median 6 cycles) for the majority of patients. RESULTS Long-term radiological response to TMZ after a median follow-up of 32 months with 4 patients still on TMZ therapy was tumor regression for 9 (20%), stable disease for 8 (17%), and tumor progression for 29 patients (63%) (outcome data available for 46 patients). Progression occurred 16 months after initiation of TMZ. Median estimated progression-free survival was 23 months. Disease stabilization and median progression-free survival did not differ between patients with APTs or PCs. Predictors of tumor response were not identified. Overall, TMZ was well tolerated. CONCLUSION We performed a nationwide survey on TMZ therapy in patients with APTs and PCs. While early response rates to TMZ are promising, long-term outcome is less favorable. Prolonged TMZ administration should be considered. We were not able to confirm previously reported predictors of tumor response to TMZ.
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Affiliation(s)
- Ulf Elbelt
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sven M Schlaffer
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulrich J Knappe
- Department of Neurosurgery, Johannes Wesling Klinikum, Universitätsklinikum der Ruhruniversität Bochum, Minden, Germany
| | - Greisa Vila
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, Essen, Germany
| | - Alexander Lammert
- Vth Department of Medicine, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Tengü Topuzoglu-Müller
- Department of Endocrinology, Diabetes and Preventive Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | | | | | - Herbert Kolenda
- Department of Neurosurgery, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Katrin Ritzel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rolf Buslei
- Institute of Pathology, SozialStiftung Bamberg, Bamberg, Germany
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutrition, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jürgen Honegger
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
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10
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Delgado GE, Krämer BK, Scharnagl H, Fauler G, Stojakovic T, März W, Kleber ME, Lammert A. Bile Acids in Patients with Uncontrolled Type 2 Diabetes Mellitus - The Effect of Two Days of Oatmeal Treatment. Exp Clin Endocrinol Diabetes 2020; 128:624-630. [PMID: 31896155 DOI: 10.1055/a-1069-7330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Beta-glucans are effective in binding bile acids (BA) thereby lowering cholesterol concentration. This might contribute to the beneficial effects of the consumption of β-glucan-rich foods like oatmeal on glucose homeostasis. OBJECTIVE We measured BA serum concentrations in patients with uncontrolled type 2 diabetes (T2DM) to investigate the effect of two days of oatmeal treatment on BA concentration as compared to a conventional T2DM-adapted diet. METHODS The OatMeal And Insulin Resistance study was performed as a randomized, open label crossover dietary intervention study with consecutive inclusion of 15 patients in an inpatient clinical setting. Bile acids were measured by high-resolution mass spectrometry. For statistical analysis, the differences in the concentration of serum BA and laboratory parameters between the fifth day and the third day of each inpatient stay were calculated and the effect compared between both phases by using the Wilcoxon test. RESULTS Whereas there was a mean decrease in total BA following oatmeal treatment (-0.82±1.14 µmol/l), there was no decrease following the control treatment. Glycocholic acid was lower after oatmeal treatment but higher following control treatment (-0.09±0.17 vs. 0.05±0.11 µmol/l). The reduction in total BA was directly correlated with a decrease in proinsulin during the oatmeal phase. Decreases in blood lipids or apolipoproteins were mostly greater after oatmeal treatment, but these differences were not statistically significant. CONCLUSION Two days of oatmeal diet led to significant reductions in total BA as compared to a diabetes-adapted control diet. The magnitude of BA reduction was directly correlated with a decrease in proinsulin.
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Affiliation(s)
- Graciela E Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernhard K Krämer
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Günther Fauler
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Graz, Graz, Austria
| | - Winfried März
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Marcus Edi Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Lammert
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Praxis für Diabetes, Stoffwechsel-und Nierenerkrankungen, Grünstadt, Germany
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11
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Di Meo G, Karampinis I, Gerken A, Lammert A, Pellicani S, Nowak K. Indocyanine Green Fluorescence Angiography Can Guide Intraoperative Localization During Parathyroid Surgery. Scand J Surg 2019; 110:59-65. [PMID: 31554490 DOI: 10.1177/1457496919877581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Intraoperative localization of pathologic parathyroid glands is of major importance for the hyperparathyroidism treatment. Based on the small size and the anatomic variability, the localization can be very challenging. The current practice is to compare preoperative ultrasonography with Technetium-99m sestamibi scintigraphy (MIBI) and plan the resection accordingly. In this study, we implemented indocyanine green angiography for the intraoperative localization of parathyroid glands. MATERIALS AND METHODS This is a retrospective analysis of 37 patients with primary, secondary, or tertiary hyperparathyroidism who were operated using indocyanine green angiography for the intraoperative localization of pathological parathyroid glands. An indocyanine green solution of 2.5 mg was were intravenously administered for parathyroid gland visualization. Different fluorescence scores were correlated with changes in postoperative parathyroid hormone levels. RESULTS Patients were divided into two groups depending on the presence of uniglandular or multiglandular disease. Sixty-four lesions were resected, and the final histopathologic analysis confirmed the parathyroid origin in 62 of them (96.8%). None of the patients with uniglandular disease developed postoperative hypoparathyroidism, whereas three patients in the multiglandular group developed temporary hypoparathyroidism symptoms. Indocyanine green imaging had higher sensitivity for the intraoperative detection of parathyroid glands compared with ultrasonography and MIBI (p < 0.001). CONCLUSION Indocyanine green angiography indicated high sensitivity for the intraoperative identification of pathologic parathyroid glands leading to a resection rate of 95.16%. The modality was useful, especially in cases of revisional surgery or ectopic parathyroid glands. Randomized trials have already proven the value of indocyanine green imaging in predicting postoperative hypocalcemia. Our results support the regular use of this method during parathyroid surgery.
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Affiliation(s)
- G Di Meo
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy.,Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - I Karampinis
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A Lammert
- Dialyse-Praxis Grünstadt, Grünstadt, Germany
| | - S Pellicani
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy
| | - K Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Surgery, RoMed Klinikum Rosenheim, Rosenheim, Germany
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12
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Vassilev G, Lammert A, Galata C, Seyfried S, Weiss C, Otto M. Myoglobin Determination After Bariatric Surgery Has No Additional Benefit. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Georgi Vassilev
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Alexander Lammert
- Department of Medical Statistics, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Christian Galata
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Steffen Seyfried
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
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13
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Zhang S, Albrecht T, Rodriguez-Niño A, Qiu J, Schnuelle P, Peters V, Schmitt CP, van den Born J, Bakker SJL, Lammert A, Krämer BK, Yard BA, Hauske SJ. Carnosinase concentration, activity, and CNDP1 genotype in patients with type 2 diabetes with and without nephropathy. Amino Acids 2019; 51:611-617. [PMID: 30610469 DOI: 10.1007/s00726-018-02692-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Abstract
This study assessed if serum carnosinase (CNDP1) activity and concentration in patients with type 2 diabetes mellitus (T2D) with diabetic nephropathy (DN) differs from those without nephropathy. In a cross-sectional design 127 patients with T2D with DN ((CTG)5 homozygous patients n = 45) and 145 patients with T2D without nephropathy ((CTG)5 homozygous patients n = 47) were recruited. Univariate and multivariate regression analyses were performed to predict factors relevant for serum CNDP1 concentration. CNDP1 (CTG)5 homozygous patients with T2D with DN had significantly lower CNDP1 concentrations (30.4 ± 18.3 vs 51.2 ± 17.6 µg/ml, p < 0.05) and activity (1.25 ± 0.5 vs 2.53 ± 1.1 µmol/ml/h, p < 0.05) than those without nephropathy. This applied for patients with DN on the whole, irrespective of (CTG)5 homozygosity. In the multivariate regression analyses, lower serum CNDP1 concentrations correlated with impaired renal function and to a lesser extend with the CNDP1 genotype (95% CI of regression coefficients: eGFR: 0.10-1.94 (p = 0.001); genotype: - 0.05 to 5.79 (p = 0.055)). Our study demonstrates that serum CNDP1 concentrations associate with CNDP1 genotype and renal function in patients with T2D. Our data warrant further studies using large cohorts to confirm these findings and to delineate the correlation between low serum CNDP1 concentrations and renal function deterioration in patients with T2D.
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Affiliation(s)
- Shiqi Zhang
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei Shi, China
| | - Thomas Albrecht
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Angelica Rodriguez-Niño
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jiedong Qiu
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Peter Schnuelle
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Verena Peters
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jacob van den Born
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexander Lammert
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Benito A Yard
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Sibylle J Hauske
- Vth Department of Medicine (Nephrology/Endocrinology/Rheumatology) University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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14
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Delgado G, Kleber ME, Krämer BK, Morcos M, Humpert PM, Wiegand K, Mauldin A, Kusterer K, Enghöfer M, März W, Segiet T, Lammert A. Dietary Intervention with Oatmeal in Patients with uncontrolled Type 2 Diabetes Mellitus – A Crossover Study. Exp Clin Endocrinol Diabetes 2018; 127:623-629. [DOI: 10.1055/a-0677-6068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
Background In a pilot study, we evaluated the efficacy of two days of oatmeal on insulin resistance and glucose metabolism and found a marked decrease of insulin requirements. The most important shortcoming of that study was that the interventions were not isocaloric (diabetes adapted diet: 1500 kcal/d vs. oatmeal 1100 kcal/d). To address these drawbacks we designed the OatMeal And Insulin Resistance (OMA-IR) study.
Methods The study was a randomized, open label crossover dietary intervention study with consecutive inclusion of 15 patients with uncontrolled type 2 diabetes. The intervention comprised two days of oatmeal on days 3 and 4 of a 5 days hospital stay. During the control period, patients received a diabetes mellitus adapted diet only. The primary endpoint was the daily insulin requirement and glycemic control.
Results Upon oatmeal treatment, the required insulin dose could be significantly reduced on the third and fourth day as compared to the second day of inpatient stay (82.0±30.3 and 69.9±29.9IU versus 112±36.2IU;P<0.001). During control treatment, insulin requirement did not change. There were no significant differences in the changes of mean blood glucose or fasting glucose between both treatments. HbA1c was lower four weeks after the oatmeal intervention.
Conclusion In this crossover study, two days of oatmeal intervention allowed a highly significant reduction of required daily insulin doses while maintaining adequate metabolic control as compared to a diabetes adapted diet only. The beneficial effects of the intervention might last for several weeks as shown by the lower HbA1c four weeks after the intervention.
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Affiliation(s)
- Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marcus E. Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Bernhard K Krämer
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Morcos
- Stoffwechselzentrum Rhein-Pfalz, Belchenstrasse 1-5, Mannheim, Germany
| | - Per M. Humpert
- Stoffwechselzentrum Rhein-Pfalz, Belchenstrasse 1-5, Mannheim, Germany
| | - Kerstin Wiegand
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Andy Mauldin
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Klaus Kusterer
- Endokrinologische Gemeinschaftpraxis Mannheim, Kurfürstenpassage P7 24, Mannheim
| | - Michael Enghöfer
- Endokrinologische Gemeinschaftpraxis Mannheim, Kurfürstenpassage P7 24, Mannheim
| | - Winfried März
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Thomas Segiet
- Diabetologische Schwerpunktpraxis Dres. Segiet und Bode, Speyer, Germany
| | - Alexander Lammert
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
- Praxis für Diabetes, Stoffwechsel-und Nierenerkrankungen, Verladeplatz 2-4, Grünstadt, Germany
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15
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Karampinis I, Di Meo G, Gerken A, Stasiunaitis V, Lammert A, Nowak K. [Intraoperative Indocyanine Green Fluorescence to Assure Vital Parathyroids in Thyroid Resections]. Zentralbl Chir 2018; 143:380-384. [PMID: 30134496 DOI: 10.1055/a-0655-7881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Total thyreoidectomy is associated with high rates of temporary or permanent hypoparathyroidism. During surgery, ICG fluorescence angiography can be used to detect and preserve well vascularised parathyroid glands; this technique has been recently introduced in retrospective and prospective trials as an intraoperative technical support to avoid postoperative hypoparathyroidism. MATERIALS UND METHODS 27 patients undergoing total thyreoidectomy were prospectively enrolled in our study. The vascularisation of the parathyroid glands was analysed intraoperatively using ICG tissue angiography. 5 mg indocyanine green were intravenously administered. Fluorescence angiography was evaluated in real time using the PinPoint (Novadaq, Canada) imaging system. The study was approved by the local ethics committee. RESULTS ICG fluorescence angiography was performed uneventfully in all cases. There was no case of postoperative hypoparathyroidism when at least one parathyroid gland with high fluorescence intensity was preserved. In 4 cases, only low fluorescence intensity was detected in the remaining parathyroid glands after completing the resection. All 4 patients received activated vitamin D3 prophylactically. Two of 4 developed symptomatic hypocalcaemia due to temporary hypoparathyroidism. CONCLUSION Implementation of ICG fluorescence angiography can help in predicting and therefore preventing postoperative hypoparathyreoidism after total thyreoidectomy. If a well vascularised parathyroid gland with high ICG fluorescence intensity can be secured, calcium substitution and postoperative prophylaxis of hypoparathyreoidism may become obsolete in the future.
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Affiliation(s)
| | - Giovanna Di Meo
- Abteilung für Biomedizinische Wissenschaft und Onkologie, Universitätsmedizin "A. Moro", Bari, Italien
| | - Andreas Gerken
- Chirurgische Klinik, Universitätsmedizin Mannheim, Deutschland
| | | | - Alexander Lammert
- Facharztpraxis für Diabetologie, Endokrinologie und Nephrologie, Grünstadt, Deutschland
| | - Kai Nowak
- Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, RoMed Klinikum Rosenheim, Deutschland
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16
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Lammert A, Walter MS, Giordano FA, Al Zhgloul M, Krämer BK, Nittka S, Schulte DM, Ratliff M, Hänggi D, Seiz-Rosenhagen M. Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor. Exp Clin Endocrinol Diabetes 2018; 128:283-289. [DOI: 10.1055/a-0640-2915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abstract
Objective Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients. Management options are surgery or conservative treatment (e. g., with dexamethasone). Surgery is commonly performed in case of severe acute neurological and visual symptoms. However, prospective studies demonstrating a benefit of surgery over conservative treatment in terms of visual, neurological and even endocrine outcomes are lacking. Decision making is still controversial, and recommendations for surgery are based on low evidence grades and focus on visual impairment. Endocrine function and especially markers identifying patients with potential for pituitary recovery after surgery are not well described in the literature.
Patients and Design We analysed data from 24 patients (m:f/16:8) with a median age of 64 yrs (38 to 83yrs) that underwent surgery for pituitary apoplexy regardless of time from symptom onset. Apoplexies were necrotic in 14 cases and haemorrhagic in 10 cases.
Results Preoperatively, 7 patients (29.2%) showed complete anterior pituitary insufficiency, 16 patients (66.6%) had partial anterior pituitary insufficiency and one patient (4.17%) had normal pituitary functions. Persistent panhypopituitarism was found in 7 patients (29.2%), whereas an overall improvement of pituitary function was noted in 13 (57.1%) patients. Preoperative prolactin (PRL) levels were significantly associated with recovery of endocrine functions, whereas specifically all patients with preoperative PRL levels of at least 8.8 ng/ml recovered partially or fully. Time to surgery (0–7 days vs. 1–4 weeks vs.>4 weeks) was not significantly associated with outcome.
Conclusions Our data emphasize that normal and high preoperative PRL levels are associated with better endocrine outcome after surgery. We conclude that patients benefit from surgical intervention even after delayed diagnosis with the serum PRL levels is being a valid biomarker for clinical decision making.
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Affiliation(s)
- Alexander Lammert
- Praxis für Diabetes, Stoffwechsel- und Nierenerkrankungen, Grünstadt, Germany
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marc Sebastian Walter
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Anton Giordano
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mansour Al Zhgloul
- Department of Neuroradiology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, Mannheim, Germany
| | - Bernhard Karl Krämer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Nittka
- Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Michael Schulte
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Miriam Ratliff
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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17
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Mattern J, Lammert A, Otto M, Hammes HP. Retinopathy in an obesity WHO III cohort: prevalence and risk factors. Br J Ophthalmol 2017; 101:1550-1554. [DOI: 10.1136/bjophthalmol-2016-309566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/31/2017] [Accepted: 02/20/2017] [Indexed: 11/03/2022]
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18
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Albrecht T, Zhang S, Braun JD, Xia L, Rodriquez A, Qiu J, Peters V, Schmitt CP, van den Born J, Bakker SJL, Lammert A, Köppel H, Schnuelle P, Krämer BK, Yard BA, Hauske SJ. The CNDP1 (CTG) 5 Polymorphism Is Associated with Biopsy-Proven Diabetic Nephropathy, Time on Hemodialysis, and Diabetes Duration. J Diabetes Res 2017; 2017:9506730. [PMID: 28553654 PMCID: PMC5434468 DOI: 10.1155/2017/9506730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/18/2022] Open
Abstract
Considering that the homozygous CNDP1 (CTG)5 genotype affords protection against diabetic nephropathy (DN) in female patients with type 2 diabetes, this study assessed if this association remains gender-specific when applying clinical inclusion criteria (CIC-DN) or biopsy proof (BP-DN). Additionally, it assessed if the prevalence of the protective genotype changes with diabetes duration and time on hemodialysis and if this occurs in association with serum carnosinase (CN-1) activity. Whereas the distribution of the (CTG)5 homozygous genotype in the no-DN and CIC-DN patients was comparable, a lower frequency was found in the BP-DN patients, particularly in females. We observed a significant trend towards high frequencies of the (CTG)5 homozygous genotype with increased time on dialysis. This was also observed for diabetes duration but only reached significance when both (CTG)5 homo- and heterozygous patients were included. CN-1 activity negatively correlated with time on hemodialysis and was lower in (CTG)5 homozygous patients. The latter remained significant in female subjects after gender stratification. We confirm the association between the CNDP1 genotype and DN to be likely gender-specific. Although our data also suggest that (CTG)5 homozygous patients may have a survival advantage on dialysis and in diabetes, this hypothesis needs to be confirmed in a prospective cohort study.
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Affiliation(s)
- Thomas Albrecht
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- *Thomas Albrecht:
| | - Shiqi Zhang
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jana D. Braun
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Li Xia
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Angelica Rodriquez
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jiedong Qiu
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Verena Peters
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Claus P. Schmitt
- Centre for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Jacob van den Born
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexander Lammert
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hannes Köppel
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Schnuelle
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard K. Krämer
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benito A. Yard
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sibylle J. Hauske
- Fifth Medical Department (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Budjan J, Benck U, Lammert A, Ong MM, Mircheva M, Diehl S, Konstandin S, Schad LR, Krämer BK, Schoenberg SO, Haneder S. Renal Denervation in Patients with Resistant Hypertension-Assessment by 3T Renal 23Na-MRI: Preliminary Results. In Vivo 2016; 30:657-662. [PMID: 27566087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Renal denervation (RDN) has been considered a promising therapy option for patients suffering from therapy-resistant hypertension. Besides, in blood-pressure regularization, the kidneys play a fundamental role in sodium ((23)Na) homeostasis. This study assesses the effect of RDN on renal (23)Na concentration using (23)Na magnetic resonance imaging (MRI). PATIENTS AND METHODS Two patients with therapy-resistant hypertension underwent RDN. (23)Na-MRI, (1)H-MRI, including diffusion weighted imaging (DWI), as well as endothelial dysfunction assessment, were performed 1 day prior, as well as 1, 30 and 90 days after RDN. RESULTS The renal corticomedullary (23)Na gradient did not change after RDN for all time points. Additionally, functional imaging and retinal vessel parameters were not influenced by RDN. Results regarding blood pressure changes and arterial stiffness, as well as patients' clinical outcome, were heterogeneous. CONCLUSION RDN does not seem to alter renal (23)Na concentration gradients, as measured by MRI.
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Affiliation(s)
- Johannes Budjan
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Urs Benck
- Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Lammert
- Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Melissa M Ong
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Miryana Mircheva
- Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen Diehl
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Simon Konstandin
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Mannheim, Germany MR-Imaging and Spectroscopy, Faculty 01 (Physics/Electrical Engineering), University of Bremen, Bremen, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Bernhard K Krämer
- Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Haneder
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Mundt HM, Matenaer M, Lammert A, Göttmann U, Krämer BK, Birck R, Benck U. Minoxidil for Treatment of Resistant Hypertension in Chronic Kidney Disease--A Retrospective Cohort Analysis. J Clin Hypertens (Greenwich) 2016; 18:1162-1167. [PMID: 27246772 DOI: 10.1111/jch.12847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/07/2016] [Accepted: 03/13/2016] [Indexed: 11/29/2022]
Abstract
Resistant hypertension is still a challenge and reserve antihypertensive agents are often necessary to achieve blood pressure control. One reserve antihypertensive is minoxidil, a direct vasodilator that is known for its strong blood pressure-lowering effect, but contemporary studies are sparse. The authors retrospectively analyzed 54 inpatients with uncontrolled hypertension despite the combined use of current antihypertensive agents. To investigate the effect of minoxidil when added to other antihypertensive agents, blood pressure was evaluated at the time minoxidil treatment was initiated and at discharge. Minoxidil treatment was associated with a significant reduction in blood pressure from 162.4±15.1/83.2±12.7 mm Hg to 135.8±12.2/72.8±6.9 mm Hg (P<.0001). This effect was sustained across all analyzed subgroups. Although the well-known adverse events of minoxidil limit its widespread use, these data show that minoxidil as a reserve antihypertensive agent still has a niche indication in the particular subgroup of patients with treatment-resistant or uncontrolled hypertension.
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Affiliation(s)
- Heiko M Mundt
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Matthias Matenaer
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alexander Lammert
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Uwe Göttmann
- Department for Nephrology, Hypertension and Dialyses, Hôpital Kirchberg, Luxembourg-Kirchberg, Luxembourg
| | - Bernhard K Krämer
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rainer Birck
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Urs Benck
- 5th Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Trost E, Otto M, Hasenberg T, Lammert A, Hammes HP. Beeinflusst die Art der Gewichtszunahme die Entstehung des metabolischen Syndroms bei Adipositas WHO Grad 3? DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lammert A, Nittka S, Otto M, Schneider-Lindner V, Kemmer A, Krämer BK, Birck R, Hammes HP, Benck U. Performance of the 1 mg dexamethasone suppression test in patients with severe obesity. Obesity (Silver Spring) 2016; 24:850-5. [PMID: 26948683 DOI: 10.1002/oby.21442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/01/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze the performance of the 1 mg dexamethasone suppression test (DST) in patients with obesity. Special attention was paid to the influence of interfering medication on DST. METHODS In this prospective cohort study (Mannheim Obesity Study), patients with obesity were evaluated before bariatric surgery. For evaluation of hypercortisolism, a 1 mg dexamethasone-suppression test (DST) in all subjects was performed. Medication was assessed for possible interference. RESULTS Two hundred seventy-eight patients with a mean age of 42.3 years (68.8% women) and a mean BMI of 47.9 ± 8.4 kg/m(2) were screened. Insufficient suppression of cortisol after DST was found in 24 patients (8.6%). In two patients hypercortisolism was confirmed. The specificity for DST was calculated at 92.0%. Only CYP3A4 inducers (n = 22, 7.9%) and estrogen therapy (n = 17, 6.1%) were significantly associated with falsely elevated cortisol after DST. Regression analysis excluded any interrelation between DST and anthropometry. CONCLUSIONS Low prevalence of hypercortisolism (0.7 or <1.8%) was found. Specificity of DST in this cohort typically screened for hypercortisolism was 92.0% (≤ 50 nmol/L). DST should be avoided in patients taking CYP3A4 inducers or estrogen therapy, due to their significant interaction. In summary, the 1 mg DST is an adequate test for screening for hypercortisolism even in patients with extreme obesity.
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Affiliation(s)
- Alexander Lammert
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Nittka
- Institute for Clinical Chemistry, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Verena Schneider-Lindner
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anne Kemmer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard K Krämer
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rainer Birck
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hans-Peter Hammes
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Urs Benck
- 5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Frohner R, Kosilek RP, Reinholz C, Hackenberg G, Gogas D, Lammert A, Reincke M, Schopohl J, Wuertz RP, Grieben R, Nilkens A, Stalla GK, Jung-Sievers C, Schneider H. Using face classification for detecting acromegaly in a web-based environment. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schöfl C, Honegger J, Droste M, Grussendorf M, Finke R, Plöckinger U, Berg C, Willenberg HS, Lammert A, Klingmüller D, Jaursch-Hancke C, Tönjes A, Schneidewind S, Flitsch J, Bullmann C, Dimopoulou C, Stalla G, Mayr B, Hoeppner W, Schopohl J. Frequency of AIP gene mutations in young patients with acromegaly: a registry-based study. J Clin Endocrinol Metab 2014; 99:E2789-93. [PMID: 25093619 DOI: 10.1210/jc.2014-2094] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CONTEXT Familial and sporadic GH-secreting pituitary adenomas are associated with mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene. Patients with an AIP mutation (AIPmut) tend to have more aggressive tumors occurring at a younger age. OBJECTIVE The objective of the study was to investigate the frequency of AIPmut in patients diagnosed at 30 years of age or younger. DESIGN The German Acromegaly Registry database (1795 patients in 58 centers) was screened for patients diagnosed with acromegaly at 30 years of age or younger (329 patients). Sixteen centers participated and 91 patients consented to AIPmut analysis. INTERVENTION DNA was analyzed by direct sequencing and multiplex ligation dependent probe amplification Main outcome Measures: The number of patients with AIPmut was measured. RESULTS Five patients had either a mutation (c.490C>T, c.844C>T, and c.911G>A, three males) or gross deletions of exons 1 and 2 of the AIP gene (n = 2, one female). The overall frequency of an AIPmut was 5.5%, and 2.3% or 2.4% in patients with an apparently sporadic adenoma or macroadenoma, respectively. By contrast, three of four patients (75%) with a positive family history were tested positive for an AIPmut. Except for a positive family history, there were no significant differences between patients with and without an AIPmut. CONCLUSIONS The frequency of AIPmut in this registry-based cohort of young patients with acromegaly is lower than previously reported. Patients with a positive family history should be tested for an AIPmut, whereas young patients without an apparent family history should be screened, depending on the individual cost to benefit ratio.
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Affiliation(s)
- Christof Schöfl
- Division of Endocrinology and Diabetes (C.S., B.M.), Department of Medicine I, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Department of Neurosurgery (J.H.), Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; Endocrine Practice (M.D.), 26122 Oldenburg, Germany; Center of Endocrinology and Diabetes (M.G.), 70178 Stuttgart, Germany; Endocrine Practice Kaisereiche (R.F.), 12159 Berlin, Germany; Interdisciplinary Center of Metabolism: Endocrinology, Diabetes, and Metabolism (U.P.), Charite-University-Medicine Berlin, 13352 Berlin, Germany; Department of Endocrinology (C.Be.), University Hospital of Essen, 45147 Essen, Germany; Division of Special Endocrinology (H.S.W.), Department of Endocrinology and Diabetes, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany; Fifth Medical Clinic (A.L.), University Medical Center Mannheim, University of Heidelberg, 68167 Heidelberg, Germany; Division of Endocrinology and Diabetes (D.K.), Department of Medicine I, Rheinische Friedrich-Wilhelms-University Bonn, 53127 Bonn, Germany; Department of Endocrinology (C.J.-H.), German Clinic of Diagnostics, Wiesbaden, 65191 Wiesbaden, Germany; Medical Department III (A.T.), University of Leipzig, 04103 Leipzig, Germany; Department of Gastroenterology, Hepatology, and Endocrinology (S.S.), Hannover Medical School, 30625 Hannover, Germany; Pituitary Surgery/Interdisciplinary Endocrinology (J.F.), UKE Hamburg, 20246 Hamburg, Germany; Endocrine Practice (C.Bu.), 20095 Hamburg, Germany; Max Planck Institute of Psychiatry (C.D., G.S.), 80804 Munich, Germany; Bioglobe GmbH (W.H.), 22529 Hamburg, Germany; and Medizinische Klinik IV (J.S.), Ludwig-Maximilians-University 80336 Munich, Germany
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Rheinberger M, Hörmann B, Lammert A, Dumann K, Gorski M, Heid IM, Krämer BK, Böger CA. Chronic Kidney Disease (CKD) and obesity in Diabetes Mellitus type 2 (DM 2): baseline characteristics of the Diabetes Cohorte Study (DIACORE). DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vanikar AV, Trivedi HL, Dave SD, Kute VB, Rawal MN, Patel HV, Gumber MR, Afghahi H, Pirouzifard M, Svensson AM, Eliasson B, Svensson MK, Dumann K, Horrmann B, Lammert A, Rheinberger M, Gorski M, Kramer BK, Heid IM, Boger CA, Demirtas L, Akbas EM, Timuroglu A, Ozcicek F, Turkmen K, Fernandez-Fernandez B, Sanchez-Nino MD, Martin-Cleary C, Izquierdo MC, Elewa U, Ortiz A, Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Gluhovschi C, Velciov S, Bob F, Vlad D, Popescu R, Petrica M, Jianu DC, Milas O, Izvernari O, Ursoniu S, Makino Y, Konoshita T, Nyumura I, Babazono T, Yoshida N, Uchigata Y, Handisurya A, Kerscher C, Tura A, Werzowa J, Heinzl H, Ristl R, Kautzky-Willer A, Pacini G, Saemann M, Schmidt A, Halbesma N, Metcalfe W, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Idorn T, Knop FK, Jorgensen MB, Christensen M, Holst JJ, Hornum M, Feldt-Rasmussen B, Naess H, Hartmann A, Jenssen TG, Holdaas H, Horneland R, Grzyb K, Bitter J, Midtvedt K, Yoshida N, Babazono T, Uchigata Y, Timar R, Gluhovschi G, Gadalean F, Velciov S, Petrica L, Timar B, Gluhovschi C, Soro-Paavonen A, Fleming T, Forsblom C, Gordin D, Tolonen N, Harjutsalo V, Nawroth PP, Groop PH, Tsuda A, Ishimura E, Uedono H, Yasumoto M, Nakatani S, Ichii M, Ohno Y, Ochi A, Mori K, Fukumoto S, Emoto M, Inaba M, Rheinberger M, Hormann B, Lammert A, Dumann K, Gorski M, Heid IM, Kramer BK, Boger CA, Siddaramaiah NH, Tez DK, Linker NJ, Bilous M, Winship S, Marshall SM, Bilous RW, Lampropoulou IT, Papagianni A, Stangou M, Didangelos T, Iliadis F, Efstratiadis G, Esposito P, Debarbieri G, Mereu R, Ditoro A, Montagna F, Groop PH, Bernardi L, Dal Canton A, Garland JS, Holden R, Morton R, Ross R, Adams M, Pruss C, Akbas EM, Demirtas L, Timuroglu A, Ozcicek F, Turkmen K, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Theodoridis M, Panagoutsos S, Bounta T, Roumeliotis S, Kantartzi K, Pouloutidis G, Passadakis P, Polaina Rusillo M, Borrego Utiel FJ, Ortega Anguiano S, Liebana Canada A, Gaber EW, Abdel Rehim WM, Ibrahim NA, Mahmoud BF, Silva AP, Fragoso A, Tavares N, Silva C, Santos N, Camacho A, Neves P, Rodriguez R, Porrini E, Gonzalez-Rinne A, De Vries A, Torres A, Salido E, Kato S, Makino H, Uzu T, Koya D, Nishiyama A, Imai E, Ando M, Jorgensen MB, Knop FK, Idorn T, Holst JJ, Hornum M, Feldt-Rasmussen B, Vaduva C, Popa S, Mitrea A, Mota M, Mota E, Theodoridis M, Panagoutsos S, Roumeliotis S, Bounta T, Kriki P, Roumeliotis A, Passadakis P, Ogawa T, Okazaki S, Hatano M, Hara H, Inamura M, Kiba T, Iwashita T, Shimizu T, Tayama Y, Kanozawa K, Kato H, Matsuda A, Hasegawa H, Elewa U, Fernandez B, Egido J, Ortiz A, Rottembourg J, Guerin A, Diaconita M, Dansaert A, Chakraborty J, Prabhu R, Nagaraju SP, Bairy M, Satyamoorthy K, Kosuru S, Parthasarathy R, Tomilina N, Zhilinskaya T, Stolyarevich E, Silva AP, Fragoso A, Guilherme P, Silva C, Santos N, Rato F, Camacho A, Neves P, Pasko N, Strakosha A, Toti F, Dedej T, Marku N, Petrela E, Zekollari E, Kacorri V, Thereska N, Roumeliotis SK, Roumeliotis AK, Theodoridis M, Tavridou A, Panagoutsos S, Passadakis P, Vargemezis V, Kim IY, Lee SB, Lee DW, Kim MJ, Shin MJ, Rhee H, Yang BY, Song SH, Seong EY, Kwak IS, Celebi K, Sengul E, Cekmen MB, Yilmaz A, Sonikian M, Dona A, Skarakis J, Miha T, Trompouki S, Karaitianou A, Spiliopoulou C, Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Kanellos IE, Fotiadis SD, Didaggelos TP, Savopoulos CG, Hatzitolios AI, Grekas DM, Hsu YH, Huang MC, Chang HY, Shin SJ, Wahlqvist ML, Chang YL, Hsu KC, Hsu CC, Miarka P, Grabowska-Polanowska B, Faber J, Skowron M, Pietrzycka A, Walus-Miarka M, Sliwka I, Sulowicz W. DIABETES CLINICAL. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lammert A, Schneider H, Bergmann T, Benck U, Krämer B, Gärtner R, Metzner C, Schöfl C, Berking C. Hypophysitis Caused by Ipilimumab in Cancer Patients: Hormone Replacement or Immunosuppressive Therapy. Exp Clin Endocrinol Diabetes 2013; 121:581-7. [DOI: 10.1055/s-0033-1355337] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Lammert
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - H. Schneider
- Division of Endocrinology, Department of Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - T. Bergmann
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - U. Benck
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - B. Krämer
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - R. Gärtner
- Division of Endocrinology, Department of Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - C. Metzner
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - C. Schöfl
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C. Berking
- Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany
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Bachmayer C, Kemmer A, Ehrmann N, Hasenberg T, Lammert A, Hammes HP. Adipokines and endothelial dysfunction in obesity WHO°III. Microvasc Res 2013; 89:129-33. [DOI: 10.1016/j.mvr.2013.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/12/2013] [Accepted: 04/28/2013] [Indexed: 12/26/2022]
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Kosilek RP, Schopohl J, Grunke M, Reincke M, Dimopoulou C, Stalla GK, Würtz RP, Lammert A, Günther M, Schneider HJ. Automatic face classification of Cushing's syndrome in women - a novel screening approach. Exp Clin Endocrinol Diabetes 2013; 121:561-4. [PMID: 23864496 DOI: 10.1055/s-0033-1349124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cushing's syndrome causes considerable harm to the body if left untreated, yet often remains undiagnosed for prolonged periods of time. In this study we aimed to test whether face classification software might help in discriminating patients with Cushing's syndrome from healthy controls. DESIGN Diagnostic study. PATIENTS Using a regular digital camera, we took frontal and profile pictures of 20 female patients with Cushing's syndrome and 40 sex- and age-matched controls. MEASUREMENTS Semi-automatic analysis of the pictures was performed by comparing texture and geometry within a grid of nodes placed on the pictures. The leave-one-out cross-validation method was employed to classify subjects by the software. RESULTS The software correctly classified 85.0% of patients and 95.0% of controls, resulting in a total classification accuracy of 91.7%. CONCLUSIONS In this preliminary analysis we found a good classification accuracy of Cushing's syndrome by face classification software. Testing accuracy is comparable to that of currently employed screening tests.
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Affiliation(s)
- R P Kosilek
- Med. Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany
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Abstract
OBJECTIVE Obesity and the metabolic syndrome (MetS) are associated with endothelial dysfunction (ED). An established method to determine ED is retinal vessel analysis. Obesity is associated with MetS, but obese patients not matching all criteria of the MetS and therefore defined as metabolically healthy obese subjects (MHOS) exist. Bariatric surgery may be an appropriate option to treat morbid obesity. The aim of this study was to compare MetS, MHOS and post bariatric patients in adipocytokine -patterns and ED. METHODS Arterio-venous ratio (AVR) and vessel diameters from retinal photographs (IMEDOS™), parameters of MetS (IDF) and obesity-associated factors (hsCRP, TNF, Il-6, MCP-1, sICAM, sVCAM, IGF-BP3, RBP 4 and adiponectin) were assessed in 51 obese patients with MetS, 20 obese patients without MetS and 21 patients pre and post bariatric surgery. RESULTS Bariatric surgery improved ED as reflected by AVR and venous diameters (p<0.05 for both). These improvements were associated with lower levels of fasting plasma glucose, insulin, HOMA-IR, LDL-C, triglycerides, cholesterol, hsCRP, sICAM, and higher levels of adiponectin and RBP4 (p<0.05 for each parameter). MHOS differed from MetS by neck circumference, fasting plasma glucose, HOMA-IR, triglycerides, HDL-C, sICAM, and adiponectin (p<0.05), but not by RRs, RRd, insulin, LDL-C, hsCRP, Il-6, TNF, MCP-1, sVCAM, RBP-4, IGF-BP3, and retinal ED. CONCLUSION These data indicate that improved insulin-sensitivity and reduced inflammatory mediators characterize the metabolic outcome of postbariatric patients in comparison to MHOS. Thus, MHOS characterizes an intermediate state between MetS and postbariatric patients.
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Affiliation(s)
- C Bachmayer
- 5th Medical Department, Universitätsmedizin Mannheim, University of Heidelberg, Germany
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Elewa U, Fernandez B, Egido J, Ortiz A, Kaifu K, Tahara N, Ueda S, Yamagishi SI, Takeuchi M, Okuda S, Buraczynska M, Zukowski P, Wacinski P, Ksiazek A, Wu HY, Peng YS, Hung KY, Wu KD, Tu YK, Chien KL, Papale M, Vocino G, Di Paolo S, Pontrelli P, Conserva F, Rocchetti MT, Grandaliano G, De Cosmo S, Gesualdo L, Prkacin I, Duvnjak L, Bulum T, Prkacin I, Duvnjak L, Bulum T, Dumann K, Horrmann B, Lammert A, Gorski M, Kramer B, Heid I, Boger C, Aggarwal HK, Jain D, Talapatra P, Lenghel AR, Moldovan D, Rusu CC, Rusu A, Rahaian R, Bondor CI, Kacso IM, Unal A, Kocyigit I, Yilmaz S, Eser B, Elmali F, Sipahioglu M, Tokgoz B, Oymak O, Velioglu A, Guler D, Arikan H, Koc M, Tuglular S, Ozener C, Pallayova M, Rayner HC, Taheri S, Dasgupta I, Fernandes FB, Fernandes AB, Febba ACDS, Vitalle MSDS, Jung F, Casarini DE, Liu F, Huang M, Fu P, Bulatovic A, Popovic J, Ille K, Jelic S, Beljic Zivkovic T, Dimkovic N, Kohli HS, Ramachandran R, Kumar S, Jha V, Sakhuja V, Hamamoto K, Inaba M, Yamada S, Yoda K, Imanishi Y, Emoto M, Okuno S, Shoji S, Silva A, Fragoso A, Pinho A, Silva C, Santos N, Faisca M, Neves PL, Capolongo G, Restivo A, Pluvio M, Capasso G, Bello BT, Mabayoje OM, Amira OC, Theodoridis M, Panagoutsos S, Roumeliotis A, Kantartzi K, Tsigalou C, Passadakis P, Vargemezis V, Deeb A, Zaoui P, Le Penven S, Tartry D, Ducher M, Fauvel JP, Angioi A, Asunis AM, Cao R, Atzeni A, Conti M, Floris M, Melis P, Pili G, Piras D, Piredda G, Pani A, Murata M, Ishikawa SE, Aoki A, Unal A, Kocyigit I, Cerci I, Dogan E, Arikan T, Sipahioglu M, Tokgoz B, Oymak O, Madziarska K, Letachowicz K, Golebiowski T, Zmonarski SC, Krajewska M, Letachowicz W, Penar J, Kusztal M, Augustyniak-Bartosik H, Klak R, Weyde W, Klinger M. Diabetes - clinical studies. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haneder S, Michaely HJ, Konstandin S, Schad LR, Morelli JN, Krämer BK, Schoenberg SO, Lammert A. 3T Renal 23Na-MRI: effects of desmopressin in patients with central diabetes insipidus. Magn Reson Mater Phy 2013; 27:47-52. [DOI: 10.1007/s10334-013-0377-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/01/2022]
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Bachmayer C, Hammes HP, Hasenberg T, Lammert A, Crowther D, Hess S. Multiplexed protein profiling after bariatric surgery: characterization of improved endothelial dysfunction. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schlaffer S, Buchfelder M, Droste M, Elbelt U, Bojunga J, Flitsch J, Honegger J, Kolenda H, Lammert A, Buslei R, Saeger W, Petersenn S. Treatment with temozolomide in aggressive pituitary tumors - data from a survey by the German Pituitary Study Group. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Frohner R, Kosilek RP, Gogas D, Lammert A, Würtz RP, Schneider HJ. Optimizing strategies for face classification in the detection of acromegaly. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dörhöfer L, Lammert A, Krane V, Gorski M, Banas B, Wanner C, Krämer BK, Heid IM, Böger CA. Study design of DIACORE (DIAbetes COhoRtE) - a cohort study of patients with diabetes mellitus type 2. BMC Med Genet 2013; 14:25. [PMID: 23409726 PMCID: PMC3577512 DOI: 10.1186/1471-2350-14-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 01/25/2013] [Indexed: 01/13/2023]
Abstract
Background Diabetes mellitus type 2 (DM2) is highly associated with increased risk for chronic kidney disease (CKD), end stage renal disease (ESRD) and cardiovascular morbidity. Epidemiological and genetic studies generate hypotheses for innovative strategies in DM2 management by unravelling novel mechanisms of diabetes complications, which is essential for future intervention trials. We have thus initiated the DIAbetes COhoRtE study (DIACORE). Methods DIACORE is a prospective cohort study aiming to recruit 6000 patients of self-reported Caucasian ethnicity with prevalent DM2 for at least 10 years of follow-up. Study visits are performed in University-based recruiting clinics in Germany using standard operating procedures. All prevalent DM2 patients in outpatient clinics surrounding the recruiting centers are invited to participate. At baseline and at each 2-year follow-up examination, patients are subjected to a core phenotyping protocol. This includes a standardized online questionnaire and physical examination to determine incident micro- and macrovascular DM2 complications, malignancy and hospitalization, with a primary focus on renal events. Confirmatory outcome information is requested from patient records. Blood samples are obtained for a centrally analyzed standard laboratory panel and for biobanking of aliquots of serum, plasma, urine, mRNA and DNA for future scientific use. A subset of the cohort is subjected to extended phenotyping, e.g. sleep apnea screening, skin autofluorescence measurement, non-mydriatic retinal photography and non-invasive determination of arterial stiffness. Discussion DIACORE will enable the prospective evaluation of factors involved in DM2 complication pathogenesis using high-throughput technologies in biosamples and genetic epidemiological studies.
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Affiliation(s)
- Lena Dörhöfer
- Department of Internal Medicine II, Nephrology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Germany
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Lammert A, Bode H, Hammes HP, Birck R, Fatar M, Zohsel K, Schmieder K, Schubert GA, Thomé C, Seiz M. Aneurysmal subarachnoid hemorrhage (aSAH) results in low prevalence of neuro-endocrine dysfunction and NOT deficiency. Pituitary 2012; 15:505-12. [PMID: 22038031 DOI: 10.1007/s11102-011-0357-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neuro-endocrine deficiencies have been argued to be common sequelae after aneurysmal subarachnoid hemorrhage (aSAH). As this, however, does not resemble our clinical experience, we studied the incidence of neuro-endocrine and neuropsychological deficits after aSAH. Twenty-six patients (20 females) were prospectively screened for neuro-endocrine and neuropsychological deficits 3, 6 and 12 months after aSAH. GH, IGF-1, prolactin, LH, FSH, estradiol, testosterone, ACTH as well as cortisol during ACTH-stimulation were assessed. Neuropsychological analysis covered verbal comprehension, short term and working memory, visuospatial construction, figural memory, psychomotor speed, attention, and concentration. During the study period 5 individuals demonstrated neuro-endocrine dysfunction. Hypogonadotrophic hypogonadism resolved spontaneously in 2 patients and central hypothyroidism in one of these patients during the study. After 12 months three patients presented low IGF-1 levels. 73.9% of our cohort was affected by neuropsychological deficits during follow-up. At 3, 6 and 12 months the prevalences were 56.5, 52.6 and 42.1%, respectively. Interestingly, all patients with neuro-endocrine dysfunction presented impaired clinical outcome with a GOS 4 at some time point of the study (GOS 4 vs. 5, 45.5% vs. 0, P = 0.007). We found a low prevalence of neuro-endocrine and a high prevalence of neuropsychological deficits in patients 3, 6 and 12 months after aSAH without significant interrelation. Spontaneous recovery of neuro-endocrine alterations most likely presents an adaption to or dysfunction after severe illness. This hypothesis is strengthened by the fact that only patients with inferior clinical outcome after aSAH as assessed by GOS demonstrated neuro-endocrine dysfunction.
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Affiliation(s)
- Alexander Lammert
- Fifth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
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Abstract
Obesity causes increased morbidity and mortality from metabolic and cardiovascular disease (CVD). We investigated the effect of bariatric surgery on endothelial dysfunction (ED) in retinal vessels as a marker of metabolic and cardiovascular risk in patients with obesity WHO III.Thirty consecutive patients (19/11, w/m) were evaluated by anthropometry, lipid profile, and oral glucose tolerance test before and after bariatric surgery (Mannheim Obesity Study (MOS); NCT 00770276). Risk stratification was performed by the presence of metabolic syndrome (MetS) according to ATP-III (adult treatment panel-III). Subclinical atherosclerosis was assessed by measurement of intima-media thickness (IMT). Flicker light response of retinal vessels was used as measures of ED. We measured their arteriole-to-venule ratio (AVR) for evaluation of vascular pathology. After a median of 9 months following bariatric surgery, mean weight loss was 39.4 kg (37.3%). Remission of impaired glucose metabolism was achieved in 53.3% of affected patients. Dyslipidemia improved significantly (triglycerides -61.3 mg/dl, P < 0.0001, total cholesterol -28.2 mg/dl, P = 0.002, and low-density lipoprotein cholesterol were reduced -24.5 mg/dl, P = 0.008). This resulted in a significant reduction of patients classified for MetS (27 vs. 9, P < 0.0001). Adiponectin increased by 2.08 µg/l (P = 0.032) and high sensitivity C-reactive protein (hs-CRP) and soluble intercellular cell adhesion molecule (sICAM) decreased (-7.3 mg/l, P < 0.0001 and -146.4 ng/ml, P = 0.0006). AVR improved significantly (+0.04, P < 0.0001), but neither Flicker light response nor IMT changed significantly. Retinal AVR is ameliorated after bariatric intervention. As an increased AVR results from either or both widening retinal arteriolar caliber and narrowing retinal venular caliber, an improvement in small vessel profile is evident 9 months after bariatric surgery.
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Affiliation(s)
- Alexander Lammert
- Fifth Medical Clinic, Universitätsmedizin Mannheim, Mannheim, Germany.
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Lammert A, Hasenberg T, Imhof I, Schnülle P, Benck U, Krämer BK, Hammes HP. High prevalence of retinal endothelial dysfunction in obesity WHO class III. Microvasc Res 2012; 84:362-6. [PMID: 23009954 DOI: 10.1016/j.mvr.2012.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/25/2012] [Accepted: 09/14/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The extent of retinal endothelial dysfunction (ED) in patients with obesity is unknown. We evaluated markers of endothelial dysfunction to assess cardiovascular risk in patients with obesity WHO III° and their interrelation with classical cardiovascular risk factors. METHODS 120 patients (mean age 42.7±10.6 years, 87 women) were prospectively evaluated for metabolic and cardiovascular risk using anthropometry, cardiovascular risk factors, lipid and glucose profiles. Intima media thickness (IMT) as marker of subclinical atherosclerosis, ED of retinal vessels, and the arteriole-to-venule ratio (AVR) of retinal vessels were assessed. RESULTS The mean BMI in our cohort was 48.7 kg/m(2). We diagnosed an overall prevalence of impaired glucose metabolism of 69.2%. 71.6% and 65.2% presented with arterial hypertension or dyslipidemia, respectively. Prevalences of retinal ED, pathologically reduced AVR, and enlarged IMT were 62.7%, 56.6% and 30%, respectively. Markers of endothelial function demonstrated correlation of neck to height ratio with dilatation of arteries (r=-0.333, p=0.01) and HDL cholesterol with dilatation of veins (r=-0.393, p=0.002). AVR was significantly related to neck circumference (r=-0.269, p=0.004). CONCLUSION Retinal ED, AVR, and IMT as direct noninvasive surrogate measures of cardiovascular risk showed a high prevalence in patients with obesity WHO III°. We found no association of classical parameters for metabolic or cardiovascular risk with markers of endothelial dysfunction. Therefore, we have to hypothesize that other factors also play a pivotal role in the development of vascular pathology in patients with obesity.
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Affiliation(s)
- Alexander Lammert
- Fifth Medical Clinic, Universitätsmedizin Mannheim, University of Heidelberg, Germany.
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Sauerhöfer SJ, Lammert A, Köppel H, Hammes HP, Krämer BK. Mixed messages on systemic therapies for diabetic retinopathy. Lancet 2010; 376:1461; author reply 1462. [PMID: 21036264 DOI: 10.1016/s0140-6736(10)61985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lammert A, Bode H, Hammes HP, Birck R, Fatar M, Zohsel K, Braun J, Schmieder K, Diepers M, Schubert GA, Barth M, Thomé C, Seiz M. Neuro-Endocrine and Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage (asah): A Prospective Cohort Study. Exp Clin Endocrinol Diabetes 2010; 119:111-6. [DOI: 10.1055/s-0030-1262815] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bode H, Seiz M, Lammert A, Brockmann MA, Back W, Hammes HP, Thomé C. SOM230 (pasireotide) and temozolomide achieve sustained control of tumour progression and ACTH secretion in pituitary carcinoma with widespread metastases. Exp Clin Endocrinol Diabetes 2010; 118:760-3. [PMID: 20496311 DOI: 10.1055/s-0030-1253419] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pituitary carcinomas are rare and neurosurgically challenging lesions, as they commonly relapse after surgical removal. Their prognosis is dismal due to their limited response to radiotherapy and chemotherapy. In recent studies, temozolomide was administered in very few patients with partial effects. We report a patient with an ACTH-secreting pituitary carcinoma and widespread intracranial, spinal and systemic metastases despite repeated surgical treatment, bilateral adrenalectomy, medical treatment and radiotherapy. Additionally to chemotherapy with temozolomide, the patient received SOM230 as salvage therapy with an improvement of the patient's clinical status, and a reduction of ACTH levels. After 12 months of combination therapy a sustained tumor control was achieved and persisted upon monotherapy with SOM230 for more than 9 months thereafter. Thus, temozolomide in combination with SOM230 seems to be promising in patients with ACTH-secreting metastasized pituitary carcinoma.
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Affiliation(s)
- H Bode
- Medical Faculty Mannheim, V Medizinische Klinik, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer, Mannheim, Germany
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Lammert A, Kräupner C, Hasenberg T, Schnülle P, Shang E, Hammes HP. Verbesserung der endothelialen Dysfunktion (ED) nach bariatrischer Therapie: Analyse der Mannheim Obesity Studie (MOS). DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lammert A, Wiegand K, Mauldin A, Kratzsch J, Kusterer K, Segiet T, Hammes HP. Präliminäre Daten der OMA-IR-Studie: Effektivität von Kohlenhydrattagen in der Therapie der Insulinresistenz. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lammert A, Kratzsch J, Selhorst J, Humpert P, Bierhaus A, Birck R, Kusterer K, Hammes HP. Clinical Benefit of a Short Term Dietary Oatmeal Intervention in Patients with Type 2 Diabetes and Severe Insulin Resistance: A Pilot Study. Exp Clin Endocrinol Diabetes 2007; 116:132-4. [DOI: 10.1055/s-2007-984456] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Selhorst J, Leweling H, Lammert A, Hammes HP. Evaluation des vaskulären Risikos bei Präadipositas und Adipositas WHO Grad I-III. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mistele I, Lammert A, Selhorst J, Voigt B, Hammes HP, Backhaus J. Einsatz von Multikanal-Nahinfrarot-Spektroskopie und multivariater statistischer Auswertemethoden in der nicht-invasiven Glucosediagnostik. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maier S, Schnülle P, Shang E, Lammert A, Selhorst J, Jonas J, Kratzsch J, Hammes HP. Adipositas WHO Grad III und endotheliale Dysfunktion: Untersuchungen an der Retina. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Long JH, Koob TJ, Irving K, Combie K, Engel V, Livingston N, Lammert A, Schumacher J. Biomimetic evolutionary analysis: testing the adaptive value of vertebrate tail stiffness in autonomous swimming robots. J Exp Biol 2006; 209:4732-46. [PMID: 17114406 DOI: 10.1242/jeb.02559] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SUMMARY
For early vertebrates, a long-standing hypothesis is that vertebrae evolved as a locomotor adaptation, stiffening the body axis and enhancing swimming performance. While supported by biomechanical data, this hypothesis has not been tested using an evolutionary approach. We did so by extending biomimetic evolutionary analysis (BEA), which builds physical simulations of extinct systems, to include use of autonomous robots as proxies of early vertebrates competing in a forage navigation task. Modeled after free-swimming larvae of sea squirts (Chordata, Urochordata), three robotic tadpoles (`Tadros'), each with a propulsive tail bearing a biomimetic notochord of variable spring stiffness, k (N m-1), searched for, oriented to, and orbited in two dimensions around a light source. Within each of ten generations, we selected for increased swimming speed, U (m s-1) and decreased time to the light source, t (s),average distance from the source, R (m) and wobble maneuvering, W (rad s-2). In software simulation, we coded two quantitative trait loci (QTL) that determine k: bending modulus, E (Nm-2) and length, L (m). Both QTL were mutated during replication, independently assorted during meiosis and, as haploid gametes, entered into the gene pool in proportion to parental fitness. After random mating created three new diploid genotypes, we fabricated three new offspring tails. In the presence of both selection and chance events(mutation, genetic drift), the phenotypic means of this small population evolved. The classic hypothesis was supported in that k was positively correlated (r2=0.40) with navigational prowess, NP, the dimensionless ratio of U to the product of R, t and W. However, the plausible adaptive scenario, even in this simplified system, is more complex, since the remaining variance in NP was correlated with the residuals of R and U taken with respect to k, suggesting that changes in k alone are insufficient to explain the evolution of NP.
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Affiliation(s)
- J H Long
- Department of Biology, Program in Cognitive Science, and the Interdisciplinary Robotics Research Laboratory, Vassar College, Poughkeepsie, NY 12604, USA.
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Humpert PM, Battista MJ, Lammert A, Reismann P, Djuric Z, Rudofsky G, Zorn M, Morcos M, Hammes HP, Nawroth PP, Bierhaus A. Association of stromal cell-derived factor 1 genotype with diabetic foot syndrome and macrovascular disease in patients with type 2 diabetes. Clin Chem 2006; 52:1206-8. [PMID: 16723689 DOI: 10.1373/clinchem.2005.065482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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