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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Zeitschrift für Rheumatologie 59 (2000), S. 119-123 
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Glukokortikoidtherapie – rheumatische Erkrankungen – genomische und nichtgenomische Glukokortikoidwirkungen ; Key words Glucocorticoid therapy – rheumatic diseases – genomic and nongenomic glucocorticoid actions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Glucocorticoids have profound anti-inflammatory and immunosuppressive actions when used therapeutically. The therapeutic dose is quite variable and depends on the disease, but ranges from very low to extremely high. The rationale for the use of vavious dosage regimens for specific clinical indications is the existence of three distinct, therapeutically relevant effects: genomic, specific nongenomic and unspecific nongenomic. Genomic effects are mediated by cytosolic receptors that alter expression of specific genes. Specific nongenomic effects occur within a few minutes and are mediated by steroid-selective membrane receptors. Unspecific nongenomic effects occur within seconds, but only at high glucocorticoid dosages, and seem to result from direct interactions with biological membranes. For unspecific nongenomic effects, methylprednisolone and other glucocorticoids have been shown to inhibit cation cycling across the plasma membrane, but to have little effect on protein synthesis. Thus, glucocorticoids could diminish or prevent the acute immune response by interfering with processes such as the rise in intracellular Ca2+ concentration. It is proposed that the additional therapeutic benefit of higher doses is obtained via these nongenomic effects.
    Notes: Zusammenfassung Glukokortikoide gehören zu den wirksamsten Modulatoren von Entzündungsprozessen und Immunfunktionen. Die therapeutische Dosis ist sehr variabel. Sie hängt von der zu behandelnden Krankheitssituation ab und bewegt sich zwischen sehr niedrig und extem hoch. Ursache für diese verschiedenen Dosisregime ist die Existenz verschiedener therapeutisch relevanter Wirkungen: genomisch, spezifisch nichtgenomisch und unspezifisch nichtgenomisch. Genomische Wirkungen werden durch zytosolische Rezeptoren vermittelt, die die Expression spezifischer Gene modifizieren. Spezifische nichtgenomische Wirkungen werden durch steroid-selektive Membranrezeptoren vermittelt. Unspezifische nichtgenomische Wirkungen resultieren aus einer direkten Wechselwirkung des Glukokortikoids mit biologischen Membranen. So wurde für Methylprednisolon und andere Glukokortikoide eine Hemmung des Kationentransportes über die Membran gezeigt, während die Proteinsynthese nahezu unbeeinflusst bleibt. Durch diese Effekte können Glukokortikoide mit Prozessen wie dem Anstieg der intrazellulären Ca2+-Konzentration interferieren und so zu einer Abschwächung einer akuten Immunantwort führen. Es wird vermutet, dass diese Wirkungen den zusätzlichen therapeutischen Nutzen hoher Glukokortikoiddosen vermitteln.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Zeitschrift für Rheumatologie 57 (1998), S. 399-408 
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Schwangerschaftsinduzierte Algodystrophie ; Kalziummetabolismus ; Kalzitonintherapie ; Key words Pregnancy-associated osteoporosis ; calcium metabolism ; calcitonin treatment ; algodystrophy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Pregnancy-induced algodystrophy is per se a rare, possibly too rarely diagnosed disease, since patients with algodystrophy may be misdiagnosed as having unspecific backache, musculoskeletal problems, and ligament pain associated with pregnancy. However, when clinical signs of beginning algodystrophia are present, immediate investigations and therapy are necessary for relief of pain and in order to prevent complications. The aim of this paper is to summarize our current knowledge on this disease. Furthermore, the clinical course and diagnostic evaluation are described in two cases with pregnancy-induced algodystrophy. The authors question the common distinction between pregnancy-induced and post-pregnancy algodystrophy, which result in a disturbed bone and calcium metabolism, but discuss both entities similary.
    Notes: Zusammenfassung Die schwangerschaftsinduzierte Algodystrophie ist eine seltene Erkrankung, die zudem kaum diagnostiziert wird, da die Beschwerden häufig als statische oder ligamentäre, durch die Schwangerschaft bedingte Probleme verkannt werden. Eine rechtzeitige Diagnosestellung ist jedoch ebenso wie die Einleitung einer adäquaten Therapie notwendig, um Komplikationen zu verhindern sowie Schmerzen zu bekämpfen. In dieser Arbeit wird über den aktuellen Kenntnisstand zu dieser Erkrankung berichtet. Darüber hinaus werden anhand von zwei Erkrankungsfällen der klinische Verlauf und die phasenspezifische Diagnostik und Therapie dargestellt. Im Ergebnis unserer klinischen Beobachtungen stellen wir die bisher übliche Trennung von schwangerschaftsinduzierter Algodystrophie und postpartaler Osteoporose in Frage und diskutieren die Vermutung, daß es sich hierbei um zwei Krankheitsbilder handelt, die sich über die Störung des Knochen- und Kalziummetabolismus gegenseitig beeinflussen.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Gesichtsschwellung ; Differentialdiagnose ; Lymphgefäßobstruktion ; Sklerödem ; Melkersson-Rosenthal-Syndrom ; Clofazimin ; Key words Swelling of the face ; Differential diagnosis ; Lymphedema ; Scleredema ; Melkersson- Rosenthal syndrome ; Clofazimine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A 54-year old, obese woman suffered from massive symmetrical swelling of the face, especially of the upper and lower eyelids. Initially the swelling occured intermittently, but after 2 years it was permanent and progressive markedly limiting her visual fields. Neither laboratory findings nor imaging procedures provided any firm evidence of an underlying cardiac, renal or endocrinological disease. There was no suggestion of a storage disease. Skin biopsy showed foam cells and granulomatous inflammation, so the patient was tentatively diagnosed as having a monosymptomatic Melkersson-Rosenthal Syndrome. Eyelid surgery was performed to improve her visual fields. Treatment with clofazimine 100 mg daily was initiated. Regular follow-up visits over 7 months revealed no evidence of recurrence. The patient died a sudden cardiac death a few months later. The relatives refused an autopsy. The definite cause of her facial swelling remains unclear as we discuss the differential diagnostic possibilities.
    Notes: Zusammenfassung Wir berichten über eine 54jährige, sehr adipöse Patientin mit einer symmetrischen Gesichtsschwellung, die zunächst intermittierend, seit 2 Jahren dann persistierend und gleichzeitig progredient aufgetreten war. Insbesondere waren die Ober- und Unterlider derart betroffen, daß die Lidspalten verengt und somit die Sehfähigkeit der Patientin deutlich eingeschränkt war. Die internistische Diagnostik ergab keinen Anhalt für das Vorliegen kardialer, nephrologischer oder endokriner Ursachen. Es bestanden keine Hinweise für das Vorliegen einer Speicherkrankheit. Eine Hautbiopsie ergab zunächst den Verdacht auf das Vorliegen eines monosymptomatisch verlaufenden Melkersson-Rosenthal-Syndroms bei zusätzlicher xanthomartiger Schaumzellvermehrung im gesamten Korium. Im Ergebnis dieser Untersuchungen wurde ein Therapieversuch mit Clofazimin eingeleitet, nachdem zuvor durch kosmetische Chirurgie die Sehfähigkeit wieder hergestellt worden war. Die Patientin verstarb einige Monate später unter dem Bild eines plötzlichen Herztodes. Eine Obduktion wurde von den Familienangehörigen abgelehnt. Wir dokumentieren anhand von Bildmaterial die klinische Symptomatik der Patientin, beschreiben die durchgeführte Differentialdiagnostik und stellen die ursächlich nicht eindeutig geklärte Gesichtsschwellung zur Diskussion.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Hautarzt 51 (2000), S. 738-745 
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Hochdosis-Steroid-Pulstherapie ; Pharmakologische Grundlagen ; Wirkmechanismen ; Dermatologische Indikationen ; Keywords High-dose steroid puls therapy ; Pharmacological basics ; Mechanisms of action ; Dermatological indications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In recent years, high-dose steroid pulse therapy has been considered an effective treatment regimen in a number of non-dermatological diseases. This review addresses in the first part the pharmacological basics and mechanisms of action of high-dose glucocorticosteroid therapy. In the second part, we discuss the clinical experience using this treatment for dermatological diseases including pemphigus vulgaris, pyoderma gangrenosum, alopecia areata, and derma-tomyositis.
    Notes: Zusammenfassung Das krankheitsspezifische Indikationsspektrum für eine Stoßtherapie mit hochdosierten Glukokortikoiden ist in den letzten Jahren erheblich erweitert worden. Im ersten Teil der folgenden Übersicht wird der aktuelle Kenntnisstand zu den pharmakologischen Grundlagen und Wirkmechanismen der Hochdosistherapie mit Glukokortikoiden vorgestellt. Im Anschluss werden die vorliegenden klinischen Erfahrungen zur Anwendung dieser Therapie bei verschiedenen dermatologischen Indikationen wie Pemphigus vulgaris, Pyoderma gangraenosum, Alopecia areata, Dermatomyositis und anderen Dermatosen besprochen und kritisch bewertet.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1434-9949
    Keywords: Anticardiolipin Antibodies ; Monitoring Disease Activity ; Rheumatic Diseases ; SLE
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The prevalence of anticardiolipin antibodies in active systemic lupus erythematosus (SLE) was compared with that in inactive SLE and other rheumatic and non-rheumatic diseases to determine the value of these autoantibodies in monitoring rheumatic diseases. Pairs of IgG- and IgM-aCL were measured by ELISA in 173 consecutive hospitalised patients, including 141 with rheumatic diseases (18 active SLE, 21 inactive SLE, 19 rheumatoid arthritis, 13 reactive arthritis, 7 other spondyloarthropathies, 16 vasculitis, 47 other autoimmune diseases) and 32 non-rheumatic controls. A further 101 aCL pairs were determined during follow-up in 19 patients with SLE. Serum concentrations were analysed with respect to SLE activity and compared between the different patient groups. IgG- and IgM-aCL levels in excess of 10 GPL and 9 MPL respectively were considered positive. 30.6% of all patients (53/173) were found to be positive for IgG-aCL, as against only 9.8% (17/173) for IgM-aCL. IgG-aCL serum levels in active SLE differed significantly from all other groups, including inactive SLE (all p〈0.005). Median IgM-aCL levels were below the cut off point in all groups, although measurable values were obtained almost exclusively in active SLE and RA. In this study IgM-aCL measurement was of less value in monitoring rheumatic diseases. IgG-aCL positivity in SLE was associated with a significantly higher odds ratio (OR) for active disease (OR 16.0, 95% confidence interval: 2.8–90.0). The results show that disease activity in SLE was accompanied by significantly increased IgG-aCL, whereas no elevation was found in other diseases. This parameter may therefore be useful in monitoring SLE activity.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Bioscience reports 12 (1992), S. 109-114 
    ISSN: 1573-4935
    Keywords: energy metabolism ; oxygen consumption ; thymocytes ; ConA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Abstract The influence of ConA on the energy metabolism of quiescent rat thymocytes was investigated by measuring the effects of inhibitors of protein synthesis, proteolysis, RNA/DNA synthesis, Na+K+-ATPase, Ca2+-ATPase and mitochondrial ATP synthesis on respiration. Only about 50% of the coupled oxygen consumption of quiescent thymocytes could be assigned to specific processes using two different media. Under these conditions the oxygen is mainly used to drive mitochondrial proton leak and to provide ATP for protein synthesis and cation transport, whereas oxygen consumption to provide ATP for RNA/DNA synthesis and ATP-dependent proteolysis was not measurable. The mitogen ConA produced a persistent increase in oxygen consumption by about 30% within seconds. After stimulation more than 80% of respiration could be assigned to specific processes. The major oxygen consuming processes of ConA-stimulated thymocytes are mitochondrial proton leak, protein synthesis and Na+K+-ATPase with about 20% each of total oxygen consumption, while Ca2+-ATPase and RNA/DNA synthesis contribute about 10% each. Quiescent thymocytes resemble resting hepatocytes in that most of the oxygen consumption remains unexplained. In contrast, the pattern of energy metabolism in stimulated thymocytes is similar to that described for Ehrlich Ascites tumour cells and splenocytes, which may also be in an activated state. Most of the oxygen consumption is accounted for, so the unexplained process(es) in unstimulated cells shut(s) off on stimulation.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    International journal of legal medicine 111 (1998), S. 91-92 
    ISSN: 1437-1596
    Keywords: Key words Suicidal injection ; Methemoglobin ; Nitrobenzene ; Hemodialysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract We describe the case of a 33-year-old man who injected 4 ml of India ink into one of the median cubital veins with suicidal intent. He was hospitalized in good general condition 10 h after the injection. Abnormal laboratory test results were a leukocytosis, an oximetrically determined methemoglobin level of 36.9% (normal range: 1.5%) and a free hemoglobin level of 74 μmol/L (normal range: 〈 25 μmol/L). Toxicological examination showed the presence of nitrobenzene in blood and urine. Intravenous administration of vitamin C and tolonium chloride plus forced diuresis led to an improvement in cyanosis and a fall in the methemoglobin concentration. Repeated increase in the concentration of aminobenzene were successfully treated by hemodialysis with a high-flux dialyzer.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Bioscience reports 12 (1992), S. 381-386 
    ISSN: 1573-4935
    Keywords: energy metabolism ; oxygen consumption ; thymocytes ; ConA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Abstract The influence of ConA on the energy metabolism of quiescent rat thymocytes was investigated by measuring the effects of inhibitors of protein synthesis, proteolysis, RNA/DNA synthesis, Na+K+-ATPase, Ca2+-ATPase and mitochondrial ATP synthesis on respiration. Only about 50% of the coupled oxygen consumption of quiescent thymocytes could be assigned to specific processes using two different media. Under these conditions the oxygen is mainly used to drive mitochondrial proton leak and to provide ATP for protein synthesis and cation transport, whereas oxygen consumption to provide ATP for RNA/DNA synthesis and ATP-dependent proteolysis was not measurable. The mitogen ConA produced a persistent increase in oxygen consumption by about 30% within seconds. After stimulation more than 80% of respiration could be assigned to specific processes. The major oxygen consuming processes of ConA-stimulated thymocytes are mitochondrial proton leak, protein synthesis and Na+K+-ATPase with about 20% each of total oxygen consumption, while Ca2+-ATPase and RNA/DNA synthesis contribute about 10% each. Quiescent thymocytes resemble resting hepatocytes in that most of the oxygen consumption remains unexplained. In constrast, the pattern of energy metabolism in stimulated thymocytes is similar to that described for Ehrlich Ascites tumour cells and splenocytes, which may also be in an activated state. Most of the oxygen consumption is accounted for, so the unexplained process(es) in unstimulated cells shut(s) off on stimulation.
    Type of Medium: Electronic Resource
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