Calciumantagonisten: Antihypertensiva der ersten Wahl

Ein 57-jähriger Bankangestellter stellt sich wegen seit Monaten bestehender Abgeschlagenheit und Müdigkeit vor. Anamnese: seit 3 Jahren dokumentierte Hypercholesterinämie (Gesamtcholesterin 350 mg/dl) und Hypertriglyzeridämie (Triglyzeride 430 mg/dl), zurzeit mit einem Statin behandelt, ferner seit einem 1/2 Jahr symptomatische Gicht (letzter Anfall vor 4 Wochen), jetzt mit 300 mg Allopurinol behandelt, sowie Claudicatio intermittens (Gehstrecke 300 m) bekannt. Seit der Jugend ist zudem ein allergisches Asthma bekannt, das mit inhalativen Steroiden und einem lang wirkenden β-Mimetikum behandelt wird. Die Frage nach Dyspnoe, Thoraxschmerzen oder einer plötzlich auftretenden Hautblässe wird verneint.Körperliche Untersuchung: Gewicht 89,2 kg, Größe 1,78 m, Blutdruck 210/90 mmHg. Die 24-h-Blutdruckmessung zeigt eine nächtliche Blutdrucksenkung von 15% systolisch und 12% diastolisch. In der Routinelaboruntersuchung keine Auffälligkeiten, insbesondere ausgeglichene Elektrolyte, normale Nierenfunktion. Im Urin-Stix keine Erythrozyt- oder Proteinurie. Verlauf: Der Patient erhält zunächst 5 mg Amlodipin und wird bezüglich nichtmedikamentöser Maßnahmen eingehend beraten. Bei einer Wiedervorstellung nach 3 Wochen hat er 1,5 kg an Gewicht abgenommen und einen Blutdruck von 170/85 mmHg.     

A randomized clinical trial with a 0.6% amino acid/ 1.4% glycerol peritoneal dialysis solution.

BACKGROUND: Glucose is an accepted osmotic agent for peritoneal dialysis (PD) although it has several drawbacks. Some of these drawbacks have been addressed by the introduction of solutions with low glucose degradation products and physiological pH in dual-chambered bags. Despite this achievement, there is a need for alternative osmotic agents.This randomized clinical trial analyzes 3-month's clinical experience with a mixture of 0.6% amino acids and 1.4% glycerol. METHODS: The study was performed at the renal units of the University Hospitals Ghent, Belgium, and Utrecht, The Netherlands. Stable PD patients were randomized for either protocol A (test solution, n = 5) or protocol B (control regimen, n = 5). In both protocols, there was a run-in phase of 1 month with a dialysis regimen of 2 x 2 L 2.27% glucose solution (Dianeal; Baxter, Nivelles, Belgium), 1 x 2 L Extraneal (Baxter), and 1 x 2 L glucose solution (Dianeal). After this month-long run-in period, patients in group A received during 3 months 2 x 2 L amino acid/glycerol solution, 1 x 2 L Extraneal, and at least 1 x 2 L of a classic glucose solution. RESULTS: Glucose absorption decreased in the test group during the test phase (from 84.2 +/- 8.7 to 11.7 +/- 11.6 g/24 hours, p = 0.001). Dialysate levels of cancer antigen 125 (CA125) increased in the test group, from 17.5 +/- 11.0 to 32.4 +/- 4.6 units/L (p = 0.04), whereas, in the control group, the levels remained stable (15.5 +/- 8.7 and 14.9 +/- 9.8 units/L respectively, p = 0.4).There were no differences in serum urea, serum bicarbonate, serum osmolarity, serum albumin, or parameters related to skin-fold thickness or serum glycerol levels between control and test solutions. No differences were observed in obtained ultrafiltration after a 4-hour dwell with 2.27% glucose or the test solution, both measured at week 4 of the run-in period and week 12 of the test period. CONCLUSION: This study demonstrated that the use of a new 0.6% amino acid/1.4% glycerol-containing dialysis solution is safe and well tolerated. Glucose load was reduced significantly and dialysate CA125 levels improved significantly. Ultrafiltration was comparable with that of a 2.27% glucose solution. All these factors, in combination with the potential nutritional benefits, can contribute to a beneficial impact on the success of the PD technique. Further long-term studies in larger patient groups are warranted to explore the potential of this promising new solution.     

Nonablative Phototherapy for Acne Vulgaris Using the KTP 532 nm Laser

BACKGROUND: Acne vulgaris is an acute inflammatory disease of the pilosebaceous units. The bastion of treatment for acne vulgaris has been the use of topical and systemic therapies. Despite many modalities available for treatment, there exists an imperative need for effective noninvasive treatments that reduce the risks of medication side effects. OBJECTIVE: To study the safety and efficacy of the potassium titanyl phosphate (KTP) 532 nm pulsed laser for the treatment of acne vulgaris. METHODS: Twenty-six subjects, clinically evaluated with moderate facial acne, were enrolled in this single-center prospective trial. The entire facial area for each subject was divided in half and randomly designated as either a treatment or a control side. Each subject was treated with four laser exposures using a KTP 532 nm laser with continuous contact cooling. The results were assessed at 1 and 4 weeks post-final treatment. Primary outcome measures were Micha?lsson acne severity score and adverse treatment effects. Secondary outcome measures included subjective evaluations from the investigator and patients assessing their overall percent satisfaction. RESULTS: Primary outcome analysis in the Micha?lsson acne severity score demonstrated a mean 34.9% (p = .011) and 20.7% (p = .25) reduction at the 1-week and 4-week post-final treatments, respectively. Subjective investigator evaluations of overall percent satisfaction indicated that all patients demonstrated a minimum 50% overall satisfaction in treatment outcomes at the 4-week follow-up period. No side effects were encountered. CONCLUSION: Use of the KTP 532 nm laser for the treatment and management of acne vulgaris is both safe and effective, with positive results enduring up to 4 weeks post-treatment.     

Avulsion of the distal tendon of the biceps brachii

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1. Avulsion of the distal tendon of the biceps brachii is a rare injury.     

Immunohistochemical localization of tissue factor pathway inhibitor-1 (TFPI-1), a Kunitz proteinase inhibitor, in Alzheimer''s disease

Senile plaques in Alzheimer's disease (AD) are composed principally of Aβ, a 4 kDa fragment of the amyloid precursor protein (APP). Longer forms of APP which contain a Kunitz proteinase inhibitor (KPI) domain are elevated in aged and in AD brains. Tissue factor pathway inhibitor-1 (TFPI) contains three tandem KPI domains and has been well characterized for its role as a natural anticoagulant in the extrinsic coagulation pathway. Functionally, the first two KPI domains of TFPI bind and inhibit the activity of factor Xa and VIIa respectively. In addition, TFPI and APP-KPI share a common clearance mechanism through the low density lipoprotein receptor-related protein (LRP). As part of an ongoing study of the role of KPI-containing proteins in AD, the current study examines TFPI localization in the brain. We report here that TFPI is immunohistochemically localized to microglia in both AD and non-AD individuals and is localized to some senile plaques in AD. Western blot analyses indicate that the amount of TFPI is elevated in frontal cortex samples from AD brains. We propose that TFPI may play a cell specific role in proteinase regulation in the brain.