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H Rau

Publications and source records attributed to H Rau.

At least 19 recordsLinked to original sources
PubMed2004

[Multicenter study of radiosynoviorthesis. Clinical outcome in osteoarthritis and other disorders with concomitant synovitis in comparison with rheumatoid arthritis].

AIM: Evaluation of the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. PATIENTS, METHODS: 803 RSO treatments were monitored in 691 patients by standardized questionnaires of 7 centers in 3 countries. Patients were assigned to 3 groups according to their age (20-40, 41-60, 61-80 years). Additionally, the data were analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis or persistent effusions after joint replacement (group B). RESULTS: Ameliorations of joint pain, swelling/effusion or flexibility were found in 80% of group A and 56% of group B (p >0.01). Quality of life improved in 78% of group A and 59% of group B (p >0.01). The response rate was similar for small- and large-sized joints in group A, but significantly higher for large-sized joints in group B (p >0.01). The positive effects on joint pain, swelling/effusion or flexibility lasted longer in group A (p >0.01). Repeated RSOs were as effective as initial ones. The clinical outcome was neither influenced by age, nor gender, nor transient immobilisation for 48 hours after RSO. CONCLUSION: Although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis.

Adult↗
PubMed2002

[Is the borderline personality disorder a complex post-traumatic stress disorder? - The state of research].

Regarding the high prevalence of traumatic experiences in patients with borderline personality disorders (BPD), we review the available literature focussing on the hypothesis that BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Research of the long-term course of BPD and PTSD, trauma research, and research of vulnerability in both disorders yielded converging results. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD und PTSD also revealed common features. A pathogenetic specificity of individual etiologic factors does not appear to exist, however the assumption of a diathesis-stress model with traumatisation as a necessary but etiologically insufficient condition seems justified. Further research will have to prove BPD as a complex and early-onset post-traumatic stress disorder after multiple and/or chronic (type II) traumatic experiences during childhood and/or youth. Definitive conclusions require further research efforts.

Adolescent↗
PubMed2002

Unbalanced amounts of HLA-DQA1 allele mRNA: DQA1*03 shows high and DQA1*0501 low amounts of mRNA in heterozygous individuals.

Genes of the HLA-DR, DQ region confer strong susceptibility to type 1 diabetes mellitus (IDDM). A possible mechanism of susceptibility is a difference in the amounts of transcripts of predisposing and neutral or protective haplotypes. In this study we developed an assay to compare the amounts of mRNA of two distinct HLA-DQA1 alleles in peripheral blood lymphocytes (PBLs) of heterozygous individuals, using a quantitative RT-PCR with an internal standard covering all HLA-DQA1 specifities. We also developed an algorithm to calculate the amounts of mRNA for two distinct alleles in heterozygous individuals based on the comparison to the same internal standard. In total, 37 HLA-DQA1 heterozygous individuals were analysed, including patients with IDDM (n = 14) and healthy controls (n = 23). Intra-individually, we observed different amounts of mRNA for different HLA-DQA1 alleles in the order: HLA-DQA1*03 > *01 > *0201 > *05. This order was observed in all individuals. We also observed a variation in the ratio of these unbalanced amounts of mRNA in individuals with the same HLA-DQA1 allele combinations. In all allele combinations the average ratio was increased in patients with IDDM compared to the control samples. HLA-DQA1*03 positive and DQA1*03, *05 heterozygous patients had the highest average ratios. Nevertheless, based on limited sample numbers, these differences did not reach significance. We therefore conclude that variations between HLA-DQA1 alleles are not limited to the nucleotide sequence but are also found at the level of amounts of mRNA.

Diabetes Mellitus, Type 1↗
PubMed2002

Effects of pioglitazone in nondiabetic patients with arterial hypertension: a double-blind, placebo-controlled study.

Hypertension is often associated with insulin resistance, dyslipidemia and obesity, which indicate a prediabetic state and increased risk of cardiovascular disease. Pioglitazone treatment of patients with type 2 diabetes reduces insulin resistance and improves lipid profiles. The present double-blind placebo-controlled study is the first study to report effects of pioglitazone in non-diabetic patients with arterial hypertension. Following a one week run-in, 60 patients were randomized to receive either pioglitazone (45 mg/day) or placebo for 16 weeks. Insulin sensitivity (M-value) increased by 1.2 +/- 1.7 mg/min/kg with pioglitazone compared with 0.4 +/- 1.4 mg/min/kg (P = 0.022) with placebo. HOMA index was decreased (-22.5 +/- 45.8) by pioglitazone but not by placebo (+0.8 +/- 26.5; P < 0.001). Decreases in fasting insulin and glucose were significantly (P = 0.002 and P = 0.004, respectively) greater with pioglitazone than placebo. Body weight did not change significantly with either treatment. HDL-cholesterol was increased and apolipoprotein B was decreased to a significantly greater extent with pioglitazone. There was a significantly (P = 0.016) greater decrease from baseline in diastolic blood pressure with pioglitazone. These changes would suggest improved glucose metabolism and a possible reduction in risk of cardiovascular disease with pioglitazone treatment of non-diabetic patients with arterial hypertension.

Apolipoproteins B↗
PubMed2002

[Surgical therapy of advanced gallbladder carcinoma].

The use of surgery for the treatment of advanced gall bladder cancer is controversially discussed. This retrospective study included 204 patients who were subjected to surgery due to advanced gall bladder cancer at the Klinikum Grosshadern. Mean survival time of all patients was 4.5 months. Advancement of the tumor stage resulted in a decreased percentage of possible R0 resections (T3 n = 48, R0 31%, T4 n = 87, R0 13%). Nonetheless, R0 resections of T3 tumors significantly increased the survival rate compared to R1 and R2 resections (mean survival 20.2 vs. 4.5 months). R0 resections of T4 tumors also significantly attenuated the survival rate (18.1 vs. 2.4 months compared to R1 and R2 resections). Thus, diagnostic procedures have to focus on identifying patients with possible R0 resections and perform extensive resections on those patients.

Cholecystectomy↗
PubMed2001

[Radiofrequency ablation of liver metastases. Technique and initial results].

Primary and secondary malignant hepatic tumors are the most common tumors with a much more higher incidence of hepatic metastases. Chemotherapy and radiation therapy are in general ineffective. Therefore, surgical resection is considered the method of choice in the treatment of malignant hepatic lesions. Due to systemic disease, general medical or procedure-related reasons hindering surgery, only 25 to 45% of the patients with metastatic disease of the liver are suitable for a curative surgical therapy. In resectable lesions thermoablative methods can offer an alternative to the surgical therapy. The most experience exists in radiofrequency ablation techniques. Technique, indications, contraindications, and limitations of the radiofrequency ablation will be discussed together with a presentation of own cases and a review of the literature. In 37 patients the primary technical success rate of the ablation was 97.3% (72 of 74 lesions). In 4 cases a hematoma of the liver capsule occurred. One of these had to be treated interventionally. During the limited follow-up period of 9 months no local recurrency was seen, however 4 patients developed new hepatic metastases. Beside differences in practicability it is not yet clarified if there are differences in the therapeutic efficacy of the different thermoablation methods. Nevertheless, the results of the ablation therapy may parallel the results of the surgical resection. Interstitial thermotherapy can provide a valuable contribution to local tumor control. However, the final significance of the thermoablation techniques within oncological therapy regimens has to be evaluated in further multidisciplinary studies.

Adult↗
PubMed2001

The codon 17 polymorphism of the CTLA4 gene in type 2 diabetes mellitus.

Several studies have demonstrated an association of CTLA4 (IDDM12) alanine-17 with type 1 diabetes, but CTLA4 variants have not yet been investigated in type 2 diabetes. The CTLA4 exon 1 polymorphism (49 A/G) was analyzed in 300 Caucasian patients with type 2 diabetes and 466 healthy controls. All patients were negative for glutamate decarboxylase and islet cell antibodies. CTLA4 alleles were defined by PCR, single-strand conformational polymorphism, and restriction length fragment polymorphism analysis using BBV:I. The distribution of alleles as well as the genotypic and phenotypic frequencies were similar among patients and controls [AA, 42 vs. 39%; AG, 47 vs. 46%; GG, 11 vs. 15%, P = not significant (n.s.); A/G, 65/35% vs. 62/38%, P = n.s.; alanine/threonine 92/58% vs. 85/61%, P = n.s.]. However, detailed analysis of clinical and biochemical parameters revealed a tendency of GG (alanine/alanine) toward younger age at disease manifestation (46.8 +/- 0.8 vs. 49.5 +/- 0.8 yr, mean +/- SEM), lower body mass index (21.4 +/- 0.5 vs. 24.4 +/- 0.5 kg/m(2), P = 0.042), and basal C-peptide level (0.33 +/- 0.07 vs. 0.53 +/- 0.07nmol/L), as well as earlier start of insulin treatment (5.8 +/- 1.2 vs. 8.7 +/- 0.6 yr) and higher portion of patients on insulin (71 vs. 61%). Patients with the AA genotype were significantly less likely to develop microangiopathic lesions (P < 0.0005). No differences were found for hypertension or family history of type 2 diabetes. In conclusion, CTLA4 alanine-17 does not represent a major risk factor for type 2 diabetes. Additional studies on larger groups and different ethnic groups are warranted to clarify the association of the GG genotype with faster ss-cell failure and the lower rate of microvascular complications in AA carriers.

Abatacept↗
PubMed2000

A preliminary report relating frequency of vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure, and cohabitation status.

The relationship between recalled frequency of penile-vaginal intercourse (FSI) and resting heart rate variability (HRV; an index of parasympathetic tone), resting diastolic blood pressure (DBP) and heart rate (HR) response to the Valsalva maneuver was examined in 51 healthy adults aged 20-47 (subjects scoring above the 86th percentile on the Lie scale of the Eysenck Personality Inventory (EPI) were excluded). As hypothesized, greater HRV and lower DBP were both associated with greater FSI (but not masturbation or non-coital sex with a partner) in cohabiting subjects, but not in non-cohabiting subjects. Valsalva ratio was unrelated to sexual behavior. Results are discussed in terms of both the modulating role of blood pressure on a number of psychological functions and the role of parasympathetic tone in HRV, FSI, and possibly pair-bonding.

Adult↗
PubMed2000

[Effects of biphasic spiral CT, conventional and iron oxide enhanced MRI on therapy and therapy costs in patients with focal liver lesions].

PURPOSE: Evaluation of the diagnostic efficacy and cost-benefit of contrast enhanced CT (CT) and MRI pre- and post-SPIO-particles in focal hepatic disease with consideration of therapeutic outcome. METHODS: In 52 patients with the suspicion of primary or secondary hepatic malignancy, biphasic spiral CT and breath-hold gradient-echo T1- and fast spin-echo T2-weighted MRI pre- and post-iron oxide administration (1.5 T, body-phased-array coil) were compared. The number of hepatic lesions and the related diagnoses resulting from each imaging modality were recorded and statistically correlated to the final diagnoses established by biopsy/OP (34/52), long term follow-up of 12 months (18/52), and a consensus reading of all imaging modalities considering all clinical imaging information. The most likely induced therapy resulting from each imaging test was correlated to the final therapy. Based on data from the hospitals accountants, the therapy-related costs were estimated without hospitalization costs. RESULTS: In 34/52 (65.4%) of the cases the correct diagnosis was primarily stated by CT (sensitivity [se.] 85.2%, specificity [sp.] 44.0%). In additional 10/52 of the cases unenhanced MRI (se. 91.4%, sp. 75.0%) enabled correct diagnoses, and in another 6 cases the diagnosis was established only by SPIO-MRI (se. 100%, sp. 86.7%). Considering the possible therapeutic recommendation arising from each modality, CT would have induced needles therapy costs of 191,042 DM, unenhanced MRI of 171,035 DM, and SPIO-MRI of 7,311 DM. In comparison to the real therapy costs of 221,873 DM, this would have corresponded to an unnecessary increase of therapy costs of 86.1%, 77.1%, and 3.3%, respectively. In two cases (1 hemangioma, 1 regenerative nodule) all modalities failed, causing unnecessary surgery in one patient. DISCUSSION: In this problem-oriented scenario unenhanced and SPIO-enhanced MRI proved to be superior to CT regarding diagnostic efficacy. The cost-benefit resulted mainly due to preserving patients from unnecessary surgical procedures.

Adenoma, Liver Cell↗
PubMed2000

Liver transplantation in primary biliary cirrhosis: risk assessment and 11-year follow-up.

BACKGROUND/AIMS: Liver transplantation (LTx) is the only established treatment in patients with end-stage primary biliary cirrhosis (PBC). Although short-term survival after LTx in this group of patients is usually good, few data exist on the long-term survival. The optimal timing of transplantation is difficult. Thus, the aims of this study were to assess the long-term survival of patients with PBC after LTx and to identify potential predictive factors for a positive outcome. METHODS: Survival of 28 patients with PBC who underwent LTx between 1985 and July 1999 in a single center was studied by Kaplan-Meier analysis and was compared to predicted survival without LTx using established prognostic models for PBC, the Mayo and European risk scores. Potential prognostic parameters obtained before LTx were tested for correlation to survival. Rates of bone fractures as markers of hepatic osteodystrophy were compared before and after LTx. RESULTS: Median follow-up after LTx was 90 months with a maximum of 140 months. Actuarial survival of patients with PBC was 89% after 1, 5, and 10 years and was significantly better than estimated survival without LTx after 1-7 years as calculated by the Mayo and European risk scores. Of several parameters tested, only serum bilirubin and the prognostic scores, but no other liver function tests obtained immediately prior to transplantation were significantly correlated with survival after LTx. The duration of intensive care after LTx was not associated with any parameters obtained before LTx. Bone fractures were diagnosed in 43% of patients of whom the vast majority were osteopenic before LTx as determined by osteodensitometry. CONCLUSION: Long-term survival of a well-defined group of patients with PBC was excellent after LTx and was inversely correlated with preoperative serum bilirubin levels as well as Mayo and European risk scores.

Adult↗
PubMed2000

Naturally occurring amino acid substitutions at Arg1174 in the human insulin receptor result in differential effects on receptor biosynthesis and hybrid formation, leading to discordant clinical phenotypes.

Missense mutations in the tyrosine kinase domain of the human insulin receptor frequently result in a dominantly inherited form of insulin resistance. We noted a marked disparity in the clinical phenotypes of our study subjects with different missense mutations at the same residue (Arg1174) of the insulin receptor. Subjects with a tryptophan substitution (W) were only moderately hyperinsulinemic, whereas those with a glutamine substitution (Q) had severe clinical and biochemical insulin resistance. Studies were undertaken to explore the molecular mechanisms underlying these differences. Both W and Q mutant receptors bound insulin normally but were kinase inactive. The W mutation resulted in more rapid degradation of newly synthesized mutant receptor, which contrasted with the near-normal biosynthesis of the Q receptor. The propensity of the W receptor to form hybrids with the cotransfected wild-type (WT) receptor was also markedly impaired compared with the Q receptor, to an extent greater than could be explained by lower steady-state expression. Thus, the more clinically benign consequences of the heterozygous W mutant receptor are likely to relate to its impaired biosynthesis and/or reduced capacity to form hybrids with WT receptors. In addition to providing an explanation for the milder phenotype of 1174W versus 1174Q carriers, these studies provide further support for the notion that the dominant-negative effect of insulin receptor tyrosine kinase mutations involves the competition between inactive mutant homodimers and WT/mutant hybrids with active WT homodimers for both ligands and intracellular substrates.

Adolescent↗
PubMed2000

[Styles of interpersonal conflict in patients with panic disorder, alcoholism, rheumatoid arthritis and healthy controls: a cluster analysis study].

OBJECTIVE: Conflict and conflict resolution in intimate relationships are not only among the most important factors influencing relationship satisfaction but are also seen in association with clinical symptoms. Styles of conflict will be assessed in patients suffering from panic disorder with and without agoraphobia, in alcoholics and in patients suffering from rheumatoid arthritis. METHODS: 176 patients and healthy controls filled out the Styles of Conflict Inventory and questionnaires concerning severity of clinical symptoms. RESULTS: A cluster analysis revealed 5 types of conflict management. Healthy controls showed predominantely assertive and constructive styles, patients with panic disorder showed high levels of cognitive and/or behavioral aggression. Alcoholics showed high levels of repressed aggression, and patients with rheumatoid arthritis often did not exhibit any aggression during conflict. CONCLUSIONS: 5 Clusters of conflict pattern have been identified by cluster analysis. Each patient group showed considerable different patterns of conflict management.

Adult↗
PubMed1999

[Diagnosis and staging of liver metastases with imaging methods].

Liver metastases are much more common than primary hepatic malignancies and may occur in up to 80% of patients with extrahepatic malignancies. To optimize the patient's management, precise detection or exclusion of liver metastases, as well as assessment of their number and extent, is indispensable. For imaging of liver metastases, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), scintigraphy, and angiography can be utilized. All these methods have been technically improved with benefits for diagnostic utility. Biphasic contrast-enhanced spiral CT (SCT) and MRI with modern pulse sequences and tissue-specific contrast agents are superior to other imaging modalities in terms of diagnostic efficacy and reproducibility of results. With SCT and MRI sensitivities and specificities in the diagnosis of focal hepatic disease are in the range of 80-95%. Moreover, their non-invasiveness is a strong advantage. The diagnostic strategy in the assessment of liver metastases has to take into account both the strengths and limitations of the respective method. Additionally, the clinical situation of a particular patient has to be considered, and conclusive diagnostic results have to be achieved in a short time in order to ensure a favourable cost-effectiveness relation.

Colorectal Neoplasms↗
PubMed1999

[Comparison of dual-phase helical CT with native and ferum oxide-enhanced magnetic resonance imaging in detection and characterization of focal liver lesions].

PURPOSE: Evaluation of the diagnostic efficacy of contrast-enhanced, dual-phase spiral CT and MRI before and after administration of SPIO particles in focal hepatic disease with previously uncertain diagnosis. MATERIAL AND METHODS: In 46 patients in whom primary or secondary hepatic malignancy was suspected, dual-phase spiral CECT and breath-held T1-weighted gradient-echo and T2-weighted fast spin-echo MRI (1.5 T, body-phased-array coil) before and after SPIO administration were compared. The indications for the subsequent MRI studies were based on ambiguous findings on CECT. The number of hepatic lesions, the overall lesion detection and characterization was evaluated by consensus and compared to the gold standard (histological proof in 30/46 of the cases, long-term follow-up in 16/46 of the cases). RESULTS: In 34 of 46 cases the correct diagnoses were established by CECT (sensitivity 96%, specificity 48%) revealing significantly less lesions than MRI. Unenhanced MRI had sensitivity of 93% and specificity of 71%, whereas SPIO-enhanced MRI had sensitivity of 97% and specificity of 88%. The differences between the modalities were even more pronounced in the detection of lesions smaller than 10 mm with SPIO-MRI as the most sensitive method. CONCLUSIONS: In this problem-oriented scenario, SPIO-enhanced MRI was superior to spiral CT and unenhanced MRI regarding the diagnostic efficacy in the pre-operative work-up of focal liver lesions. SPIO-enhanced MRI can be recommended as a problem-solving tool for the clinical routine.

Adult↗