Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1994
Review[The value of metformin in therapy of type 2 diabetes: effect on insulin resistance, diabetic control and cardiovascular risk factors].
In this review article recently published controlled clinical studies of metformin treatment in type-2 diabetic patients are summarized. Several studies demonstrate that body weight decreases and insulin resistance improves--as evaluated by peripheral glucose utilisation--under metformin treatment. HbA1c is lowered by approximately 20% (absolute decrease of HbA1c: 1.0%-1.5%). Since plasma lipid values and plasminogen-activator-inhibitor (PAI-1) concentrations are also lowered under metformin therapy, it currently represents the treatment of choice for the obese group of type-2 diabetic patients.
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Wien. Klin. Wochenschr. · Jan 1992
Review[Differential diagnosis and therapy of various forms of hyperphenylalaninemia: facts and fiction].
The various conditions which can lead to elevated blood phenylalanine (PHE) levels must be differentiated promptly in the neonatal period so that the correct treatment can be implemented as soon as possible. In order to exclude the rare tetrahydrobiopterin (BH4) deficiency, it is advisable to perform a BH4 loading test and to determine the renal excretion of pterins, as well as the dihydropteridine reductase activity in erythrocytes. The practical consequence of differentiating the various types of PHE hydroxylase deficiency is that with both phenylketonuria (PKU; PHE greater than 20 mg/dl) and hyperphenylalaninemia (HPA) with PHE levels above 15 mg/dl a diet restricted in PHE is initiated, whereas HPA infants with PHE levels below 8 mg/dl are fed normally. ⋯ Psychometric investigations of PKU patients after diet discontinuation at different ages, as well as animal studies are in favour of a diet-for-life. The diet in PKU patients is known to lead to some side effects such as bony changes and amino acid imbalance, as well as deficiency of selenium and carnitine. Finally, great efforts have to be made in order to avoid the increasing danger of PHE embryofetopathy in the offspring of PKU mothers (maternal PKU).
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Wien. Klin. Wochenschr. · Jan 1991
Review[Noninvasive monitoring of rejection in heart transplant patients. An overview of current status and use at a small transplant center].
In view of the numerous techniques known for noninvasive rejection monitoring for heart transplant recipients, it is important, especially for small transplant centres, to select suitable parameters for routine monitoring. We verified the methods for rejection monitoring and on the basis of the good results after orthotopic heart transplantation in our unit (33 patients, 78% overall survival, no death later than 6 months after transplantation), consider the following parameters useful for small transplant centres: heart/thorax ratio, echocardiography and neopterin. The Fast-Fourier analysis should prove of great value for small transplant units, given the availability of suitable apparatuses.
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GABAA-benzodiazepine receptors and epilepsy. gamma-Aminobutyric acid (GABA) is quantitatively one of the most important neurotransmitters in the central nervous system. Since the predominant action of GABA on neurons is inhibitory, activation of GABA receptors, and especially of GABAA receptors, causes an anticonvulsive effect. GABAA receptors can be activated either directly by GABA or GABA-agonists, or indirectly by allosteric modulation of these receptors. ⋯ These compounds cause convulsions and are called "inverse agonists" of the benzodiazepine receptors. Recent evidence indicates the existence of several different benzodiazepine receptor (and, thus, GABAA receptor) subtypes. Since these receptor subtypes exhibit a different regional distribution in the central nervous system, the development of subtype-selective GABAA receptor agonists or benzodiazepine receptor agonists should result in anticonvulsants with less side effects.