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Probiotics are living microorganisms that upon ingestion exert health benefits. The impact of probiotics on gut flora represents a new and interesting therapeutic approach in a number of diseases of the gastrointestinal tract. According to actual publications and guidelines of medical societies, the clinical relevance of probiotics can be described as follows: (a) In the case of ulcerative colitis, available data demonstrate benefits of probiotic therapy. (b) The available data regarding pouchitis are limited, but the therapeutic effect seems to be excellent. (c) In the case of Crohn's disease, the role of probiotics is not clearly defined, thus the results of new trials have to be awaited before probiotic therapy is recommended. (d) Further indications such as antibiotic-associated diarrhea, acute pancreatitis or irritable bowel syndrome have been reported recently. The results of these clinical trials have been encouraging, but they often included only a small number of patients and therefore a clear-cut assessment seems difficult at the moment.
The purpose of this investigation was to evaluate the changes in blood pressure and the pulse rate of hypertensive patients having dental extraction under a local anesthetic containing a vasopressor. The study included 64 patients (42 female and 22 male), 38 to 78 years of age. Twenty-six of the patients were normotensive, 38 were hypertensive patients. The hypertensive patients were identified as those patients who had histories of medically diagnosed high blood pressure and baseline recordings of blood pressures higher than 140/90 mm Hg. Articain HCl with 0.012 mg epinephrine hydrochloride, was used as the local anesthetic for all patients and one tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded immediately prior to anesthesia, just before extraction and 5 minutes after extraction. The data were analyzed by a two-way ANOVA with repeated measures. Analysis of the data indicated no statistically significant changes in the systolic and diastolic blood pressures and pulse rate for all interval measurements in both normotensive and hypertensive patients (P > 0.05). In this study, it was determined that there were no significant changes in the blood pressures and the pulse rate of hypertensive patients during surgical procedure, and one cartridge local anesthetic with articain HCl containing 0.012 mg pinephrine may be used safely in hypertensive patients with blood pressure equal or smaller than 154/99 mm Hg.
Primary malignant schwannoma of the small bowel is an extremely rare disease. Only 24 malignant schwannomas of the small bowel have been reported in the medical English literature. We report a primary malignant schwannoma of the distal ileum in a 53-year-old woman, who was admitted to the hospital because of abdominal pain. CT scan revealed a semisolid mass in the small intestine of the serosa. The tumour measuring 14 x 13 x 8 cm and 100 cm of the distal ileum were resected. We observed a recurrence after seventeen months and the recurrent tumour measured 6 x 2.5 x 1 cm was excised.
Today obesity has already reached epidemic proportions in the industrialised nations and is seen as the main problem of this century. Because of the epidemiological situation and the risk of associated and resultant illnesses it is, in future, particularly important to strengthen the awareness of the problem amongst the general population, among experts in the fields of health and politics, as well as to develop public health strategies for health promotion, to reinforce target group oriented prevention measures in appropriate settings, and offer professional therapies in accordance with evidence-based guidelines. Within the framework of nutritional therapy, the general nutritional recommendations, (<30 En% fat, >55 En% carbohydrates, 10-15 En% protein) combined with a daily energy deficit of 300-1000 kcal are accepted for chronic disease prevention. In order to avoid long-term deficits in intake of macro- and micro-nutrients, a varied diet is recommended. The aim, not only of therapy, but also of prevention is a long-term change in dietary practices, which can only be achieved in combination with exercise and implementation of suitable behavioural methods.
Twenty patients suffering from malignancy received furosemide, twenty patients were examined by FDG-PET without diuretics. Urine volume and radioactivity were measured before and after acquisition. Bladder activity was evaluated qualitatively and quantitatively. Radioactivity in the bladder was lower and the image quality higher in the furosemide group. SUV values showed a median of 3.0 in the furosemide and 6.0 in the control group. With furosemide, a larger excreted volume was seen compared to the control group. The furosemide group showed a significantly higher ratio of excreted/ injected radioactivity early after injection. However, the totally excreted radioactivity was not significantly different (p = 0.93). Diuretics cause a higher urine volume with a diluted FDG concentration leading to an improved image quality. Furosemide accelerates early renal FDG elimination, reducing radiation exposure.
The change of therapeutic concepts in oncology in the last few years is demonstrated in many examples like: influence on cell surface receptors, signal transduction, inactivation of oncogenes, activation of tumor suppressor genes, induction of apoptosis and inhibition of degradation of intracellular peptides. Therapeutic targets have become more specific in the last years using the results of experimental laboratories for clinical application. Unfortunately, however, only very few oncologic ailments can be influenced substantially so far. This may be explained by the hypothesis that the mechanisms of tumor growth can fluctuate--adaptation of tumor cell growth to the Controlling molecular biologic pattern may thus be the concequence. Finally we have to admit that in spite of all our efforts our methodology is still not precise enough (well illustrated by the example of the effectivity of Gefitinib) to reach our therapeutic goal--constant inhibition of tumor growth.
Etiology and clinical manifestation of subclinical hypothyroidism is different in neonates and in young. In the neonatal period babies present with jaundice and/or constipation due to thyroid hypoplasia, thyroid ectopia or transient hypothyroidism. The main reason for subclinical hypothyroidism in the youth is Hashimoto thyroiditis. Indication for thyroxin therapy in subclinical hypothyroidism is discussed controversial in the literature. For best growing and maturation in childhood thyroxin therapy should be given. Subclinical hyperthyroidism is rare in childhood. The main reasons are Graves' disease or Hashimoto thyroiditis (initial period). The therapy of subclinical hyperthyroidism is the same as in overt hyperthyroidism.
Diabetes mellitus is the leading single cause for renal replacement therapy. Its development and progression, however, can be ameliorated by adequate therapy. The present article represents the recommendations of the Austrian Diabetes Association for the prevention and treatment of diabetic nephropathy.
These are the guidelines for diagnosis and treatment of diabetic neuropathy. This diabetic late complication comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy. The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotoric neuropathy, are provided.
The increase in cancer incidence with increasing age is becoming more obvious and more important as the average age of population increases. Currently over 50% of all cancers occur in people who are 65 and older. The clinical behaviour of common malignant diseases may change with age because of intrinsic variation of the neoplastic cells and the ability of the tumor host to support neoplastic growth. Therapeutic decisions should be based on an estimation of patient's life expectancy, functional status, comorbidity, polypharmacy, socioeconomic conditions, nutrition and the presence of geriatric syndromes. This review should give some answers to the many existing questions about cancer in the elderly.
These are the guidelines for preventive care, diagnosis and treatment of diabetic foot syndrome. Diabetic neuropathy, peripheral vascular disease, bone deformity and altered biomechanics are foot-related risk conditions. The position statement is focused on screening methods and recommendations for clinical care for diabetics, who currently have no foot ulcers. A decision pathway is offered with respect to diagnosis and management of diabetic patients at increased risk or who manifest injuries.
In infertile men thyroid hormone and antibody testing was performed and correlated with the results of semen analyses. Evaluation included semen analyses, physical examination, evaluation of sex steroid hormones, thyroid hormones (bTSH, fT4, fT3) and thyroid antibody testing (TGA, TPO-Ab, TRAK). Furthermore 45 men with normal thyroid function were scheduled for TRH testing. No one was diagnosed as having manifest hypo- or hyperthyroidism. Latent thyroid dysfunction had no effect on semen parameters. Elevated TPO-Ab were significantly correlated with reduction in motility of spermatozoa. The routine assessment of thyroid hormones and antibodies in infertile men is not recommended. Subclinical hypothyroidism as a result of TRH testing is a rare finding in infertile men.
Latent subclinical hypothyroidism represents a particular problem in treatment for sterility, and can only be diagnosed after the results of a TRH test have been obtained (delta TSH > 15 microE/ml). Bearing these results in mind and by the administration of thyroid gland hormones or combinations of gonadotropins or clomifen, pregnancy rates in women with anovulatory sterility can be improved.
Since 1928, among the thousands of patients treated for insulinoma, only 32 cases with peripheral neuropathy have been reported. None of these described an affection of the cranial nerves. We present a 56 old woman, who suffered from chronic hyperinsulinism due to an insulinoma. For ten years, the patient has developed progressively marked hypoglycemic attacks of up to 20 mg/dl. Recently we have observed the development of a paresis of the right abducens nerve lasting for 6 weeks.
Acute atherothrombotic complications, as part of the accelerated atherosclerosis, contribute to cardiovascular morbidity and mortality in diabetic patients. Inhibition of platelet aggregation can reduce the risk for acute atherothrombosis. The present article represents the recommendations of the Austrian Diabetes Association for the use of antiplatelet drugs in diabetic patients according to current scientific evidence.
In this article we summarize the available information regarding the epidemiology, the pathophysiology as well as the risk factors and complications of the sleep apnea syndrome (SAS). Central, obstructive and mixed forms of SAS are known, however, the obstructive form is (resulting from the actual high prevalence of obesity) definitely the most frequent. Latest years of experimental and clinical research have pointed towards the clinical importance of this sleep related breathing disorder. High prevalence in the population and especially the cardiovascular complications (e. g. systemic and pulmonary hypertension, atherosclerosis, arrhythmias) have contributed to the recent increase in knowledge about SAS. Nevertheless, there are numerous unsolved problems and unanswered questions in the pathophysiology of SAS. Future studies should, thus, provide us with more information and shed light on regarding the hidden mysteries of SAS.
Risk factors for the development of type 2 diabetes mellitus, including weight gain, lack of physical exercise and increasing age, are associated with an impaired mitochondrial function. Clinical studies could demonstrate a reduced mitochondrial activity in non-diabetic but insulin-resistant offsprings of type 2 diabetics. A key enzyme in the regulation of cellular energy supply and thus also in glucose and lipid metabolism is AMP-activated proteinkinase (AMPK). Pharmacological substances, which stimulate AMPK-activity ameliorate insulin resistance induced by free fatty acids. Various therapeutical interventions for the improvement of insulin sensitivity, including weight loss, physical exercise, as well as metformin and glitazones, increase AMPK activity.