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H Lehnert

Publications and source records attributed to H Lehnert.

At least 37 records · Page 2Linked to original sources
PubMed2004

Diabetes and cardiovascular risk evaluation and management in primary care: progress and unresolved issues - rationale for a nationwide primary care project in Germany.

This review highlights established and more recently recognized risk factors for coronary heart disease (CHD) relevant for patients seen in primary care, emphasizing the key role of diabetes mellitus type 2. Recent trends in risk factor research as well as current methods of risk stratification, and new systemic markers are discussed. Beyond the need for more forceful public health strategies to improve early recognition and intervention, the necessity of an integrated comprehensive investigation of the overall characteristics of cardiovascular disease, especially in primary care patients as a prerequisite for future concerted actions is pointed out. Based on this, a large-scale epidemiological investigation focusing on CHD and diabetes in the primary care sector is suggested.

Cardiovascular Diseases↗
PubMed2004

Mutation analysis of leukemia inhibitory factor-receptor (LIF-R) in ACTH-secreting pituitary adenomas.

Numerous cytokines and particularly leukemia inhibitory factor (LIF) are involved in the differentiation, proliferation, and secretory function of ACTH-producing pituitary cells. LIF and its receptor LIF-R are abundantly expressed in normal pituitaries and in ACTH producing adenomas. The present study was performed to evaluate the possible role of LIF-R in the pathogenesis of ACTH-secreting pituitary adenomas. To test the hypothesis that a possible mutation of LIF-R might be involved in pathogenesis of Cushing's disease we analyzed ACTH-producing pituitary adenomas as well as inactive pituitary adenomas by RT-PCR and direct cycle sequencing. No mutations have been found in the adenomas investigated. We thus conclude that mutations in LIF-R are an unlikely cause for the development of Cushing's disease.

Adenoma↗
PubMed2004

Antibiotic therapy for diabetic foot infections: comparison of cephalosporines with chinolones.

Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations and uncontrolled infections represent a major risk factor. This open prospective, multicenter trial compared the efficacy of two antibiotic regimens for treatment of foot infections Wagner stage II or III in diabetic adults. Three hundred diabetic patients with severe, limb-threatening foot infection were consecutively enrolled in a prospective, observational, matched pairs controlled study to test two different antibiotic regimes (ceftriaxone vs chinolones) in addition to standard treatment of foot infection. After matching, 90 patients--each receiving ceftriaxone or chinolones--were analyzed. Our study demonstrated that treatment with a third generation cephalosporine is as effective as a treatment with chinolones. Response (reaching Wagner I or 0) was achieved in 58.0% in the ceftriaxone group and in 51.1% in the chinolone group (NS.). Fourteen days after initiation of treatment, the number of patients with microbiological isolates decreased in both groups (52 to 5 in the ceftriaxone group and 60 to 12 in the chinolone group). At hospital discharge, 66.0% of ceftriaxone and 64.4 of chinolone-treated diabetic ulcers were cured or improved. In summary, both substances proved to be effective in the primary antibiotic treatment of the diabetic foot; an early broad spectrum antibiotic treatment, that covers both gram-positive and gram negative bacteria as well as anerobes is undisputedly an imperative therapeutic intervention for the treatment of diabetic foot infection.

Adult↗
PubMed2004

Expression of cell surface antigens in diabetic patients and healthy controls after injury.

AIMS: Due to the systemic character of Type 2 diabetes, cellular disturbances paralleled by an altered expression of various growth factors constitute the basis for impaired wound healing. Cell-surface antigens are altered in chronic wounds and may also have an effect on the persistance of diabetic foot lesions. METHODS: We investigated blood samples of diabetic patients with diabetic foot ulcers (n=21) in comparison with those from healthy control patients subsequent to an injury (n=9). A blood sample (EDTA) was taken from each participant (in the trauma control group on the third day after injury) and examined by flow cytometry [fluorescence-activated cell sorter (FACS)]. Typical cell surface antigens involved in wound healing were studied [cluster of differentiation (CD)2, CD3, CD4, CD25 and human leukocyte antigen (HLA)-diabetic retinopathy (DR)]. RESULTS: known to adversely affect wound healing were elevated in diabetic patients (CD2 p<0.001; CD3 p=0.016, CD4 p=0.22, CD25 p<0.001). HLA-DR expression was also decreased in diabetic foot patients (p=0.023). CONCLUSIONS: Cell-surface antigens appear to be altered in diabetic patients when compared to healthy controls. Thus, due to the systemic character of Type 2 diabetes, cellular disturbances may well constitute the basis for impaired wound healing in diabetes.

Adult↗
PubMed2004

[Role of the class II tumor suppressor gene maspin in thyroid carcinogenesis].

The presented study was aimed to investigate new mechanisms of carcinogenesis in thyroids at the molecular level and to find potential protein markers involved in the initiation of the different histological subtypes of thyroid carcinoma. For this, we performed differential proteome analysis on primary cultured thyrocytes and transformed thyrocytes derived from 238Pu alpha-particle irradiation using two-dimensional electrophoresis (2-DE) and peptide mass fingerprinting (PMF) with matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS). Proteome analysis identified a strong upregulation of maspin, a serine protease inhibitor and class II tumor suppressor, in irradiated thyrocytes. To clarify the role of maspin in thyroid carcinogenesis, we searched for mRNA/protein expression in 30 normal (tumor-free) thyroid tissues, 35 follicular adenomas, 68 papillary carcinomas, 38 follicular carcinomas, 25 poorly differentiated carcinomas, and 34 undifferentiated carcinomas and compared the results with maspin promoter methylation status, p53 expression, clinicopathological data and prognosis. Maspin expression was detectable in 48 of 68 papillary carcinomas exclusively. There was a low methylation rate of 28% in papillary carcinomas in contrast to the other tissues (89-100%). p53 was positive in 2% of maspin positive cases, and in 80% of maspin negative cases. After 110 month follow-up 83% of the maspin positive patients had recurrence-free disease, whereas only 40% of the maspine negative patients were recurrence-free. Our data suggest: (1) maspin expression is a special feature of papillary thyroid carcinomas, (2) promotor methylation-caused maspin repression plays a major role in gene balance and in the process of tumor determination, (3) maspin protein possibly functions as a clinically relevant inhibitor of tumor progression, (4) our data delivers the hints for a p53-depentent regulatory pathway of the maspin protein in human cancer.

Amino Acid Sequence↗
PubMed2003

[IRMA-pRAcs: irbesartan in the treatment of microalbuminuria and proteinuria in patients with type 2 diabetes and hypertension-prospective observational study involving 38,016 patients in the general practice setting].

BACKGROUND AND AIMS: In daily practice, nephropathy is diagnosed in a high percentage of type 2 diabetics, including those in whom blood pressure is well controlled. The aim of the present study was to reduce albuminuria in these patients by changing over antihypertensive treatment to the AT, blocker irbesartan. 9,838 general practitioners recruited a total of 38,016 type 2 diabetics aged at least 18 years to an open observational study: In the majority of cases, current antihyprertensive treatment was discontinued and patients given 300 mg (a small percentage received 150 mg or 75 mg) irbesartan, either as monotherapy or in combination with 12.5 mg hydrochlorothiazide (HCT). The primary target outcome for efficacy was the 6-months normalization rate in patients with microalbuminuria or proteinuria; secondary target parameters included the change in protein excretion (grades: negative, 20 mg, 50 mg, 100 mg), normalisation of the systolic or diastolic blood pressure, and responder and blood pressure normalization rates. The target criterion for tolerability was the number of patients with adverse events (AE). RESULTS: 46% of the patients were controlled with 300 mg irbesartan alone, and 40% with irbesartan in combination with HCT. Albumin excretion normalized in 60.5% of the patients, improved by at least one grade in 81.9%, remained unchanged in 17.5%, and increased in 0.7% of the cases. The beneficial response was found to be independent ofthe type of prior antihypertensive treatment (including ACE-inhibitors) and was also seen in normotensive patients. Only 0.4 % of the patients reported AEs. CONCLUSION: In type 2 diabetics, treatment with 300 mg irbesartan administered alone or in combination with 12.5 mg HCT produced a pronounced nephroprotective effect.

Adolescent↗
PubMed2003

[Aim, design and methods of the "Hypertension and diabetes screening and awareness" -- (HYDRA) study].

Aim of the study is a comprehensive clinical-epidemiological description of the prevalence of arterial hypertension and diabetes among primary care patients along with an assessment of doctor's recognition rates and prescription behaviour. The paper describes methods and design of the study and provides background information on the sampling process, instruments used as well as characteristics of doctors and patients. The study is based on a nationally representative sample of 1,912 primary care doctors and 45,000 patients that attended the doctors' office on the target days. The patients were also characterized by laboratory tests. The first stage of study consisted of a comprehensive description of the doctors' characteristics in terms of psychosocial, qualification- and provider aspects as well as attitudes towards hypertension and diabetes and their management. In the second stage all patients completed a questionnaire to describe their health behaviour and attitudes as well as the treatment history and therapy. In the third stage all patients were characterized by their doctors in terms of their diagnostic status and their past and current interventions.

Adolescent↗
PubMed2003

[Management of diabetes and hypertension: how do primary care physicians judge their performance?].

With regard to the management of hypertension and diabetes, HYDRA reveals that doctors report multiple problems in their everyday practice. Being confronted with an average of 73 patients a day, with almost every second having either diabetes or hypertension, frequently associated with multiple comorbid conditions, the core obstacle is the time factor. Doctors do not have sufficient time to perform diagnostic tests and especially no time for non-drug interventions of any type. Further available treatment guidelines are only used in 1 out of 2 doctors. Further they seem not to affect doctors performance significantly.

Adult↗
PubMed2003

[Hypertension, diabetes mellitus and comorbidity in primary care].

Almost every second patient seeing a primary care doctor suffers from arterial hypertension and about every fifth has diabetes mellitus. These diseases often occur at the same time. They are associated in more than 80% of the cases with other severe concomitant and subsequent diseases (heart attack, stroke, renal failure, neuropathy etc.). The magnitude especially of subsequent and concomitant diseases, the dimension of the personal suffering and the immense diagnostic and therapeutic challenges for the doctors have been massively underestimated so far. The article informs about the prevalence of the above disease, and structure of the problem. Before the background of an extremely high patient load seen by German General Physicians, the mainstay challenge is highlighted how to achieve further improvements of the quality of care on the basis of scientific guidelines alone, without a concomitant change in the system structure.

Adolescent↗
PubMed2003

[Microalbuminuria is an early marker for increased morbidity and mortality].

Recent studies have shown the beneficial effects of a blockade of the renin-angiotensin system (RAS) not only for blood pressure reduction but also end organ protection. One of the markers that is closely correlated with the increased cardiovascular risk is microalbuminuria. A common mediator for the development of both, microalbuminuria and end organ damage seems to be Angiotensin II, the blockade of which apparently reduces microalbuminuria as well as end organ damage. Therefore we had a closer look into pathophysiology of microalbuminuria and the relevance for end organ damage and discuss current medical strategies to alleviate these diseases.

Albuminuria↗
PubMed2003

[Diabetes, hypertension and microalbuminuria in primary care].

Microalbuminuria has been widely appreciated in recent years to be a valuable risk marker for an increased cardiovascular disease morbidity and mortality. Thus guidelines for the treatment of type-2-diabetes in Germany and the US recommend an annual screening as soon as the diagnosis of diabetes is established and a quarterly control when microalbuminuria is present. While nationally representative epidemiologic data from the US have been available, data from Germany, especially from the primary care sector are missing. This is especially important in light of the gatekeeper function of the primary care physician. The "Hypertension and Diabetes Risk Screening Study" (HYDRA) has been identifying 37.8% of patients with hypertension and diabetes to have a positive dipstick test for microalbuminuria on the study day while only 12.5% of these are diagnosed by the doctor as having nephropathy. These patients additionally show a high burden of associated comorbidities and thus call for early detection and intervention especially because effective therapy is available. Although screening for microalbuminuria is recommended in the guidelines the value of a routine screening for microalbuminuria in primary care is under recognized.

Adult↗
PubMed2003

[Nephropathy: an overview for daily practice].

The examination of renal function in the daily practice may give important information on the risk status of a given patient. For example, the diagnosis of microalbuminuria carries high predictive value for a future cardiovascular risk of patients with hypertension, diabetes, congestive heart failure, as well as myocardial infarction. The findings of the Hypertension and Diabetes Screening and Awareness Study (HYDRA) indicate that screening for microalbuminuria is performed not often enough in patients with diabetes or hypertension, respectively, and a positive screening finding often does not trigger necessary consequences as for additional diagnosis or therapy.

Adult↗
PubMed2003

[The harmonic scalpel in conventional thyroid surgery. Possibilities and advantages].

INTRODUCTION: Use of the harmonic scalpel is well established in surgery. The simple use and ability to save blood and time make this equipment usable in thyroid surgery, too. METHODS: In a prospective, nonrandomized study including 32 patients, operating time, weight of resected thyroid tissue, and complications were analysed. A classic surgery group (ligature and HF electrosurgery) was compared with an ultracision group. RESULTS: Mean+/-SD operative time was shorter in the harmonic scalpel group than in the conventional technique group (143.12+/-25.24 min vs 64.68+/-23.83 min, P<0.01). There was no difference between the two techniques regarding complications and patient characteristics. CONCLUSIONS: Use of the harmonic scalpel in thyroid surgery is a safe procedure. The possibility it presents of saving operative time without increasing complications has now been published in several studies.

Adult↗
PubMed2003

[Thyrotoxic crisis].

Besides the typical and in this case severe signs of hyperthyroidism the thyrotoxic crisis is characterized by additional signs and symptoms such as fever, cardiac involvement (tachycardia, arrhythmia, heart failure) and central nervous impairment eventually leading to coma. Additional diseases and comorbidities impair the diagnostic process and may mask the symptoms of thyrotoxicosis. If undiagnosed, this situation harbors a mortality of approximately 90%. The precise knowledge of typical (and atypical) symptoms is mandatory in order to rapidly recognize this situation and to initiate pharmacological treatment and/or surgery. An experienced endocrinologist should always be involved in this decision process.

Antithyroid Agents↗
PubMed2003

[Hypoglycemia, classification, therapy and preventable errors].

Hypoglycemia is a multifactorial problem that is caused by the interaction of numerous variables such as a individual pathophysiological response, treatment aspects and self control. In particular, the increasing use of intensified insulin therapy and thus the goal of normoglycemia has made hypoglycaemia to become a major hazard among the acute complications of diabetes mellitus. Early diagnosis and treatment is thus mandatory to reduce the increased morbidity and mortality of hypoglycaemia. Among the acute therapy of hypoglycaemia treatment includes a modification of diabetes therapy, patient education and a special training of hypoglycaemia awareness.

Diabetes Mellitus, Type 1↗