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Biomedical subjects

M Wolters

Publications and source records attributed to M Wolters.

At least 19 recordsLinked to original sources
PubMed2006

Effects of combined supplementation with B vitamins and antioxidants on plasma levels of asymmetric dimethylarginine (ADMA) in subjects with elevated risk for cardiovascular disease.

Elevated plasma asymmetric dimethylarginine (ADMA) concentrations have been suggested as a potential risk factor for cardiovascular disease (CVD). Studies indicate a linkage between hyperhomocysteinemia, oxidative stress and ADMA metabolism. We tested the hypothesis that combined supplementation of B vitamins and antioxidants reduces ADMA concentrations in subjects with at least two CVD risk factors. A total of 123 men and women (58+/-8.1 years) were randomly assigned to take either a preparation including B vitamins and antioxidants (verum) or placebo for 6 months in a double-blind design. Blood concentrations of ADMA, symmetric dimethylarginine (SDMA), L-arginine, B vitamins, total homocysteine (tHcy), alpha-tocopherol, antioxidant capacity (TEAC), and oxLDL were measured pre- and post-intervention. Treatment with verum significantly decreased tHcy (-2.14 micromol/L; P<0.001) and significantly increased TEAC values (+39.3 microM; P<0.022), but no effect on ADMA was observed. OxLDL was significantly reduced in verum (-7.3 U/L; P=0.001) and placebo (-9.2U/L; P<0.001). At baseline, significant correlations were found only between ADMA and SDMA (r=0.281; P=0.002), L-arginine/ADMA and SDMA (r=-0.294; P<0.001), L-arginine/ADMA and oxLDL (r=-0.281; P=0.016), and L-arginine/ADMA and age (r=-0.231; P=0.010). Our results indicate that combined supplementation of B vitamins and antioxidants is not an adequate strategy to reduce ADMA plasma levels in subjects with elevated CVD risk.

Adult↗
PubMed2006

[The significance of diet and associated factors in psoriasis].

Psoriasis is a T cell mediated inflammatory skin disease characterized by hyperproliferation and reduced differentiation of epidermal keratinocytes. In severe cases, the disease can result in an insufficient nutritional status which may even be promoted by nutrient-drug interactions. Both the general diet and single food components have been suggested to play a role in etiology and pathogenesis of psoriasis. Fasting periods, vegetarian diets, and diets rich in omega-3 polyunsaturated fatty acids from fish oil have all been associated with improvement in some studies. The most likely explanation is the reduced amounts of arachidonic acid and the increased eicosapentaenoic acid intake resulting in a modulated eicosanoid profile. However, only one of four controlled studies showed a benefit of omega-3 fatty acids compared to placebo. Some psoriasis patients are gluten-sensitive and may benefit from a gluten free diet. The active form of vitamin D exhibits anti-proliferative and immunoregulatory effects and has been shown to be useful in the treatment of psoriasis.

Adolescent↗
PubMed2006

Selenium and antioxidant vitamin status of elderly German women.

OBJECTIVE: Low antioxidant intake and status have been shown to be associated with an elevated risk for various diseases. Data on the status of antioxidant vitamins, selenium and coenzyme Q10 of younger female seniors are scarce. The aim of this study was to assess the status of these antioxidants, as well as influencing factors such as dietary intake, anthropometric data and educational level in female seniors (60-70 years) in Germany. DESIGN: Dietary intake of alpha-tocopherol, beta-carotene and ascorbic acid was determined by a 3-day diet record. Serum concentrations of alpha-tocopherol, beta-carotene, ascorbic acid, selenium and coenzyme Q10 were measured. Anthropometric measures, socioeconomic and educational status were assessed. SETTING: In total, 178 elderly women without severe diseases in the region of Hannover, Germany, were included in the study. The mean (+/- s.d.) age and BMI of the women was 63.2 (2.73) years and 25.6 (3.77) kg/m2, respectively. The study participants were generally better educated than the overall German female population. RESULTS: Dietary intake of the ascorbic acid and alpha-tocopherol was below RDA in six and 75% of the women, respectively. In comparison to estimated desirable serum concentrations of alpha-tocopherol, ascorbic acid, beta-carotene and selenium, lower concentrations were found in 23, 1, 6, and 39% of the women, respectively. Ascorbic acid (r = 0.205, P = 0.009) and beta-carotene (r = 0.173, P = 0.025) intake were significantly associated with serum concentrations. Beta-carotene concentrations were influenced by the type of diet, BMI, and school education (R2 = 0.128, P < 0.001). Serum selenium was positively associated with alcohol intake (r = 0.229, P = 0.003). Neither employment nor vocational training was predictive for the serum concentrations of antioxidant vitamins, selenium or coenzyme Q10. CONCLUSIONS: Poor status of selenium and alpha-tocopherol is highly prevalent even among younger, well-educated female seniors, whereas ascorbic acid and beta-carotene status seems sufficient in most women.

Aged↗
PubMed2006

[Complications after dermal fillers and their treatment].

All dermal fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of these risks and be prepared to accept them. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., the implantation of a long-lasting filler substance was too superficial). Such adverse events can be treated with intradermal 5-fluorouracil and steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunological phenomena such as late-onset allergy and non-allergic foreign body granulomas. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions should remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granulomas in the subcutaneous fat.

Animals↗
PubMed2006

Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2.

BACKGROUND: According to previous studies, cinnamon may have a positive effect on the glycaemic control and the lipid profile in patients with diabetes mellitus type 2. The aim of this trial was to determine whether an aqueous cinnamon purified extract improves glycated haemoglobin A1c (HbA1c), fasting plasma glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triacylglycerol concentrations in patients with type 2 diabetes. METHODS: A total of 79 patients with diagnosed diabetes mellitus type 2 not on insulin therapy but treated with oral antidiabetics or diet were randomly assigned to take either a cinnamon extract or a placebo capsule three times a day for 4 months in a double-blind study. The amount of aqueous cinnamon extract corresponded to 3 g of cinnamon powder per day. RESULTS: The mean absolute and percentage differences between the pre- and post-intervention fasting plasma glucose level of the cinnamon and placebo groups were significantly different. There was a significantly higher reduction in the cinnamon group (10.3%) than in the placebo group (3.4%). No significant intragroup or intergroup differences were observed regarding HbA1c, lipid profiles or differences between the pre- and postintervention levels of these variables. The decrease in plasma glucose correlated significantly with the baseline concentrations, indicating that subjects with a higher initial plasma glucose level may benefit more from cinnamon intake. No adverse effects were observed. CONCLUSIONS: The cinnamon extract seems to have a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control.

Aged↗
PubMed2005

Monitoring the development of intertidal habitats on former agricultural land after the managed realignment of coastal defences at Tollesbury, Essex, UK.

The managed realignment of coastal defences and subsequent creation of intertidal habitats is one of several 'soft' engineering options that could reduce the costs of maintaining embankments and at the same time deliver environmental benefits. The managed realignment at Tollesbury was one of the first in the UK, undertaken as an experimental test case to improve understanding of the practical techniques and processes involved. Independent studies were undertaken on the development of soils, benthic invertebrates and vegetation within the site in addition to methods of enhancing the process of natural colonisation of saltmarsh plants. Bathymetric and vegetation monitoring were undertaken on the adjacent estuary to determine any breach effect that may be attributed to the realignment. This paper summarises the results from the vegetation, sedimentation and invertebrate monitoring and discusses the implications for other managed realignment schemes in the UK.

Agriculture↗
PubMed2005

Diet and psoriasis: experimental data and clinical evidence.

Psoriasis is considered as a T-cell-mediated inflammatory skin disease which is characterized by hyperproliferation and poor differentiation of epidermal keratinocytes. While susceptibility to psoriasis is inherited, the disease is influenced by environmental factors such as infections and stress. Diet has been suggested to play a role in the aetiology and pathogenesis of psoriasis. Fasting periods, low-energy diets and vegetarian diets improved psoriasis symptoms in some studies, and diets rich in n-3 polyunsaturated fatty acids from fish oil also showed beneficial effects. All these diets modify the polyunsaturated fatty acid metabolism and influence the eicosanoid profile, so that inflammatory processes are suppressed. Some patients with psoriasis show an elevated sensitivity to gluten. In patients with IgA and/or IgG antigliadin antibodies the symptoms have been shown to improve on a gluten-free diet. The active form of vitamin D, 1,25-dihydroxyvitamin D(3), exhibits antiproliferative and immunoregulatory effects via the vitamin D receptor, and thus is successfully used in the topical treatment of psoriasis. In this review, dietary factors which play a role in psoriasis are assessed and their potential benefit is evaluated. Furthermore, the risk of drug-nutrient interactions in psoriasis therapy is discussed.

Antioxidants↗
PubMed2004

[Infant crying diary: a useful aid in distinguishing between normal and excessive crying behavior].

Three infant girls aged 9, 10 and 8 weeks, who cried excessively according to their parents, were referred by the general practitioner to the paediatrician. Using a crying diary it was possible to ascertain that one infant fulfilled the criteria of infantile colic. The diary showed that a second infant was not crying excessively and her mother could be reassured that her baby's behaviour was normal. The third infant proved to be suffering from an organic disease (Alpha-I antitrypsin deficiency), which had not been obvious at clinical assessment. The crying diary provided clues that warranted further investigation. The parents of all 3 infants were reassured and the crying lessened over a period of several weeks. When parents complain that their child cries excessively, it is useful to chart the amount of crying time in a diary. Registration for one week is sufficient. If the child does not suffer from an organic disease, the mainstay of treatment is to explain normal crying behaviour and that it often helps if the infant is not offered too many stimuli. Parents can be reassured that spontaneous resolution will generally occur at the age of three months.

Adult↗
PubMed2004

[Age-associated changes in the metabolism of vitamin B(12) and folic acid: prevalence, aetiopathogenesis and pathophysiological consequences].

The increasing number of older people is characteristic for most industrialised nations and implicates the known psychosocial and economic consequences. Therefore, an optimal nutrient supply that promotes continuing mental and physical well-being is particularly important. In this respect, vitamin B(12) and folic acid play a major role, since deficiency of both vitamins is associated with the pathogenesis of different diseases such as declining neurocognitive function and atherosclerotic lesions. Vitamin B(12) and folic acid act as coenzymes and show a close molecular interaction on the basis of the homocysteine metabolism. In addition to the serum concentrations of the vitamins, the metabolites homocysteine and methylmalonic acid are sensitive markers of cobalamin and folate status. Depending on the used marker, 3-60% of the elderly are classified as vitamin B(12) deficient and about 29% as folate deficient. Predominantly, this high prevalence of poor cobalamin status is caused by the increasing prevalence of atrophic gastritis type B, which occurs with a frequency of approximately 20-50% in elderly subjects. Atrophic gastritis results in declining gastric acid and pepsinogen secretion, and hence decreasing intestinal digestion and absorption of both B vitamins. This is the reason why an insufficient vitamin B(12) status in the elderly is rarely due to low dietary intake. In contrast, folic acid intake among elderly subjects is generally well below the recommended dietary reference values. Even moderately increased homocysteine levels or poor folate and vitamin B(12) status are associated with vascular disease and neurocognitive disorders. Results of a meta-analysis of prospective studies revealed that a 25% lower homocysteine level (about 3 micromol/L) was associated with an 11% lower ischemic heart disease risk and 19% lower stroke risk. It is still discussed, whether hyperhomocysteinemia is causally related to vascular disease or whether it is a consequence of atherosclerosis. Estimated risk reduction is based on cohort studies, not on clinical trials. Homocysteine initiates different proatherogenetic mechanisms such as the formation of reactive oxygen species and an enhanced fibrin synthesis. Supplementation of folic acid (0.5-5 mg/d) reduces the homocysteine concentration by 25%. Additional vitamin B(12) (0.5 mg/d) induces further reduction by 7%. In secondary prevention, supplementation already led to clinical improvements (reduction of restenosis rate and plaques). Depression, dementia, and mental impairment are often associated with folate and vitamin B(12) deficiency. The biochemical reason of this finding may be the importance of folic acid and vitamin B(12) for the transmethylation of neuroactive substances (myelin, neurotransmitters) which is impaired in vitamin deficiency ("hypomethylation hypothesis"). In recent years, there is increasing evidence for a role of folic acid in cancer prevention. As a molecular mechanism of a preventive effect of folic acid the hypomethylation of certain DNA sections in folate deficiency has been suggested. Since folate and vitamin B(12) intake and status are mostly insufficient in elderly subjects, a supplementation can generally be recommended.

Aged↗
PubMed2003

[Dietary supplements and functional food for weight reduction -- expectations and reality].

Looked at with scientific dispassion, much of the frequently aggressive advertising for slimming products must be considered to be dishonest and misleading. This applies, for example, to the "fat burner" carnitine or for chromium-containing preparations such as chromium picolinate, which in large doses have been shown to have detrimental effects on health. Products for which there actually is a scientific rationale all have minor weight-reducing effects, so that they must be considered to have at most an adjuvant role within the framework of evidence-based concepts for losing weight. Examples of alleged slimming substances that in reality can do no more than support weight reduction are the so-called medium-chain triglycerides (MCT) or caffeine, with the latter showing an effect vis-à-vis placebo only in combination studies with ephedrine.

Anti-Obesity Agents↗
PubMed2001

Sentinel node procedure in Ib cervical cancer: a preliminary series.

The aim of this study was to determine the diagnostic accuracy and feasibility of sentinel lymph node (SLN) detection using a gamma probe in patients with Figo IB cervical cancer. Between January 1999 and September 2000, 14 patients with cervical cancer, planned for radical hysterectomy were eligible for the study. The day before radical hysterectomy we injected technetium(99)m-labelled nanocolloid in each quadrant of the cervix. Dynamic and static images were recorded using a gamma camera. SLNs were identified intraoperatively using a handheld gamma-detection probe. After resection of SLNs a standard radical hysterectomy with pelvic lymph node dissection was performed. Patients and tumour characteristics were compared with sentinel node detection and with final histopathological and immunohistochemical results. Scintigraphy showed focal uptake in 13 of the 14 patients. Intraoperatively we detected 26 sentinel nodes by gamma probe. In 8 of 13 patients, one or more sentinel nodes were identified unilaterally, in 5 women bilaterally. Histologically positive SLNs were found in only 1 patient. We did not find any false-negative SLN in our series. In conclusion identification of sentinel nodes in cervical cancer is feasible with preoperatively administered technetium(99)m-labelled nanocolloid. A larger series will be required to establish sentinel node detection in cervical cancer for further therapy concepts and planning.

Adenocarcinoma↗
PubMed2001

Sacrospinous ligament fixation for vaginal vault prolapse.

INTRODUCTION: To assess intra- and postoperative complications and to look for long term follow-up results in women with sacrospinous ligament fixation. METHODS: Between 1988 and 1999, 200 women (mean age 59.8 years, range 33 to 83 years) underwent vaginal unilateral sacrospinous ligament fixation. 172 patients had had prior hysterectomy. In 28 patients concomitant hysterectomy and sacrospinous ligament fixation was performed. Sacrospinous ligament fixation was combined with the following procedures: 109 enterocele repairs (54.5%), 88 anterior colporrhaphies (44%), 57 reconstructions of urogenital diaphragma (28.5%) and 23 posterior colporrhaphies (11.5%). Additional Burch colposuspension and a Stamey procedure were carried out in 7 (3.5%) and 15 (7.5%) patients, respectively. RESULTS: All 200 patients were analysed for intra- and postoperative complications. Urinary tract infection (n = 16, 8.0%), temporary irritation of the sciatic nerve (n = 15, 7.5%), temporary partial ureteral obstruction (n = 11, 5.5%) and blood loss less than 400 ml (n = 7, 3.5%), occurred in the postoperative phase. Long-term data (range from 6 months to 9 years, mean 4.8 years) exist for 123 patients. 119 were completely cured without any signs of urinary incontinence and prolapse. At follow-up 4 patients (3.25%) showed recurrent vaginal vault prolapse. Recurrent cystoceles, rectoceles, enteroceles, were found in 10 cases (8.1%), one (0.8%) and one (0.8%), respectively. Two patients with complete recurrence of vaginal vault prolapse successfully underwent colpectomy and repeated sacrospinous ligament fixation, respectively. CONCLUSIONS. Sacrospinous ligament fixation is an effective and safe procedure with a low recurrence and complication rate.

Adult↗
PubMed2001

[Possibilities and limits of ambulatory surgery: demands and reality in plastic surgery].

With the development of office-based operating rooms and improved office anesthesia, the ability to perform more extensive surgery outside the hospital is now given. Experience with the tumescent technique for liposuction and abdominoplasty has demonstrated that extensive plastic surgery can performed with minimal postoperative discomfort. An emergency phone after surgery is necessary, and a call on the operating day evening and the initial postoperative day is a safe strategy with high patient acceptance for most types of plastic surgery. Additionally, the cost savings of office-based plastic surgery makes this surgery much cheaper for the patients and the health insurance organizations.

Ambulatory Surgical Procedures↗
PubMed2000

Significance of endovaginal ultrasonography in assessing tamoxifen-associated changes of the endometrium. A prospective study.

BACKGROUND: A prospective study was conducted investigating the value of endovaginal ultrasound in the assessment of tamoxifen-associated changes of the endometrium in patients with breast cancer. METHODS: Seventy postmenopausal patients with breast cancer treated with anti-estrogens for at least 6 months were entered. Those with bleeding disorders and/or an endometrial thickness of > or =10 mm found on ultrasonography underwent hysteroscopy and dilatation and curettage (D&C) for further histological evaluation. In 22 patients, positive ultrasound findings could be compared with histopathology. RESULTS: 82% of the 22 patients with positive sonographic findings had a glandular-cystic hyperplasia or a glandular-cystic polyp. No adenomatous hyperplasia or endometrial cancer was observed in our series. CONCLUSION: Vaginal ultrasound represents a useful diagnostic tool to detect tamoxifen-associated changes of the endometrium. A threshold of 10 mm endometrial thickness appears suitable to identify endometrial abnormalities while reducing the rate of false-positive findings to an acceptable level. However, the role of vaginal ultrasound in screening for endometrial cancer or premalignant lesions remains uncertain.

Aged↗
PubMed2000

Deep brain stimulation of the globus pallidus pars interna in advanced Parkinson's disease.

Pallidotomy is now widely performed for the treatment of advanced Parkinson's disease (PD). Preliminary reports of the effect of globus pallidus pars interna deep brain stimulation (GPi DBS) have also been promising. We have analyzed a cohort of 22 consecutive patients enrolled in a multicenter study. Surgery was bilateral in 17 and unilateral in five patients. At 6-month follow-up, the bilaterally GPi-implanted patients demonstrated a marked improvement when examined after drug withdrawal ("off") and under optimal medication ("on") using the Unified Parkinson's Disease Rating Scale (UPDRS). The benefit induced by the stimulation in the "off" medication condition in the total motor score was 31% and in the activities of daily living (ADL) scores was 39%. During the "on" medication period, the reduction in the total "on" dyskinesias score was 66% and in the ADL score was 32%. A similar pattern of improvement was seen in the group of patients with unilateral GPi stimulation, although a second cohort of 12 patients not included in the multicenter study showed greater improvements in "on" motor functioning. Although the effect of DBS is predominantly reversible, electrode insertion alone resulted in measurable clinical effects in the absence of stimulation. Thus, at 6-month follow-up, the benefit observed without stimulation was up to 44% in the "on" dyskinesias score and 29% in timed tapping scores undertaken in the "off" medication state. Complications among 34 patients from all centers included perioperative infection (n=3), hardware fracture (n=2), and premature battery failure (n=3). These results show a positive antiparkinsonian effect of pallidal DBS. No specific complications were observed with bilateral procedures.

Adult↗
PubMed1999

Changes in quality of life following unilateral pallidal stimulation in Parkinson's disease.

Twenty patients with Parkinson's disease (age range 38-70 years) completed the Sickness Impact Profile (SIP) 2 months before and 3 months after long-term high-frequency electrostimulation of the globus pallidus internus to improve clinical symptoms. The SIP provides an estimate of perceived quality of life on 12 health-status categories. Neurological assessment with the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale revealed a significant postoperative reduction in clinical symptomatology (p<0.001). The patients experienced a general improvement in self-reported quality of life that exceeded the purely motor and physical aspects of quality of life. The significant postoperative drop in perceived impairment of communication skills can be considered the most important subjective improvement. Longitudinal research on a larger sample of patients is necessary to evaluate the durability of the subjective improvement in quality of life after unilateral pallidal stimulation.

Adult↗