Acta medica Austriaca最新文献

Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations in the diabetic range. In case of a high risk for GDM/type 2 diabetes (history of GDM or prediabetes [impaired fasting glucose or impaired glucose tolerance]; malformation, stillbirth, successive abortions or birth-weight > 4500 g in previous pregnancies) performance of the OGTT (120 min; 75 g glucose) is recommended already in the first trimester and--if normal--the OGTT should be repeated in the second/third trimester. In case of clinical symptoms of diabetes (glucosuria, macrosomia) the test has to be performed immediately. All other women should undergo a diagnostic test between 24 and 28 gestational weeks. If fasting plasma glucose exceeds 95 mg/dl, 1 h 180 mg/dl and 2 hrs 155 mg/dl after glucose loading (OGTT) the woman is classified as GDM (one pathological value is sufficient). In this case a strict metabolic control is mandatory. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 130 mg/dl) insulin therapy should be initiated. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria).

Obesity is a chronic disease with a worldwide increasing incidence. The mainstay of therapy consists in modification of behaviour related to obesity such as overeating and physical inactivity. When these life-style modifying attempts fail, the use of anti-obesity drugs is warranted. Public health efforts and current anti-obesity agents have not controlled the increasing epidemic of obesity, which has led to an extensive research on novel anti-obesity agents. This review presents an overview on potential future candidates.

The endocrine system plays a central role in the regulation of body weight and fat distribution. The influence of thyroid hormones, growth hormone, cortisol und sex steroids on body weight are described with a focus on hyper- and hypofunction of these systems. In addition, sequelae of therapeutic interventions aiming to restore homeostasis in dysfunction are discussed. Finally, neuroendocrine control of appetite and syndromes that are consequences of disturbed neuroendocrine control of food intake are described.

There has been a tremendous increase in overweight and obesity in industrialized countries. Because of its comorbidities obesity is defined as a disease. The abdominal fat distribution is associated with insulin resistance and with a number of cardiovascular risk factors; all of them are included in the metabolic syndrome. The metabolic syndrome can easily be defined by clinical symptoms and laboratory results, which are defined in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (AP III). Abdominal obesity is characterised by a waist circumference of over 102 cm for men and over 88 cm for women, plasma triglycerides >150 mg/dL, a low HDL cholesterol level (<40 mg/dL for men, <50 mg/dL for women), a blood pressure of over 130/85 mm Hg and an abnormal fasting glucose value >110 mg/dL.

The prevalence of diabetes is increasing in westernized countries. In addition, about half of all patients suffering from diabetes are not diagnosed. The current article represents the recommendations of the Austrian Diabetes Association for the screening and prevention of type 2 diabetes, based on currently available evidence.

Diabetes education, nutritional advice, exercise recommendations and training for smoking cessation comprise the mainstay of diabetes treatment before starting drug therapy. Prevention as well as treatment of diabetes mellitus is positively influenced by life-style modification. In addition cardiovascular risk factors can be reduced by such measures. The article gives in brief recommendations leading towards life-style modification based on current evidence.

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.

The adipose tissue stores excess energy but also produces a series of substances including cytokines (adipocytokines) which participate in regulatory processes. The physiologic and pathophysiologic relevance of these factors has only recently been described in more detail. Defects in adiponectin as well as overproduction of free fatty acids play an important role in the development of insulin resistance typical for obesity. Rare forms of obesity or lipodystrophy can now be explained by defects in the leptin system. The contribution of adipose tissue and its cytokines to the relationship between inflammation and the metabolic syndrome is currently under investigation.

Summary: Differentiated thyroid cancer is a rare tumour with an incidence of 4 – 9/100 000/year. For preoperative assessment of thyroid nodules, ultrasonography (US) and US-guided fine needle aspiration biopsy are the methods of choice to detect thyroid cancer. The value of preoperative fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) in differentiating malignant from benign nodules, especially in cases of follicular proliferation, has not yet been evaluated. After thyroidectomy and radioiodine remnant ablation, several methods are used to follow patients with differentiated thyroid cancer, including serum thyroglobulin, ultrasonography of the neck, iodine-131 (¹³¹I) whole body scintigraphy (WBS) and scintigraphy with nonspecific tracers such as technetium-99 m (^99mTc) Tetrofosmin or Sestamibi. Whereas the specificity of ¹³¹I-WBS is high, sensitivity is low, especially if one takes into account that only two-thirds of recurrences or metastases store iodine. With the introduction of ¹⁸F-FDG in oncology, it is also used for the detection of local recurrences and metastases of differentiated thyroid cancer. Elevated thyroglobulin but negative ¹³¹I-WBS belongs to the 1a indications for ¹⁸F-FDG-PET in oncology according to the German Consensus Conference 2000. The sensitivity for detecting ¹³¹I-negative metastases with ¹⁸F-FDG-PET can be increased by elevated thyroid-stimulating hormone (TSH) after withdrawal of thyroid hormone therapy or after intramuscular injection of recombinant TSH. Most of the ¹³¹I-negative metastases demonstrate ¹⁸F-FDG uptake, which represents rapid tumour growth and poor differentiation, whereas most of the ¹³¹I-positive metastases are ¹⁸F-FDG negative. The combination of ¹³¹I-WBS and ¹⁸F-FDG-PET leads to an increase in the detection rate to more than 90 – 95 % in cases of elevated thyroglobulin, because well- and less-differentiated cancer cells may be present in one patient. In rare cases, a recurrent tumour or metastasis may accumulate ¹³¹I as well as ¹⁸F-FDG. In these patients, it may be possible that well- and less-differentiated cells are present in one metastasis. The early use of ¹⁸F-FDG-PET in patients with elevated thyroglobulin, especially in the case of negative ¹³¹I-WBS, changes the therapeutic strategy in up to half of the patients (surgery, external radiation).