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Biomedical subjects

G Biesenbach

Publications and source records attributed to G Biesenbach.

At least 37 records · Page 2Linked to original sources
PubMed1997

Incidence of acute oligoanuric renal failure in dextran 40 treated patients with acute ischemic stroke stage III or IV.

Two hundred eleven patients with acute ischemic stroke, stage III or IV, received daily intravenous infusion of 500-1000 mL low-molecular dextran (dextran 40) over a period of 4 days. In 10 cases (4.7%) acute renal failure, associated with dextran infusion, could be observed; oligoanuria occurred after a mean time of 4 (3-6) days. The incidence of dextran-induced acute renal failure was significantly higher in patients with a preexisting reduction of glomerular filtration rate below 30 mL/min/1.73 m2 (p < 0.005). Five of the patients (50%) with acute renal failure died within 4-12 days after the hemodilution therapy with dextran 40; this high lethality was due to nonrenal complications.

Acute Disease↗
PubMed1997

[Cerebrolysin in treatment of painful diabetic neuropathy].

Cerebrolysin is a peptide solution with free amino acids and biologically active peptides showing neurotrophic efficiency. In a placebo-controlled longitudinal study we investigated the effect of that drug for treatment of painful diabetic neuropathy in 20 type-II diabetic patients (9 women, 11 men, mean age 63 +/- 9 years, duration of diabetes 14 +/- 7 years). Patients received daily a cerebrolysin-infusion (20 ml in 500 ml Ringer) over a period of 10 days. In an age- and diabetes-duration matched placebo group of 10 type-II diabetic patients (7 women, 3 men, age 66 +/- 9 years, duration of diabetes 12 +/- 5 years) vitamin B infusion was administered (5 ml vitamin B complex in 500 ml Ringer) during 10 days. We compared a five-item symptom score scale (FIS) for pain, dysesthesia, paresthesia, nightly exacerbation, and sleep disturbances (grade 0 to 3) and a graphic visual analogue rating scale (VAS) for recording the magnitude of the pains (scale 0 to 100 mm) at the beginning and the end of the infusion therapy as well as 6 weeks later. Cerebrolysin was associated with a significant decrease in total FIS score from 8.7 +/- 1.9 at the start of therapy to 5.1 +/- 2.2 after 6 weeks (p < 0.001), and to a reduction of the VAS score from 4.2 +/- 0.8 to 2.8 +/- 0.9 (p < 0.001) during the same period of observation. In contrast in the placebo group the total FIS score decreased only from 7.9 +/- 1.2 at the beginning to 6.6 +/- 1.1 (p < 0.05) 6 weeks later and the VAS score from 4.5 +/- 0.6 to 4.0 +/- 0.5 (NS). Thus cerebrolysin led to a significant subjective improvement of painful diabetic neuropathy in type-II diabetic patients at least for a period of 6 weeks.

Aged↗
PubMed1997

Influence of cigarette-smoking on the progression of clinical diabetic nephropathy in type 2 diabetic patients.

Cigarette smoking was known to promote the progression of diabetic nephropathy in patients with type 1 diabetes, but its influence on the course of diabetic nephropathy in patients with type 2 diabetes had not been previously established. In a prospective follow-up study we therefore compared the progression of nephropathy in type 2 diabetic patients with or without tobacco consumption. Initiation of dialysis treatment or death of the patient were the end points of the study. 36 patients with type 2 diabetes complicated with diabetic nephropathy were included in the study, 16 smoked and 20 did not. The main outcome measures were proteinuria, arterial blood pressure, HbAlc, serum-creatinine and creatinine clearance, which were controlled at least every six months. In the smoking diabetic patients the mean (SD) creatinine-clearance decreased from 82 +/- 10 to 10 +/- 6 ml/min/1.73 m2 over a period of 62 +/- 21 months. The rate of decline of the creatinine-clearance was 1.24 +/- 0.34 ml/min/month. In the non-smoking patients the creatinine-clearance decreased from 79 +/- 8 to 9 +/- 3 ml/min/1.73 m2 within 79 +/- 27 months. The rate of decline in the creatinine-clearance was 0.99 +/- 0.35 ml/min/month (p < 0.025). HbAlc, systolic and diastolic blood pressure as well as serum cholesterol and triglycerides were not significantly different in both patient groups. Therefore, we conclude that cigarette smoking promotes the progression of diabetic nephropathy in patients with type 2 diabetes, just as it is known in type 1 diabetic patients.

Case-Control Studies↗
PubMed1997

Profile of antihypertensive drugs in hypertensive patients on renal replacement therapy (RRT).

Hypertension is frequently observed in end-stage renal failure. We analysed the incidence and severity of hypertension as well as antihypertensive treatment in a large group of patients on renal replacement therapy (RRT). Questionnaires were sent to all 49 dialysis centers caring for a total of 2090 patients on RRT in Austria. Hypertension was classified as mild, moderate or severe according to WHO criteria. 22 dialysis centers returned completed questionnaires accounting for 1087 patients on RRT. Of these 653 (60%) patients were hypertensive; 425 (39%) patients had mild or moderate, while 228 (21%) patients had severe hypertension. Patients with mild or moderate hypertension need on average 1.5, while those with severe hypertension on average 3.3 antihypertensive drugs. Calcium antagonists were the antihypertensive drugs most frequently administered, in 71% of the patients, followed by ACE inhibitors, alpha- and beta-blockers. Despite multidrug antihypertensive therapy severe hypertension is still a serious problem in patients on RRT. Tassin's center experience showed that longer dialysis time normalizes hypertension and reduces the requirement of antihypertensive treatment in patients on hemodialysis.

Adult↗
PubMed1996

Autoimmune reactions in patients with silicone breast implants.

Silicone breast implants have been surgical routine for over 30 years. An association between silicone augmentation and immune related diseases has been reported in approximately 100 cases. In a retrospective single center study we investigated 36 non-selected women with silicone breast implants and 36 sex- and age-matched controls. Autoimmune reactions were evaluated by measuring antinuclear antibodies (ANA), rheumatoid factor (RF) and thyroid gland antibodies (TMS), along with angiotensin-converting enzyme (ACE), C-reactive protein (CRP) and other immunological and laboratory parameters. In the controls only 3 (8%) women had an elevated ANA titer and 1 demonstrated thyroid autoantibodies (microsomal), giving a total of 4 (11%) women with detectable autoantibodies. By contrast, 12 (33%) of the 36 women with silicone augmentation had raised ANA titers (> or = 1 : 80), a significantly higher percentage than in the control group (p < 0.02). Of the 12 women, 1 showed antismooth muscle antibodies (ASMA; titer 1 : 40) and 2 of the patients displayed antineutrophilic cytoplasm antibodies (ANCA; 1 : 320 and 1 : 40, respectively), one of the latter also being positive for rheumatoid factor. 2 further women demonstrated thyroid autoantibodies (microsomal), giving a total of 14 (39%) women in whom significant autoantibodies were detectable. Clinical symptoms (musculoskeletal) were present in 1 patient. Most of the observed autoantibodies were organ-unspecific, with a predominance of elevated ANA titers of the heterogeneous type and not related to a distinct clinical entity. However, none of the investigated women with silicone breast implants showed clinical symptoms or signs of connective tissue disease according to ARA criteria.

Acute-Phase Proteins↗
PubMed1996

Influence of smoking on the survival rate of diabetic patients requiring hemodialysis.

OBJECTIVE: To study the influence of cigarette smoking on the survival rate of diabetic patients on hemodialysis. RESEARCH DESIGN AND METHODS: We evaluated 1- and 5-year survival rates and the mean values of HbA1c, serum lipids, fibrinogen, and blood pressure. We compared the prevalence of vascular damage at the beginning of dialysis therapy and the endpoint of the study, as well as the causes of death in 22 diabetic patients who smoked (> 10 cigarettes/day) and 30 nonsmoking diabetic patients. RESULTS: There were no differences with respect to HbA1c, cholesterol, and triglycerides. In contrast, diabetic patients with tobacco consumption had significantly (P < 0.05) higher levels of fibrinogen (428 +/- 98 vs. 378 +/- 76 mg/dl) and higher systolic blood pressures (154 +/- 12 vs. 146 +/- 13 mm Hg) than the nonsmoking group. The 1- and 5-year survival rates of the smoking patients were 68 and 9%, respectively, and in the nonsmoking subjects, 80 and 37%, respectively (P < 0.05). The prevalence of vascular damage was similar in both groups, but at the endpoint of the study, the incidence of myocardial infarctions was significantly higher (P < 0.005) in the smoking patients (77 vs. 13%). Cardiovascular events were the most frequent cause of death in both patient groups but more frequently in the smoking subjects (80 vs. 63%). CONCLUSIONS: Hemodialyzed diabetic cigarette smokers show higher fibrinogen and systolic blood pressure values, a higher incidence of myocardial infarctions, and their 5-year survival rate is significantly decreased when compared with nonsmoking patients on hemodialysis.

Blood Pressure↗
PubMed1996

Effect of mild dietary protein restriction on urinary protein excretion in patients with renal transplant fibrosis.

In recent studies, it has been demonstrated that strict dietary protein restriction has a beneficial effect on renal transplant patients who show chronic rejection, or transplant fibrosis respectively; however, the protein intake in those investigations usually has been below 0.6 g/kg day, and such a strong restriction may be associated with both a negative nitrogen balance, and low patient compliance. Our study was therefore undertaken to investigate whether the same beneficial effect could be attained with a more moderate dietary protein restriction in renal transplant recipients. In a randomized cross-over study, 14 patients with biopsy-proven transplant fibrosis received a mildly protein restricted diet (0.7 g/kg/day), and a normal protein diet (1.2 g/kg/day) respectively during two 3-week periods. In the patients undergoing moderate protein restriction, a significant reduction in urinary albumin, and total protein excretion, as well as a decrease in albumin/creatinine ratio was observed at the end of the 3-week period when compared to the patients on normal protein diet (p < 0.05). The 51Cr-EDTA-clearance did not differ at the end of each of these dietary periods. In contrast to earlier studies with lower protein intake, the moderate protein restriction in our investigation was not associated with a decrease in serum proteins. In conclusion, a mildly restricted protein intake has also proved effective in significantly reducing the urinary protein excretion in patients with renal transplant fibrosis, yet, without causing decreasing serumprotein-concentrations, which are a sign for a negative nitrogen balance.

Adult↗
PubMed1996

[Serum uric acid level in type 1 and type 2 diabetic patients].

In 50 type-1 and 50 type-2 diabetic patients serum uric acid levels were measured. Type-1 diabetics showed significantly lower serum uric acid levels in comparison to type-2 diabetics (p < 0.02). This significant difference has been observed in both women (p < 0.001) and men (p < 0.01). Serum uric acid level was lower in type-1 diabetics than in healthy controls but only in diabetic men the difference was statistically significant (p < 0.001). Male type-2 diabetic patients showed serum uric acid levels similar to the controls, but levels were higher in women with type-2 diabetes (p < 0.001). The results of this study show that in type-1 diabetic patients the serum uric acid levels are lower in normal (creatinine clearance > or = 80 ml/min) as well as in slightly decreased (creatinine clearance < 80 ml/min) glomerular filtration rate. But in type-2 diabetic patients the serum uric acid levels were significantly higher when glomerular filtration rate was below 80 ml/min in contrast to normal renal function (p < 0.05).

Adolescent↗
PubMed1996

[Diabetes and pregnancy].

During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. In case of pre-existing diabetic nephropathy, especially when GFR is decreased before conception there is a high risk for both progression of nephropathy during pregnancy and increased incidence of gestosis and intrauterine growth retardation which lead to earlier delivery (before the 36th week of gestation) in most cases. Perinatal mortality newborns of diabetic women with nephropathy has been decreased significantly during the past years, but perinatal morbidity in these newborns is still high. Pre-existing proliferative retinopathy can show progressive deterioration during pregnancy, but spontaneous regression post partum is usual. In rare cases progression of retinopathy also after delivery has been described even when laser coagulation was performed. Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.

Blood Glucose↗
PubMed1996

[Terminal myoglobinuric renal failure in lovastatin therapy with pre-existing chronic renal insufficiency].

Atraumatic rhabdomyolysis with consecutive oliguric renal failure occurred in a 67-year-old man with chronic renal insufficiency in the pre-dialysis phase after four years of therapy with lovastatin without complications. Diuresis remained low after normalization of the muscle enzymes, and the patient required chronic hemodialysis. This case report shows that lovastatin-associated rhabdomyolysis with consecutive myoglobinuric renal failure can be seen also after long-standing lovastatin therapy. In pre-existing renal insufficiency this can lead to earlier requirement of chronic dialysis treatment.

Aged↗
PubMed1994

Abnormal increases in urinary albumin excretion during pregnancy in IDDM women with pre-existing microalbuminuria.

We compared urinary albumin excretion during and after pregnancy in 30 insulin-dependent diabetic (IDDM) women with normoalbuminuria and in 12 IDDM women with microalbuminuria (> 15 micrograms.min-1) prior to conception. There was a 6.7-fold increase in the urinary albumin excretion up until the third trimester in the women with pre-existing microalbuminuria, compared with a 3.8-fold increase in the normoalbuminuric women. In both groups of patients the urinary albumin excretion reached a peak during the third trimester with 492 +/- 404 micrograms.min-1 in the microalbuminuric women vs 43 +/- 36 micrograms.min-1 in the normoalbuminuric women (p < 0.0005). Two women from each of the groups developed eclampsia with diastolic blood pressure over 90 mm Hg, mild or moderate oedema and macroproteinuria. Four of the pregnant women with pre-existing microalbuminuria showed a transient nephrotic syndrome (33.3%) with protein excretion over 3 g in 24-h urine samples during the third trimester. In contrast, this was not observed in any of the normoalbuminuric women (p < 0.05). Within 12 weeks after delivery the urinary albumin excretion rates dropped to the pre-conception values in both patient groups. Renal function remained normal during pregnancy in both of the groups, with a physiological increase in creatinine clearance up until the third trimester (26% increase in the normoalbuminuric women vs 22% in the microalbuminuric women). In conclusion, the effect of pregnancy on the urinary albumin excretion in diabetic women with pre-existing microalbuminuria is an exaggeration of the increase of albuminuria in diabetic women with normoalbuminuria; normalization occurs within 12 weeks after delivery in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Similar rate of progression in the predialysis phase in type I and type II diabetes mellitus.

Progression of diabetic nephropathy from the stage of macroproteinuria with near-normal renal function until start of dialysis was compared in 16 patients with type I and 16 patients with type II diabetes mellitus. The mean creatinine clearance at the beginning of the study was 89 +/- 13 ml/min/1.73 m2 in patients with type I and 81 +/- 6 ml/min/1.73 m2 in those with type II diabetes. Dialysis was started after a mean interval of 77 (44-133) months, when creatinine clearance had decreased to 8 +/- 2 ml/min/1.73 m2 in type I diabetic patients. The respective figures for type II diabetic patients were 81 (40-124) months and 7 +/- 2 ml/min/1.73 m2. The mean rate of decrease in creatinine clearance was 1.05 +/- 0.45 ml/min/month in type I and 0.91 +/- 0.41 ml/min/month in type II diabetes. The mean rate of decrease was 1.46 +/- 0.30 ml/min/month in type I diabetic patients with a systolic BP > 160 mmHg versus 0.80 +/- 0.42 ml/min/month with < 160 mmHg (P < 0.01). In the type II diabetics the respective figures were 1.38 +/- 0.40 ml/min/month versus 0.78 +/- 0.15 ml/min/month (P < 0.01). During the observation period the prevalence of coronary heart disease increased from 6 to 50% in type I and from 31 to 87% in type II diabetes. In conclusion, the rate of progression of diabetic nephropathy during the predialytic phase is similar in type I and type II diabetes; BP adversely affects the rate of progression to the same extent in both groups.

Acute Kidney Injury↗
PubMed1994

Increases in serum lipids during pregnancy in type 1 diabetic women with nephropathy.

During pregnancy women with Type 1 diabetes do not differ from normal women with respect to pregnancy-associated changes in serum lipid levels. However influence of diabetic nephropathy on lipoprotein metabolism in pregnancy has not been described previously. Changes in lipids were compared during and after pregnancy in 10 Type 1 diabetic women without macroproteinuria as well as in 5 diabetic women with macroproteinuria due to diabetic nephropathy. In the pregnant women with macroproteinuria, compared to the diabetic women without macroproteinuria, we observed both significantly higher total and percent increases in serum levels of total cholesterol (97% versus 48%) and of LDL-cholesterol (137% versus 50%), which had risen progressively throughout gestation. The percent increases in serum triglycerides (115% versus 128%) were similar in both patient groups. Metabolic control was improved during pregnancy in both groups of women. Renal function remained normal throughout pregnancy in the diabetic women without nephropathy and worsened during pregnancy in the proteinuric women. The mean protein excretion showed a physiological rise from 0.107 +/- 0.040 g 24 h-1 before pregnancy to 0.336 +/- 0.234 g 24 h-1 in the third trimester in the nonproteinuric women, and an increase from 2.2 +/- 1.0 to 7.1 +/- 1.7 g 24 h-1 during the same period in the women with macroproteinuria. Therefore, it is concluded that the greater increase in serum lipid levels during pregnancy in the women with pre-existing diabetic nephropathy can mainly be explained by the concomitant increase in proteinuria associated with development of the nephrotic syndrome in these patients.

Adult↗
PubMed1994

High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy.

We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase.

Aged↗
PubMed1994

High prevalence of hypertensive retinopathy and coronary heart disease in hypertensive patients with persistent microalbuminuria under short intensive antihypertensive therapy.

In 84 patients with insufficiently treated essential hypertension (systolic blood pressure > or = 160 mmHg and/or diastolic blood pressure > or = 100 mmHg) and normal renal function (creatinine clearance Mean +/- SD = 114 +/- 22 ml/min/1.73 m2) the mean urinary albumin excretion was 39 +/- 19 mg/24h in comparison to 14 +/- 13 mg/24h (p < 0.001) in 10 healthy controls. In 39 of the hypertensive patients albumin excretion was increased (> 30 mg/24h urine) in a subclinical range (microalbuminuria). After 3 days of effective antihypertensive treatment (systolic blood pressure < 150 mmHg and diastolic blood pressure < 90 mmHg) the mean albumin excretion of the microalbuminuric patients decreased from 66 +/- 33 mg/24h to 44 +/- 28 mg/24h (p < 0.01). 27 of these hypertensive patients showed persistent microalbuminuria; in the other 12 patients with primary microalbuminuria the albumin excretion rate was normal now. In the patients with persistent microalbuminuria the prevalence of hypertensive retinopathy was 85% in comparison to only 33% in the patients with reversible microalbuminuria under intensified antihypertensive treatment (p < 0.01) and 31% in the patients with primary normoalbuminuria. The prevalence of coronary heart disease was 11% in the patients with normoalbuminuria and 29% in those with irreversible microalbuminuria (ns). Thus hypertensive patients with persistent but not with reversible microalbuminuria under short intensive antihypertensive therapy show a statistically significant higher prevalence of hypertensive retinopathy and therefore can be considered as an indicator of general microvascular damage in essential hypertension.

Adult↗