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Kananen L, Eriksdotter M, Boström A, Kivipelto M, Annetorp M, Metzner C, Bäck Jerlardtz V, Engström M, Johnson P, Lundberg L, Åkesson E, Sühl Öberg C, Hägg S, Religa D, Jylhävä J, Cederholm T. Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19. Clin Nutr 2022; 41:2973-2979. [PMID: 34389208 PMCID: PMC8318666 DOI: 10.1016/j.clnu.2021.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.
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Affiliation(s)
- L. Kananen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M. Eriksdotter
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - A.M. Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Kivipelto
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Annetorp
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - C. Metzner
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - V. Bäck Jerlardtz
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - M. Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - P. Johnson
- Department of Geriatric Medicine, Capio Geriatrik Nacka AB, Nacka, Sweden
| | - L.G. Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - E. Åkesson
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - C. Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - S. Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D. Religa
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - J. Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland
| | - T. Cederholm
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Metzner C, Hörsch F, Mark C, Czerwinski T, Winterl A, Voskens C, Fabry B. Detecting long-range interactions between migrating cells. Sci Rep 2021; 11:15031. [PMID: 34294808 PMCID: PMC8298713 DOI: 10.1038/s41598-021-94458-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Chemotaxis enables cells to systematically approach distant targets that emit a diffusible guiding substance. However, the visual observation of an encounter between a cell and a target does not necessarily indicate the presence of a chemotactic approach mechanism, as even a blindly migrating cell can come across a target by chance. To distinguish between the chemotactic approach and blind migration, we present an objective method that is based on the analysis of time-lapse recorded cell migration trajectories: For each movement step of a cell relative to the position of a potential target, we compute a p value that quantifies the likelihood of the movement direction under the null-hypothesis of blind migration. The resulting distribution of p values, pooled over all recorded cell trajectories, is then compared to an ensemble of reference distributions in which the positions of targets are randomized. First, we validate our method with simulated data, demonstrating that it reliably detects the presence or absence of remote cell-cell interactions. In a second step, we apply the method to data from three-dimensional collagen gels, interspersed with highly migratory natural killer (NK) cells that were derived from two different human donors. We find for one of the donors an attractive interaction between the NK cells, pointing to a cooperative behavior of these immune cells. When adding nearly stationary K562 tumor cells to the system, we find a repulsive interaction between K562 and NK cells for one of the donors. By contrast, we find attractive interactions between NK cells and an IL-15-secreting variant of K562 tumor cells. We therefore speculate that NK cells find wild-type tumor cells only by chance, but are programmed to leave a target quickly after a close encounter. We provide a freely available Python implementation of our p value method that can serve as a general tool for detecting long-range interactions in collective systems of self-driven agents.
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Affiliation(s)
- C Metzner
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - F Hörsch
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - C Mark
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - T Czerwinski
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - A Winterl
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - C Voskens
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen - European Metropolitan Area of Nürnberg (CCC-ER-EMN), Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - B Fabry
- Biophysics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Samigullin A, Morcos M, Feier F, Oikonomou D, Weihrauch J, Metzner C, Humpert PM. The influence of Empagliflozin on NT-proBNP and blood pressure in type 2 diabetes patients: a retrospective analysis. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Samigullin
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
- starScience GmbH, Heidelberg, Germany
| | - M Morcos
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
| | - F Feier
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
| | - D Oikonomou
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
| | - J Weihrauch
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
| | - C Metzner
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
| | - PM Humpert
- Stoffwechselzentrum Rhein-Pfalz, Mannheim, Germany
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Hagenah J, Werrmann E, Scharfschwerdt M, Ernst F, Metzner C. Prediction of individual prosthesis size for valve-sparing aortic root reconstruction based on geometric features. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:3273-3276. [PMID: 28269006 DOI: 10.1109/embc.2016.7591427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Valve-sparing aortic root reconstruction is an up- and-coming approach for patients suffering from aortic valve insufficiencies which promises to significantly reduce complications. However, the success of the treatment strongly depends on the challenging task of choosing the correct size of the prosthesis, for which, up to now, surgeons solely have to rely on their experience. Here, we present a novel machine learning based approach, which might make it possible to predict the size of the prosthesis from pre-operatively acquired ultrasound images. We utilize support vector regression to train a prediction model on three geometric features extracted from the ultrasound data. In order to evaluate the accuracy and robustness of our approach we created a large data base of porcine aortic root geometries in a healthy state and an artificially dilated state. Our results indicate that prediction of correct prosthesis sizes is feasible. Furthermore, they suggest that it is crucial that the training data set faithfully represents the diversity of aortic root geometries.
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Samigullin A, Andersson K, Östman E, Metzner C, Rascon A, Morcos M, Björck I, Öste R, Humpert PM. Amino acid and chromium enriched table water added to a standardized meal influences the glucose response depending on insulin sensitivity. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hagenah J, Scharfschwerdt M, Schlaefer A, Metzner C. A machine learning approach for planning valve-sparing aortic root reconstruction. Current Directions in Biomedical Engineering 2015. [DOI: 10.1515/cdbme-2015-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Choosing the optimal prosthesis size and shape is a difficult task during surgical valve-sparing aortic root reconstruction. Hence, there is a need for surgery planning tools. Common surgery planning approaches try to model the mechanical behaviour of the aortic valve and its leaflets. However, these approaches suffer from inaccuracies due to unknown biomechanical properties and from a high computational complexity. In this paper, we present a new approach based on machine learning that avoids these problems. The valve geometry is described by geometrical features obtained from ultrasound images. We interpret the surgery planning as a learning problem, in which the features of the healthy valve are predicted from these of the dilated valve using support vector regression (SVR). Our first results indicate that a machine learning based surgery planning can be possible.
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Affiliation(s)
- J. Hagenah
- Institute for Robotics and Cognitive Systems, University of Lübeck
| | - M. Scharfschwerdt
- Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Lübeck
| | - A. Schlaefer
- Institute of Medical Technology, Technical University Hamburg-Harburg
| | - C. Metzner
- Institute for Robotics and Cognitive Systems, University of Lübeck
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Vetter K, Kaschube I, Metzner C, Lindenau K, Fröhling PT. Evaluation of nutritional status in the GDR trial. Contrib Nephrol 2015; 81:208-13. [PMID: 2093499 DOI: 10.1159/000418755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Vetter
- Research Clinic of Nutrition, Potsdam-Rehbrücke
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Lammert A, Schneider H, Bergmann T, Benck U, Krämer B, Gärtner R, Metzner C, Schöfl C, Berking C. Hypophysitis Caused by Ipilimumab in Cancer Patients: Hormone Replacement or Immunosuppressive Therapy. Exp Clin Endocrinol Diabetes 2013; 121:581-7. [DOI: 10.1055/s-0033-1355337] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Lammert
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - H. Schneider
- Division of Endocrinology, Department of Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - T. Bergmann
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - U. Benck
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - B. Krämer
- Fifth Medical Clinic, University Medical Center Mannheim, Mannheim, Germany
| | - R. Gärtner
- Division of Endocrinology, Department of Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - C. Metzner
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - C. Schöfl
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C. Berking
- Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany
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Maasberg S, Klose S, Weber F, Metzner C, Hörsch D, Schott M, Weber MM, Auernhammer C, Pape UF, Goretzki P. Clinical outcome of poorly differentiated (neuro)-endocrine carcinomas (NEC-G3) in a multi-center cohort from Germany. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Metzner C, Raupach C, Mierke CT, Fabry B. Fluctuations of cytoskeleton-bound microbeads--the effect of bead-receptor binding dynamics. J Phys Condens Matter 2010; 22:194105. [PMID: 21386432 DOI: 10.1088/0953-8984/22/19/194105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The cytoskeleton (CSK) of living cells is a crosslinked fiber network, subject to ongoing biochemical remodeling processes that can be visualized by tracking the spontaneous motion of CSK-bound microbeads. The bead motion is characterized by anomalous diffusion with a power-law time evolution of the mean square displacement (MSD), and can be described as a stochastic transport process with apparent diffusivity D and power-law exponent β: MSD ∼ D (t/t(0))(β). Here we studied whether D and β change with the time that has passed after the initial bead-cell contact, and whether they are sensitive to bead coating (fibronectin, integrin antibodies, poly-L-lysine, albumin) and bead size (0.5-4.5 µm). The measurements are interpreted in the framework of a simple model that describes the bead as an overdamped particle coupled to the fluctuating CSK network by an elastic spring. The viscous damping coefficient characterizes the degree of bead internalization into the cell, and the spring constant characterizes the strength of the binding of the bead to the CSK. The model predicts distinctive signatures of the MSD that change with time as the bead couples more tightly to the CSK and becomes internalized. Experimental data show that the transition from the unbound to the tightly bound state occurs in an all-or-nothing manner. The time point of this transition shows considerable variability between individual cells (2-30 min) and depends on the bead size and bead coating. On average, this transition occurs later for smaller beads and beads coated with ligands that trigger the formation of adhesion complexes (fibronectin, integrin antibodies). Once the bead is linked to the CSK, however, the ligand type and bead size have little effect on the MSD. On longer timescales of several hours after bead addition, smaller beads are internalized into the cell more readily, leading to characteristic changes in the MSD that are consistent with increased viscous damping by the cytoplasm and reduced binding strength.
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Affiliation(s)
- C Metzner
- Center for Medical Physics and Technology, University of Erlangen-Nuremberg, Erlangen, Germany
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11
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Metzner C, Sajitz-Hermstein M, Schmidberger M, Fabry B. Noise and critical phenomena in biochemical signaling cycles at small molecule numbers. Phys Rev E Stat Nonlin Soft Matter Phys 2009; 80:021915. [PMID: 19792159 DOI: 10.1103/physreve.80.021915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Indexed: 05/28/2023]
Abstract
Biochemical reaction networks in living cells usually involve reversible covalent modification of signaling molecules, such as protein phosphorylation. Under conditions of small molecule numbers, as is frequently the case in living cells, mass-action theory fails to describe the dynamics of such systems. Instead, the biochemical reactions must be treated as stochastic processes that intrinsically generate concentration fluctuations of the chemicals. We investigate the stochastic reaction kinetics of covalent modification cycles (CMCs) by analytical modeling and numerically exact Monte Carlo simulation of the temporally fluctuating concentration. Depending on the parameter regime, we find for the probability density of the concentration qualitatively distinct classes of distribution functions including power-law distributions with a fractional and tunable exponent. These findings challenge the traditional view of biochemical control networks as deterministic computational systems and suggest that CMCs in cells can function as versatile and tunable noise generators.
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Affiliation(s)
- C Metzner
- Biophysics Group, Department of Physics, University of Erlangen, Henkestrasse 91, D-91052 Erlangen, Germany.
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Metzner C, Raupach C, Zitterbart DP, Fabry B. Simple model of cytoskeletal fluctuations. Phys Rev E Stat Nonlin Soft Matter Phys 2007; 76:021925. [PMID: 17930083 DOI: 10.1103/physreve.76.021925] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 05/01/2007] [Indexed: 05/25/2023]
Abstract
The spontaneous motion of microbeads bound to the cytoskeleton of living cells is not an ordinary random walk. Unlike Brownian motion, the mean-square displacement undergoes a transition from subdiffusive to superdiffusive behavior with time. This transition is associated with characteristic changes of the turning angle distribution. Recent experimental data demonstrated that force fluctuations measured in an elastic hydrogel matrix beneath the cell correlate with the bead motion [C. Raupach, Phys. Rev. E 76, 011918 (2007)]. These data indicate that the bead trajectory is driven by motor forces originating from the actomyosin network and that cytoskeletal remodeling processes with short- and long-time dynamics are mainly responsible for the non-Brownian behavior. We show that the essential statistical properties of the spontaneous bead motion can be reproduced by a particle diffusing in a potential well with a slowly drifting minimum position. Based on this simple model, which can be solved analytically, we develop a biologically plausible numerical model of a tensed and continuously remodeling actomyosin network that accounts quantitatively for the measured data.
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Affiliation(s)
- C Metzner
- Biophysics Group, Department of Physics, University of Erlangen-Nuremberg, Henkestrasse 91, 91052 Erlangen, Germany
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Abstract
HISTORY AND CLINICAL FINDINGS A 74-year-old man presented with bone pain of the right hip, night sweat and weight loss for 18 months. The diagnosis of Paget's disease was confirmed four months before admission, but pain and elevated serum alkaline phosphatase levels remained despite treatment with i.v. bisphosphonates. The physical examination showed no specific abnormalities. INVESTIGATIONS Laboratory findings were elevated levels of serum alkaline phosphatase (AP), CA 19-9 and CEA. Radiological and tomographic images showed an aggressive periostal reaction consistent with Paget's sarcoma. The bone biopsy revealed the presence of prostatic cancer which was confirmed in a subsequent prostate biopsy. TREATMENT AND COURSE Because of the multiple bone and lung metastases the disease proved to be incurable and the patient received palliative therapy with flutamide. He died 12 months later. CONCLUSION In patients with Paget's disease lacking of response to bisphosphonate administration (permanently increased AP and sustained pain) radiological and clinical re-assessment of the diagnosis is indicated and may sometimes also include bone biopsy.
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Affiliation(s)
- C Metzner
- Medizinische Klinik I, Sektion Osteologie, Ruprecht-Karls Universität Heidelberg, 69120 Heidelberg
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Metzner C, Nöldge G, Delling G, Nawroth PP, Kasperk C. Metastasis of prostate cancer simulates Paget's sarcoma. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-932991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Metzner C, Fabry B. Computational study of rheological properties and spontaneous fluctuations of particles within a prestressed cytoskeletal network. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)83905-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Passie T, Metzner C, Seifert J, Zedler M, Schneider U, Emrich HM, Karst M. [Accidental intraartrial injection of diacethylmorphine (heroin) in drug addicts -- three case reports]. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:419-22. [PMID: 16001321 DOI: 10.1055/s-2005-870099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Accidental intrarterial injections are not uncommon in medical treatments. This is also true for uncontrolled injections by drug-addicts. Since 2002 a number of 600 heavy opiate addicts in Germany are substituted in a country-wide study with pure diacetylmorphine (Heroine). We report the course and outcome of three cases of accidental intraarterial injections of pure diacetylmorphine under controlled conditions. After initial symptoms of vasospasms, all cases were without symptoms within one hour and no obvious loss of tissue was observed. After discussing the literature about medical literature and treatment options in intraarterial injections it is concluded, that the cause of major complications after intraarterial injections may not be the pure diacetylmorphine but additional substances in impure "street-heroin" samples.
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Affiliation(s)
- T Passie
- Abteilung Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover.
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Seifert J, Metzner C, Paetzold W, Borsutzky M, Ohlmeier M, Passie T, Hauser U, Becker H, Wiese B, Emrich H, Schneider U. Mood and affect during detoxification of opiate addicts: a comparison of buprenorphine versus methadone. Addict Biol 2005; 10:157-64. [PMID: 16191668 DOI: 10.1080/13556210500123191] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Twenty-six in-patients with Diagnostic and Statistical Manual version IV (DSM-IV) criteria for opioid dependence were selected at random to receive either a combination of an 11-day low-dose buprenorphine and a 14-day carbamazepine regimen (n = 14) or a combination of an 11-day methadone and a 14-day carbamazepine regimen (n = 12) in a double-blind, randomized 14-day in-patient detoxification treatment. Patients with buprenorphine and carbamazepine showed a significantly better psychological state after the first and second weeks of treatment. Above all, the buprenorphine-treated patients demonstrated a less marked tiredness, sensitiveness and depressive state as well as a more prominent elevated mood during the detoxification process. Seven non-completers (after 7 days: four of 12 = 33.3%; after 14 days: seven of 12 = 58.3%) were treated with methadone and carbamazepine and five non-completers (after 7 days: two of 14 = 14.3%; after 14 days: five of 14 = 35.7%) received buprenorphine and carbamazepine. The difference in the overall dropout rate after day 14 was not significant. The present study supports the hypothesis that the combination of buprenorphine and carbamazepine leads to a better clinical outcome than does a combination of methadone and carbamazepine in the detoxification of opioid addicts with additional multiple drug abuse. The buprenorphine and carbamazepine-regimen provides a more effective short-term relief of affective disturbances than does methadone and carbamazepine. No severe side effects occurred during the treatment period in both groups.
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Affiliation(s)
- J Seifert
- Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School, Germany.
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Seifert J, Peters E, Jahn K, Metzner C, Ohlmeier M, te Wildt B, Emrich HM, Schneider U. Treatment of alcohol withdrawal: chlormethiazole vs. carbamazepine and the effect on memory performance--a pilot study. Addict Biol 2004; 9:43-51. [PMID: 15203438 DOI: 10.1080/13556210410001674086] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although relatively little attention has been paid to the question how acute alcohol withdrawal might affect cognitive functions, this factor remains of particular interest because it influences psychotherapeutic treatment during detoxification. The clinical outcome and neuropsychological state of 37 inpatients with alcohol withdrawal was investigated in a randomized single-blind approach. Two different medical strategies [chlormethiazole (CMZ) vs. carbamazepine (CBZ)] in the treatment of inpatients with alcohol withdrawal syndrome were compared. Among comparable groups (related to gender, age, initial alcohol level, severity of abuses, severity of initial withdrawal symptoms such as tremor, perspiration, psychomotor agitation, hallucinations, orientation, intelligence, patient demographics), CBZ is just as potent as CMZ in therapy of withdrawal symptoms (circulatory function, vegetative function, psychomotor activity). Patients in both groups showed initial impairments in some neuropsychological tests (d2, Zahlen-Verbundings test, Beck Depression Inventory, Anxiety Sensitivity Index) with significant improvement during detoxification. Additionally, CBZ-treated patients showed significantly better verbal memory performance during the first days of treatment. Without any addictive potential, CBZ therapy could be very supportive in alcohol detoxification. In addition a higher verbal memory performance state could be favourable for a psychotherapeutic approach.
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Affiliation(s)
- J Seifert
- Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany.
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Seifert J, Metzner C, Paetzold W, Borsutzky M, Passie T, Rollnik J, Wiese B, Emrich HM, Schneider U. Detoxification of opiate addicts with multiple drug abuse: a comparison of buprenorphine vs. methadone. Pharmacopsychiatry 2002; 35:159-64. [PMID: 12237786 DOI: 10.1055/s-2002-34115] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Over the last few years, there has been a growing tendency for opioid addicts to abuse multiple drugs, although many patients are in substitution therapy with methadone. Abuse of multiple drugs leads to a more complicated withdrawal syndrome; it is therefore necessary to investigate new drug strategies as a treatment for detoxification. Buprenorphine appears to be an effective and safe drug in opioid-addicted patient detoxification. In this study, we have compared the short-term efficacy of an 11-day low-dose buprenorphine/14-day carbamazepine regime [BPN/CBZ] (n = 14) to an 11-day methadone/14-day carbamazepine regime [MET/CBZ] (n = 12) in a double-dummy, randomized 14-day inpatient detoxification treatment study. Twenty-six inpatients met the DSM-IV criteria for opioid dependence and were included in this study. All patients abused various additional drugs. Fourteen of 26 patients (53.8 %) completed the study. Seven non-completers (seven of 12 = 58.3 %) were treated with methadone/carbamazepine and five non-completers (five of 14 = 35.7 %) received buprenorphine/carbamazepine, but the difference in the dropout rate was not significant. However, patients with buprenorphine/carbamazepine showed significantly fewer withdrawal symptoms after the first two weeks of treatment. The present study supports the hypothesis that buprenorphine/carbamazepine is more effective than methadone/carbamazepine in detoxification strategies for opioid addict with additional multiple drug abuse. No severe side effects occurred during treatment in either group.
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Affiliation(s)
- J Seifert
- Department of Clinical Psychiatry and Psychotherapy, Medical School, Hannover, Germany.
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21
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Metzner C. [Become a nutrition counselor. Your patients will appreciate it (interview by Christine Vetter)]. MMW Fortschr Med 2002; 144:16. [PMID: 11928257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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22
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Totzke G, Metzner C, Ulrich-Merzenich G, Ko Y, Sachinidis A, Vetter H. Effect of vitamin E and vitamin C on the DNA synthesis of human umbilical arterial endothelial cells. Eur J Nutr 2001; 40:121-6. [PMID: 11697444 DOI: 10.1007/s003940170012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Endothelial cell growth and reendothealization after vascular injury protect the vessel wall against endothelial dysfunction which is believed to play a major role in the pathogenesis of atherosclerosis. AIM of the study To investigate a possible protective role of antioxidant vitamins in the present study, the effect of vitamin E (alpha-tocopherol) alone and in combination with vitamin C on the DNA synthesis of human umbilical arterial endothelial cells (HUAEC) was examined. Furthermore, because oxidized low-density lipoprotein (ox-LDL) is thought to be involved in atherogenesis, the combined effect of vitamin E and vitamin C with ox-LDL and the influence of vitamin-pretreated LDL on HUAEC proliferation were investigated. METHODS DNA-synthesis was determined by measurement of [3H]thymidine incorporation into the cell DNA. RESULTS Vitamin E alone and in combination with vitamin C resulted in an increase in [3H]thymidine incorporation into cell DNA, especially in the presence of basic fibroblast growth factor (bFGF). All vitamin-pretreated LDL samples and ox-LDL led to a nearly complete inhibition of endothelial DNA-synthesis. The ox-LDL-induced effect could not be prevented by vitamin E alone nor in combination with vitamin C. CONCLUSIONS It seems that once LDL oxidation is in process, vitamin E alone and in combination with vitamin C is ineffective to exert its antioxidative capacity under the conditions used. Thus, vitamin E alone and combined with vitamin C may act as antiatherogens by inducing endothelial cell growth.
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Affiliation(s)
- G Totzke
- Medizinische Universitäts-Poliklinik, Bonn, Germany
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23
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Abstract
Whether to perform emergency carotid thromboendarterectomy (CTEA) in the presence of crescendo transient ischemic attacks or stroke-in-evolution is controversial, with the operative mortality in some reports exceeding 20% and improvement in neurologic deficit of less than 40% in others. Our anecdotal experience with emergency CTEA for acute, persistent, or crescendo neurologic deficit had been strikingly better than published reports. Accordingly, we carried out a restrospective comparison of 43 such patients undergoing emergency CTEA with 237 patients concurrently undergoing elective CTEA for conventional indications. A standard protocol followed in emergency CTEA patients included carotid Doppler ultrasonography, computed cerebral tomography (CT), four-vessel cerebral arteriography, and intravenous heparin. Exclusions from emergency CTEA included coma or cerebral CT scan evidence for either hemorrhagic or ischemic infarction with edema. Operative techniques included standard carotid endarterectomy with Dacron patch or direct suture, eversion endarterectomy, or shortening resection. No mortality or central neurologic complications resulted among the 43 emergency CTEA patients, in comparison to no deaths and one temporary hemiparesis (0.4% central neurologic morbidity) in the 237 elective CTEA patients. Our results suggest that in the absence of coma or cerebral CT scan evidence for an unstable blood-brain barrier, emergency carotid reconstruction can be performed safely and with excellent outcome notwithstanding the magnitude and severity of the acute preoperative neurologic deficit.
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Affiliation(s)
- C Schneider
- Department of Visceral, Trauma, and Vascular Surgery, Krankenhaus der Barmherzigen Brüduder, Teaching Hospital of the University of Mainz, Nordallee 1, 54292 Trier, Germany
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Busch HP, Hoffmann HG, Metzner C, Oettinger W. [MR angiography of the lower extremities with an automatic table translation (Mobitrak) compared to i.a. DSA]. ROFO-FORTSCHR RONTG 1999; 170:275-83. [PMID: 10230437 DOI: 10.1055/s-2007-1011040] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Comparison of the diagnostic information obtained by MRA using a moving bed ("MobiTrak") with i.a.DSA for angiography of the lower extremities. MATERIALS AND METHODS In 20 patients, i.a.DSA and MRA were performed within a few days. The image quality and diagnostic information were evaluated by two radiologists and two surgeons. RESULTS The radiologists assessed the quality of MRA higher for 18%, for 79% image quality was equal, for 3% the quality was graded as lower in comparison to i.a.DSA. The surgeons found the quality of MRA higher for 16%, equal for 75% and lower for 9%. In all cases, MRA was sufficient for planning of further treatment. CONCLUSIONS For examinations of the arterial vessels of the lower extremities, MRA with a moving bed ("MobiTrak") can be used instead of i.a.DSA. The diagnostic information from MRA is sufficient for planning the further treatment. The advantages of MRA (no radiation, no i.a. puncture, no contrast medium with iodine) will lead to an increasing application of this method.
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Affiliation(s)
- H P Busch
- Abteilung für Radiologie, Brüderkrankenhaus Trier
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25
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Schneeweiss B, Graubaum HJ, Schneider B, Metzner C. [Symptomatic local therapy of the uncomplicated common cold. Multicenter controlled study of the effectiveness of an antiseptic lozenge]. Fortschr Med 1998; 116:32-3. [PMID: 9630779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Schmidt T, Müller SG, Gulden KH, Metzner C, Döhler GH. In-plane transport properties of heavily delta -doped GaAs n-i-p-i superlattices: Metal-insulator transition, weak and strong localization. Phys Rev B Condens Matter 1996; 54:13980-13995. [PMID: 9985317 DOI: 10.1103/physrevb.54.13980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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27
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Metzner C, Schrüfer K, Wieser U, Luber M, Kneissl M, Döhler GH. Disorder effects on luminescence in delta -doped n-i-p-i superlattices. Phys Rev B Condens Matter 1995; 51:5106-5115. [PMID: 9979387 DOI: 10.1103/physrevb.51.5106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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28
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Renn M, Metzner C, Döhler GH. Effect of random impurity distribution on the luminescence of n-i-p-i doping superlattices. Phys Rev B Condens Matter 1993; 48:11220-11227. [PMID: 10007429 DOI: 10.1103/physrevb.48.11220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Schmidt T, Metzner C, Müller SG, Döhler GH. Classical theory of impurity bands in delta -doped n-i-p-i superlattices. Phys Rev B Condens Matter 1993; 47:10633-10647. [PMID: 10005179 DOI: 10.1103/physrevb.47.10633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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30
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Metzner C, Beyer HJ, Döhler GH. Theory of donor-acceptor-pair luminescence in delta -doping n-i-p-i superlattices. Phys Rev B Condens Matter 1992; 46:4128-4138. [PMID: 10004143 DOI: 10.1103/physrevb.46.4128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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31
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Metzner C, Jung K, Laue R, Wagenknecht C, Graubaum HJ, Kranz D, Seifert P. [Use of the stable nitrogen isotope 15N in assessing liver metabolism in hormonal contraception]. Leber Magen Darm 1990; 20:34-7. [PMID: 2314186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 37 women with long-term use of oral contraceptives (average use 13.4 years) and 12 women who had not taken oral contraceptives for at least 5 years we determined the serum enzymes ALAT, ASAT, Gamma-GT and conducted the 15N-ammonium test as a marker of partial metabolic performance of the liver. In addition we studied total protein, protein fractions in the serum and haematologic parameter. 18 out of 37 women showed a morbid result in the 15N-ammonium test. In 4 of these 18 women morphological changes representing hepatic damage caused by contraceptives could be detected. On the average ALAT, Gamma-GT and 15N-ammonium test in both groups are clearly different. Because the enzymic levels are being in the normal range, only the 15N ammonium test enables to give a hepatotoxic evidence. It is possible to conclude that long-term use of oral contraceptives influences the liver metabolism.
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Affiliation(s)
- C Metzner
- Poliklinik, Bezirkskrankenhauses, Leipzig
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32
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Metzner C, Hartig W, Matkowitz R, Graubaum HJ, Jung K, Wagenknecht C, Ritter R. [Value of various amino acid mixtures for the treatment of chronic liver damage]. Infusionsther Klin Ernahr 1987; 14:256-60. [PMID: 3126135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A reproducible liver lesion was caused in 28 pigs by intermittent, intraperitoneal administration of thioacetamide. The morphological degree of the liver lesion was checked by histological investigations (material drawn from the liver by biopsy). During a 3-day infusion period a so-called liver solution (Aminofusin hepar) was given to one group of animals, a normal solution (Infesol) to a second group, and only an electrolyte infusion solution under oral nutrition ad libitum to a third one. The solutions were labelled with (15N) glycine. The amounts of total N, total 15N, 15N with single non-protein fractions, a number of enzymes of 15N incorporated into the liver protein were measured in urine, and the following points were established: 1. The catabolic situation of metabolism is eliminated both by the so-called normal solution and the specific amino acid solution. The two mixtures of L-amino acids thus have a nutritive effect. 2. The toxic liver lesion is an indication for parenteral nutrition. Oral nutrition alone is not sufficient. 3. The so-called liver solution influences the liver metabolism of the protracted liver lesion more than the so-called normal solution does, and considerably more than an electrolyte infusion solution under oral nutrition ad libitum.
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Affiliation(s)
- C Metzner
- Chirurgische Klinik, Bezirkskrankenhauses St. Georg Leipzig
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Abstract
Twenty-five patients with clinically and histologically verified acute hepatitis were subjected to a submaximal bicycle ergometer exercise during the first week after inpatient admission and afterwards subdivided into two groups. The first group maintained bedrest, and the other group trained for 30 minutes a day over six weeks at an exercise level amounting to 70% of the submaximal performance of the initial ergometry. Histological, clinical and laboratory results did not differ between the groups. It is concluded that immobilization for a short time only is indicated in acute hepatitis.
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Metzner C, Graubaum HJ, Wagenknecht C, Haupt R. [Liver diagnostics]. Z Gesamte Inn Med 1985; 40:712-4. [PMID: 4096056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prerequisite of a scientific and rational liver diagnostics is the knowledge of the physician of function and structure of the liver. The laboratory demand should always be an accomplishment of the physician and should be performed only upon such a scale that it is also followed by therapeutic consequences and/or consequences concerning the expert's opinion. The biochemical blood analysis gives information about the size of the injury to the parenchyma and about the disturbance of the various partial functions of the liver. In this case is to be taken into consideration that biochemical and histological parameters are no concurrent, but supplementing diagnostic methods. A progress in liver diagnostics is the use of the isoenzymes of the aspartate aminotransferase and the lactate dehydrogenase as well as of the enzymes of the metabolism of the connective tissue. With the entering into selected parameters of the liver diagnostics possibilities to the establishment of the disturbed liver metabolism by means of markers are shown and at the same time recommendations for the praxis of the liver diagnostics are derived.
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35
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Ziesenhenn K, Metzner C, Graubaum HJ, Wiese M. [Acute viral hepatitis and body loading--a self-excluding therapeutic principle?]. Z Gesamte Inn Med 1985; 40:715-6. [PMID: 4096057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Of 27 patients with acute virus hepatitis 16 patients performed successfully a daily training programme during their stay in hospital. On the basis of both clinical and clinical chemical parameters in comparison to the control group of 10 patients who observed the conventional rest in bed the course of healing did not deteriorate. Also with regard to the late prognosis no higher rate of recidivation or chronification could be proved. Our examinations support the thesis that the demand of strong rest in bed is to be regarded as out of date in the treatment of acute virus hepatitis.
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36
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Schmoz G, Hartig W, Vetter K, Weiner R, Metzner C, Herrmann B, Roick M. [Importance of the modern hospital diet in medical practice]. Z Ernahrungswiss 1983; 22:241-54. [PMID: 6419485 DOI: 10.1007/bf02023857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hospital diet is an essential part of modern therapy in all medical departments. It comprises both the so-called normal diets which are prepared according to modern nutritional knowledge, dietetic foods and the various forms of artificial nutrition (nutrient-defined and chemically defined diets, parenteral and combined nutrition, i.e. enteral and parenteral nutrition). The integration of nutritional therapeutic problems into the treatment of patients requires optimal scientific and practical forms of organisation of nutrition in the clinic. For that purpose, cooperation of clinical, technical, economic and pedagogic divisions is of prime importance. The organisation of patient nutrition in the St. Georg District Hospital in Leipzig is described as a feasible model.
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37
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Wiese M, Metzner C, Ziesenhenn K, Haupt R. [Effect of a bicycle ergometry training program in the acute phase of viral hepatitis on its late prognosis]. Z Gesamte Inn Med 1983; 38:42-4. [PMID: 6880313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
37 patients with clinically and histologically ascertained acute virus hepatitis (51% virus hepatitis B) underwent a bicycle-ergometric load a short time after admission to hospital and 17 of them were subsequently submitted to a training from twice a day to 30 minutes with 70% of the submaximal steady state effect. After their discharge from hospital all patients were repeatedly examined in the outpatient department for on an average 2.7 years; 20 patients (8 in the load group, 12 in the comparative group) were submitted to a liver biopsy on an average after one year. In 11 of the other patients the result of a histological examination of the liver from the end of the clinical treatment was present. The comparison of the training group and the control group showed nearly the same percentage of cures for the two groups as well as no transitions into chronic hepatitis in the training group. Also clinical and biochemical relapses did not appear in the load group. In a follow-up observation up to five years in the training group did not appear any disadvantage concerning the complete cure of virus hepatitis so that we apparently do not fear any negative sequels of physical activity in the acute phase of virus hepatitis. A forced immobilisation of the body--after proved ineffectiveness of diet and medicamentous treatment last support of the therapeutic regime--thus seems no more be indicated, since it is also accompanied by impairing reduction of the bodily function.
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38
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Wagenknecht C, Metzner C. [Diagnosis of acute hepatitis]. Z Gesamte Inn Med 1983; 38:17-20. [PMID: 6135283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The following recommendations are to be given for the basis diagnosis of hepatitis: --In the blood donation and blood transfusion institutions the control of the donors is performed by means of the combination ALAT and HBs-antigen (transmigration electrophoresis); depending on methods limits were established showing a high diagnostic specificity. Thus, no doubt, the diagnostic sensitivity is decreased, but the number of the examined persons with falsely positive findings probably diminishes. --For the diagnostics in the clinic the parameters ALAT, ASAT, bilirubin and the thymol turbidity test are at the disposal as criteria of the liver cell damage as well as AP (alkaline phosphatase), AAP and GGT as criteria of the cholostasis and the thymol turbidity test, serum protein including immunoglobulins as criteria of the mesenchymal reaction. The reference areas must be established method-specifically corresponding to the interrogation of the physician. --The isoenzymes of the ALD, the ASAT and the LDH represent an essential enrichment of the diagnostic and prognostic estimation of hepatitis. But at present it is not yet possible to determine these parameters in routine work. However, there gradual introduction into practice should be the aim.
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39
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Ziesenhenn K, Metzner C. [Problems of so-called functional ECG changes]. Z Gesamte Inn Med 1982; 37:155-8. [PMID: 7080566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
It is reported on a 25-year-old African student with healthy heart in whom on account of an enlarged hepatologic diagnostics considerable changes of the ECG with repeated alteration between the ST-elevations and the T-negativations became manifest in the anterolateral BW-leads. In the otherwise inconspicuous findings functional changes of the ECG (early repolarization syndrome) with pronounced vegetative lability are concerned. The influence on the changes of the ECG by sympathicomimetics (isoproterenol test) may help to alleviate the diagnostics. In connection with diagnostic interventions the recognition and correct explanation of such ECG-findings is of decisive importance.
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40
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Metzner C, Ziesenhenn K, Haupt R. [Diagnostic problems of diabetic nephropathy in elderly patients with diabetes from a clinical point of view]. Z Gesamte Inn Med 1981; 36:275-7 suppl. [PMID: 7257462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The clinical findings of 28 diabetic females with suspicion of diabetic nephropathy were compared with the findings of 27 decreased female diabetics with ascertained diabetic glomerulosclerosis. In the two groups above all elderly female diabetics were concerned with an average duration of diabetes of more than 10 years. Of the parameters examined duration of diabetes and diabetic retinopathy still possessed the greatest diagnostic certainty. All the other symptoms (particularly proteinuria, hypertension) were only signs of reference. On account of the difficult differential diagnosis of the diabetic nephropathy an undiscriminating use of the notion should be avoided, above all then when a bioptical clarification is not possible.
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Weise I, Metzner C, Behn P, Haupt R. [Aortic stenosis in old age - a diagnostic problem]. Z Gesamte Inn Med 1980; 35:887-90. [PMID: 7222835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
From 1973 to 1978 in the dissection material of the Medical Clinic in 78 deceased a stenosis of the aortic valve was diagnosed. Clinically diagnosed was the failure of the aortic valve, however, only in 33 cases. The retrospective analysis of the dissection material showed from the clinical point of view that the old age of the patients at admission (x = 70 years), the short stay in the ward and the reduced general condition were factors which rendered difficult the diagnosis of a stenosis of the aortic valve. On the basis of our results we are of the opinion that when a systolic murmur is present above the basis in connection with signs of the load of the left heart in the ECG in every case the diagnosis of the stenosis of the aortic valve is to be included into the diagnostic considerations also when a picture of heart complaints is not present in older persons.
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42
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Ziesenhenn K, Metzner C. [Exercise ECG and serum enzymes in women using oral contraceptives]. Z Gesamte Inn Med 1980; 35:619-23. [PMID: 7467570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 45 women who in an average period of 5.6 years took oral contraceptives and who became evident in the transaminase screening a bicycle-ergometric load examination was carried out. At the same time before and after load estimations of enzymes (ALAT, ASAT, LDH, CK) were performed. Only in 4 women (8.9%) under load suspicious ECG-findings could be proved, which, however, could not be regarded as secure signs of ischaemia, but above all as falsely positive changes of the ECG in psychovegetative heart syndrome. The estimation of total enzyme activities did not achieve an additional gain of information.
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43
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Metzner C, Ziesenhenn K, Kirsch WD, Schmerling S. [Bicycle ergometric testing in the acute phase of liver disease with particular reference to changes in serum enzymes]. Z Gesamte Inn Med 1979; 34:411-4. [PMID: 524940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is reported on 20 patients (17 women, 3 men) who had undergone a bicycle-ergometric load in the acute phase of virus hepatitis (an average at the 16th day after admission to hospital). Among the significant changes of the activity the slight increase of SGPT 30 minutes after the end of the load as well as the clear decrease of the enzyme activities of SGPT and SGOT below the initial value 48 hours after load are particularly to be emphasized. LDH and CPK exhibited only insignificant changes of activity. It remains open to what extent there exists a connection between the ECG-changes proved in about half the women and the virus hepatitis as a cyclic infectious disease. In the 20 patients examined a clinically recognizable deterioration in the course of the disease by the load examination did not appear.
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Metzner C, Weise I, Haupt R, Stolle K. [Hepatitis B and chronic lymphadenosis]. Z Gesamte Inn Med 1979; 34:111-3. [PMID: 433364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is reported on a 79-year-old female patient who died from coma hepaticum. As evoking cause an immunesuppressive treatment with cyclophosphamide or prednisolone, respectively, on account of chronic lymphadenosis with excessive thrombocytopenia is discussed. An accessible preliminary lesion of the liver after an infectious jaundice with persistence of the HBs-antigen from which the patient formerly suffered is probable. It is referred to the combination of the chronic aggressive hepatitis with malignant systemic diseases and immunopathy, taking into consideration the decision of therapy.
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45
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Wiese M, Metzner C, Brunner HP, Klemm HP. [Cholestatic hepatosis caused by Talinolol (Cordanum)?]. Z Gesamte Inn Med 1979; 34:86-8. [PMID: 34271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is reported on a 38-year-old female patient who was treated for 18 days with 150 mg cordanum (talinolol) each and then fell ill with a dyspeptic clinical picture and signs of cholestase. The result of a liver biopsy was the picture of a cholestatic hepatosis. According to the results of the lymphocyte transformation test and the monocyte test as well as to the reexposition with following clinical recidivation the talinolol medication is to be regarded as cause. Pathogenetically is referred to the structural relations of talinolol to substances with paragroups as well as to a possible summation of different loads of the liver function.
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46
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Julich H, Fiedler H, Metzner C. [Proposals for the explanation of diagnostic procedures in gastroenterology]. Z Arztl Fortbild (Jena) 1978; 72:1013-5. [PMID: 154213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Ziesenhenn K, Metzner C. [Does abdoman cause ileus?]. Z Gesamte Inn Med 1978; 33:532-4. [PMID: 695795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
On account of its favourable pharmacological properties Abdoman has proved in the treatment of patients with uncomplicated duodenal ulcer. On the basis of its pronounced motility inhibiting effect on the gastrointestinal canal it may be additionally used for the treatment of diarrhoea. It is reported on 5 patients in which under Abdoman therapy a paralytic ileus developed as severe complication, so that it must be warned of an uncontrolled prescription of abdoman concerning this indication. Abdoman should be used above all in juvenile patients, in which case particular attention must be paid to obstipation as most frequent side-effect.
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48
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Metzner C, Ziesenhenn K, Bager KH, Kirsch WD. [Physical capacity of patients with liver diseases as well as its significance for therapy and evaluation]. Z Gesamte Inn Med 1978; 33:211-4. [PMID: 664803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 50 patients with different liver diseases (20 with subsided viral hepatitis and 30 with degenerative liver damages) the serum enzyme course of SGOT, SGPT, LDH and CPK was investigated after ergometer load. The enzymes were estimated before as well as 1/2, 2, 4, 24, and 48 hours after load. 48 hours after load additionally the liver biopsy after Menghini was carried out. According to the histological findings the 20 patients with viral hepatitis were subdivided into 13 with still active and 7 with residual hepatitis as well as the 30 patients with degenerative liver damages into 15 with toxical hepatosis, 6 with fatty degeneration of the liver cells and 9 with signs of metabolic activation. Since the significant increases of enzymes could not be proved in any of the fours enzymes 1/2 to 48 hours after load we are of the opinion that the liver, independent on the kind of the lesion, better tolerates physical work. Moreover, it seems that load investigations under ergometry with estimation of the course of the serum enzymes are unsuited for the judgment of the degree of activity and the degree of cure of liver diseases, respectively.
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49
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Link H, Metzner C, Ziesenhenn K. [Incidence of toxic liver lesions due to Gravistat]. Z Gesamte Inn Med 1978; 33:187-9. [PMID: 645155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 200 women who on the average 5.6 years took ovosiston and/or non-ovlon, and in 40 women who during the last three months had not taken an oral contraceptive we determined the GOT, the GPT, and LP-X and the cholesterol in the serum before and after a three weeks intake of gravistat. After a three weeks intake of gravistat of the two groups ca. one fourth showed pathological transaminases. 30 women with pathological transaminases and/or positive LP-X were hepatologically investigated including liver biopsy after an on an average 7.3 weeks exposition of gravistat. In ca. one third of the cases histologically provable changes of the liver (toxic hepatosis, fatty liver, infectious hepatitis) and in ca. two thirds of the cases the picture of the metabolic activation were found. Morphologically no signs of an intrahepatic cholostasis could be proved, so that it does not seem to be the leading parameter of the toxic liver damage.
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50
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Metzner C, Ziesenhenn K, Müller H, Kirsch WD. [Toxic hepatoses due to Gravistat]. Z Gesamte Inn Med 1977; 32:407-8. [PMID: 595698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
With the help of 5 cases with toxic hepatosis by administration of Gravistat the problems concerning ovulation inhibitor and toxic hepatosis were explained. The clinical, paraclinical and histological findings may be pronounced differently. Anamnestically in prescribing ovulation inhibitors particularly a jaundice during pregnancy or a pronounced pruritus in the 3rd trimester of the pregnancy must be taken into consideration. Toxic liver damage may appear not only when the ovulation inhibitor is given the first time, but also after changing it. For this reasons idiopathic jaundice during pregnancy and condition after toxic hepatosis by ovulation inhibitor in every case must be regarded as contraindications for the application of oral contraceptives. In order to establish subclinical courses a control of transaminases in the first three cycles of using the remedies is to be demanded.
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