Acta medica Austriaca最新文献

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.

It is now clear that atherosclerotic disease is a chronic inflammatory disease triggered by a sequence of events initiated at sites with turbulent flow under normal conditions such as in the coronary arteries or at bifurcations or where normal laminar flow is replaced by turbulent flow because of vessel pathologies. Normally, laminar flow is protected by generation of NO by endothelial NO synthase (eNOS), which becomes activated via stretch activated channels. When the flow turns turbulent, such protective NO generation ceases, leading to endothelial cell activation and lipid deposition into the extra-cellular space. There, lipoproteins and specifically phospholipids become oxidized by cells of the monocytic-macrophage lineage. Only when the LDL-cholesterol level is high enough lipid peroxidation products are generated in sufficient amounts to perpetuate the disease by generating a feed forward loop of endothelial cell activation leading to an inflammatory response. That inflammatory response might also be added by bacterial or viral infections such as Chlamydia pneumoniae or viruses. The disease then progresses to a chronic inflammatory state, whereby the immune system seems to contribute significantly and markers of chronic inflammation such as fibrinogen, leukocytes, PAI-1 and CRP are found increased.

Most hereditary periodic fever syndromes known today have their onset in the first year of life. Only two, namely Familial Mediterranean Fever (FMF) and TNF-Receptor Associated Periodic Syndrome (TRAPS) occur later, with most patients having become symptomatic by their twentieth birthday. Therefore this review will concentrate on FMF and TRAPS, the latter being a very rare disease, while the former has become somewhat more common in mid-Europe as a result of migration.

Hyper- and Dyslipidemia contribute to cardiovascular morbidity and mortality in diabetic patients. Pharmacological therapy with statins has convincingly proved to reduce cardiovascular risk in diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the use of lipid-lowering drugs in diabetic patients according to current scientific evidence.

Morbid obesity is defined as obesity with body mass index (BMI) > or = 40 kg/m2 with secondary serious diseases. Conservative treatment generally fails to produce long-term weight loss in these patients, since several bariatric surgical techniques have been developed which are based on gastric restriction and/or gastric malabsorption resulting in permanent weight loss over years. Preoperative evaluation might detect suitable patients and reduce both non-surgical and surgical complications. Postoperative follow-up in a multidisciplinary program, including specialists in various fields of medicine, e.g. surgery, internal medicine, radiology, paediatrics and nutritional surveillance are mandatory in the treatment of patients after obesity surgery. Bariatric surgery results in a major weight loss, with amelioration of most obesity-associated conditions. The most serious side effect of some surgical procedere is malnutrition.

Hyperglycemia contributes to morbidity and mortality in diabetic patients. Reaching treatment targets with regard to control of glycemia is thus a central goal in the treatment of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of oral antidiabetic drugs according to current scientific evidence.

Hyperglycemia contributes to morbidity and mortality in diabetic patients. Reaching treatment targets with regard to control of glycemia is thus a central goal in the treatment of diabetic patients. The present article represents the recommendations of the Austrian Diabetes Association for the practical use of insulin according to current scientific evidence.

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.

BNP and NT-proBNP are new markers with potential applications for the diagnosis and management of patients with cardiovascular diseases. In patients with acute dyspnea, these markers might strengthen the clinical suspicion of decompensated congestive heart failure. Vice versa, below-threshold marker concentrations allow to virtually exclude significant left ventricular dysfunction in symptomatic patients. Furthermore, BNP and NT-proBNP are predictors of morbidity and mortality in patients with heart failure, but also in acute coronary syndrome, myocardial infarction, pulmonary embolism and other cardiovascular diseases. The markers therefore appear suitable for additional risk stratification. Independently from the clinical application, however, it is important to note that extracardiac variables may affect marker concentrations and need to be considered when marker concentrations are interpreted. Due to their diagnostic and prognostic value, the cardiac markers BNP and NT-proBNP have a clear potential to further improve the care of patients with cardiovascular diseases.