Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Apr 2004
Review Comparative Study[Future targets in the treatment of type 2 diabetes].
Prevention and treatment of type 2 diabetes mellitus (T2DM) and the metabolic syndrome represent a major clinical challenge, because effective strategies such as fat restriction and exercise are difficult to implement into diabetes treatment. Based on the increasing knowledge on the pathogenesis of T2DM, new therapeutic approaches are currently under investigation. Potential targets of new therapeutic approaches include: (i) Inhibition of hepatic glucose production, (ii) stimulation of glucose-dependent insulin secretion, (iii) enhancement of insulin signal transduction, and (iv) reduction of body fat mass. ⋯ The glucose-lowering effect of current modulators of lipid oxidation is not pronounced and their use could be limited by side effects. In addition to clinically approved thiazolidendiones, new agonists of the peroxisome proliferator activator receptor gamma (PPAR gamma) as well as combined PPAR alpha/gamma agonists are developed at present. The direct modulation of insulin signal transduction is still limited to experimental studies.
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Wien. Klin. Wochenschr. · Mar 2004
Clinical Trial Controlled Clinical TrialSex-hormone-binding globulin is negatively correlated with femoral bone-mineral density in male cardiac-transplant recipients.
Osteoporosis and the subsequent increase in incidence of fractures are a common problem after cardiac transplantation. ⋯ This investigation demonstrates for the first time an association between high sex-hormone-binding globulin levels and low femoral-neck bone-mineral density in a cohort of male cardiac-transplant recipients. Our data support the important role of sex-hormone-binding globulin in the pathogenesis of post-transplantation bone disease, although--possibly because of the small number of patients--we could not prove an interrelation of sex-hormone-binding globulin with vertebral fractures.
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Adequate volume replacement therapy is a mainstay of managing the critically ill. The ideal kind of volume replacement in this situation still remains a challenge. In spite of an immense number of contributions to this problem there is still no definite answer. ⋯ The different physico-chemical properties of the available HES solutions, however, should be taken into account. Anphylactoid reactions as well as negative effects on coagulation, kidney/liver function and on the immune system are frequently used arguments against the administration of HES, but they can virtually be neglected when using modern HES preparations to correct hypovolemia. There are, however, still open questions concerning the use of HES in children, pregnant patients, patients with altered kidney function and in burn patients.
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Wien. Klin. Wochenschr. · Mar 2004
Comparative StudyMeasuring the pressure pattern of the joint surface in the uninjured knee.
Testing an applicable intraoperative system for measuring surface pressure in knee joints, simulating as accurately as possible operating theatre conditions. ⋯ The pressure relationship between the medial and lateral knee compartments could be recorded and was found reproducible in simulated operating-theatre conditions. The measurement of joint surface pressure during implantation of an anterior cruciate ligament graft could provide data for individual intraoperative quality control, thus improving surgical results.