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Biomedical subjects

P H Kann

Publications and source records attributed to P H Kann.

At least 19 recordsLinked to original sources
PubMed2006

[The new role for endoscopic ultrasound in endocrinology: imaging of the adrenals and the endocrine pancreas].

Endoscopic ultrasound imaging of the adrenals and the endocrine pancreas enriches the diagnostic repertoire and improves the clinical opportunities of endocrinology. Its resolution enables detection of tumors as small as 2-3 mm. Endoscopic ultrasound imaging is especially relevant in the diagnosis of insulinomas and primary hyperaldosteronism, because it has direct consequences in planning a diagnostic and therapeutic strategy.

Adrenal Gland Diseases↗
PubMed2006

Small neuroendocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1): least significant change of tumor diameter as determined by endoscopic ultrasound (EUS) imaging.

Endosonography enables detection and localization of small pancreatic neuroendocrine tumors (PETs) which cannot be detected by computed tomography, magnetic resonance imaging, or somatostatin receptor scintigraphy. Knowledge about the prognosis of very small PETs in MEN1 is limited, and if there are no clinical symptoms, endocrine activity or mechanical problems and thus no clear indication for surgical therapy, an appropriate decision for the management of such patients might be to control their follow-up by endosonographic imaging. Therefore, the reproducibility of the measurement of the diameter of very small PETs by endosonographic imaging was investigated in this prospective study. We included 33 PETs smaller than 15 mm in their largest diameter detected by endosonographic imaging (Pentax FG 32 UA) in ten patients with genetically confirmed MEN1-disease. Three repeated measurements of each tumor were performed. Reproducibility was expressed as mean coefficient of variation of intra-observer variability. Mean tumor diameter was 6.9 +/- 3.4 mm (range 2.8 - 14.2 mm). Mean coefficient of variation was 5.5 +/- 4.6 % (range 0.0 - 19.4 %): in tumors < 5 mm (n = 13) 7.1 +/- 6.3 %, in tumors > 5 mm (n = 20) 4.4 +/- 2.6 %. Least significant change (p < 0.05) was calculated as 15.4 % (tumors < 5 mm: 19.9 %; tumors > 5 mm: 12.3 %). In conclusion, endosonographic imaging enables the measurement of small PETs with an acceptable reproducibility. Changes of tumor diameter of more than 20 % have to be taken as statistically significant.

Carcinoma, Neuroendocrine↗
PubMed2006

Starting insulin therapy in type 2 diabetes: twice-daily biphasic insulin Aspart 30 plus metformin versus once-daily insulin glargine plus glimepiride.

AIM: To compare the efficacy and safety of two analog insulins as starting regimens in insulin-naïve Type 2 diabetes patients. METHODS: In this randomized, open-label parallel study, twice-daily biphasic insulin aspart 30 (30% soluble and 70% protaminated insulin aspart; BIAsp 30) plus metformin (met) was compared with once-daily insulin glargine (glarg) plus glimepiride (glim) in 255 insulin-naïve patients (131 male; mean+/-SD age, 61.2+/-9.1 years). Mean baseline HbA (1c) (+/-SD) was 9.2+/-1.4% and 8.9+/-1.3% for BIAsp 30 plus met ( N=128) and glarg plus glim ( N=127), respectively ( P=0.0747). Primary endpoint was the difference in absolute change in HbA (1c) between groups after 26 weeks of treatment. RESULTS: HbA (1c) change was significantly greater in the BIAsp 30 plus met group than the glarg plus glim group (between-group difference: -0.5% (95% CI: -0.8; -0.2); P=0.0002). Mean prandial plasma glucose increment was significantly lower for BIAsp 30 plus met compared with glarg plus glim: 1.4+/-1.4 mmol/l vs. 2.2+/-1.8 mmol/l; P=0.0002. During the maintenance phase (weeks 6-26), one major hypoglycemic episode occurred in each group; 20.3% and 9% of patients experienced minor hypoglycemic episodes in the BIAsp 30 plus met and glarg plus glim groups, respectively ( P=0.0124). At end-of-trial, mean daily insulin doses were 0.40 U/kg BIAsp 30 and 0.39 U/kg glarg. Glarg plus glim-treated patients experienced significant weight gain of 1.5 kg (95% CI: 0.84; 2.19; P<0.0001). Weight change with BIAsp 30 plus met of +0.7 kg was not statistically significant (95% CI: -0.07; 1.42; P=0.0762). CONCLUSIONS: Starting insulin in Type 2 diabetes patients with twice-daily BIAsp 30 plus met can reduce HbA (1c) and mean prandial plasma glucose increment to a greater extent than once-daily glarg plus glim.

Aged↗
PubMed2006

Natural course of small, asymptomatic neuroendocrine pancreatic tumours in multiple endocrine neoplasia type 1: an endoscopic ultrasound imaging study.

Endoscopic ultrasound (EUS) enables detection and localization of pancreatic neuroendocrine tumours. Even small tumours down to a diameter of 1-2 mm can be visualized. Since such small tumours usually cannot be detected by computed tomography (ct), magnetic resonance imaging (mri) and somatostatin receptor scintigraphy (srs), and experience with EUS imaging is limited, there is no clear evidence for clinical management in multiple endocrine neoplasia type 1 (MEN1). Knowledge about the natural course of growth and metastatic distribution is mandatory to come to appropriate clinical decisions and guidelines. This prospective study was aimed to assess the natural course of small (<15 mm) neuroendocrine pancreatic tumours without clinical symptoms due to endocrine activity or mechanical problems and without clear indication for surgical therapy in MEN1 by EUS. A total of 82 asymptomatic tumours<15 mm (5.9+/-3.2 mm diameter at baseline) in 20 patients with MEN1-disease (8 female/12 male, 43+/-13 years) were studied over a period of 20+/-12 months (33.8 patient years, 106.7 tumour years) by EUS. Change in largest diameter of each tumour and annual tumour incidence rate in the patients' cohort were calculated. Increase of largest tumour diameter was found to be 1.3+/-3.2% per month, annual tumour incidence rate 0.62 new tumours per patient year. In one patient, rapid progressive pancreatic manifestation of MEN1 was observed. There was no evidence in ct and/or srs and/or mri for metastatic disease in all patients. Only 4/84 (4.8%) pancreatic tumours could be visualized by computed tomography, 5/79 (6.3%) by somatostatin receptor imaging and 4/39 (10.3%) by magnetic resonance imaging. Small asymptomatic neuroendocrine pancreatic tumours in MEN1 usually seem to grow slowly. Annual tumour incidence rate is low. However, faster growing tumours and patients with rapidly progressive disease can be observed. Risk for obvious metastatic disease from asymptomatic neuroendocrine pancreatic tumours<15 mm in MEN1 seems to be low.

Adult↗
PubMed2006

Antidiabetic medications in overdose: a comparison of the inquiries made to a regional poisons unit regarding original sulfonylureas, biguanides and insulin.

OBJECTIVE: The drugs most commonly used to treat diabetes mellitus are sulfonylureas, biguanides and insulin. The most serious effects seen in overdose with these agents are hypoglycemia or lactic acidosis which may be fatal or cause cerebral defects. The present investigation analyzes inquiries made to a regional poisons unit involving overdoses with sulfonylureas, biguanides and insulin. PATIENTS AND METHODS: A total of 218,070 made inquiries between 1995 and 2004 were evaluated. The inquiries were received by telephone and a standardized questionnaire was sent subsequently to the physicians calling for follow-up information. The cases were analyzed with regard to gender, age, etiology, symptoms and clinical outcome. RESULTS: 263 inquiries concerning sulfonylureas (48.3% female, 49.4% male, 2.3% sex unknown, average age 39.1 +/- 26.8 years), 172 concerning biguanides (60.5% female, 37.2% male, 2.3% sex unknown, average age 41.5 +/- 24.1 years), and 191 concerning insulin (53.9% female, 41.9% male, 4.2% sex unknown, average age 44.6 +/- 16.7) were made. In cases involving sulfonylureas, the etiology was deliberate self-poisoning in 62.7% and accidental in 31.9% (biguanides 60.5% and 29.1%, insulin 85.3% and 9.4%). Using the Poisoning Severity Score, no symptoms were observed in 41.4% of the patients with sulfonylurea overdose (biguanides 40.1%, insulin 22.5%), minor symptoms in 37.6% (biguanides 32.6%, insulin 33.5%), major symptoms in 14.4% (biguanides 13.4%, insulin 26.2%) and serious symptoms in 4.6% (biguanides 12.2%, insulin 14.7%). Returned questionnaires reporting clinical outcomes showed that a full recovery occurred in most patients (sulfonylureas 97.4%, biguanides 93.0%, insulin 94.4%), cerebral defects persisted in 1.8% of the cases involving sulfonylureas (biguanides 1.5%, insulin 2.4%), and that 0.9% of the patients with sulfonylurea overdose died (biguanides 6.1%, insulin 3.6%). CONCLUSIONS: Sulfonylureas were the most frequently observed medication in cases of overdose with antidiabetic agents. Insulin overdose caused the highest number of major and serious symptoms. Overdose with biguanides led to the most deaths.

Adult↗
PubMed2005

Transiliac bone biopsy in osteoporosis: frequency, indications, consequences and complications. An evaluation of 99 consecutive cases over a period of 14 years.

Bone biopsy is a diagnostic procedure restricted to untypical, unclear and complicated cases in evidence-based guidelines on diagnosis and treatment of osteoporosis. Its relevance has been a topic of recent controversial discussion. This study was performed to evaluate its role and relevance in routine use. A total of 99 horizontal transiliac bone biopsies performed over a time period of 14 years because of an osteological indication in one single centre were analysed, which reflects that bone biopsy followed about 0.003% of patients' consultations. Bone biopsies were indicated for osteoporotic males (n = 63) and premenopausal osteoporotic females (n = 18) without endocrine abnormality and normal immunofixation (serum and urine), suspected systemic/malignant disease such as mastocytosis, osteogenesis imperfecta, non-secreting plasmocytoma, metastatic infiltration (n = 16) and decreasing bone mineral density under anti-osteoporotic treatment (n = 2). The most frequent diagnoses besides osteoporosis were normal histology, borderline finding towards mild osteoporosis, and osteoporomalacia with relevant osteoidosis. In some cases, pathological findings in bone marrow were detected. In most cases (82/99), bone biopsy led to consequences in medical treatment. Following histopathological diagnosis, 16 patients did not receive any anti-osteoporotic treatment. In six patients, further diagnostic procedures were initiated because of bone histology. Bone biopsy was well tolerated and complications were rare and mild. In conclusion, despite all progress in non-invasive diagnostic procedures for metabolic bone diseases such as osteoporosis, there remains a small but significant subset of patients who may benefit from inclusion of bone biopsy into the diagnostic procedure.

Adult↗
PubMed2005

[Minimal-invasive operative treatment of organic hyperinsulinism].

BACKGROUND: Insulinomas are small, solitary and benign endocrine pancreatic tumours, causing organic hyperinsulinism by autonomous insulin-secretion. Episodes of severe hypoglycemia and progressive obesity are the most frequent clinical signs. Surgical resection of the tumours is always indicated for cure. Because the tumours are small and surgical trauma for adequate exposure of the pancreas is considerable, laparoscopic techniques to approach these tumours are attractive. On the occasion of two cases, this report describes the laparoscopic treatment of these rare tumors. ANAMNESIS: Two male patients (15 years of age and 50 years of age) were admitted for seizures and symptoms of hypoglycaemia. FINDINGS: During fasting tests, both were diagnosed organic hyperinsulinism, with a blood glucose level of 28 mg/dl, insulin of 15.9 mU/ml and a c-peptide of 1.7 microg/l for an insulinogenic index of 0.57 determined in the young man. Similar values were obtained in the older man. Conventional imaging procedures were non diagnostic whereas endoscopic ultrasound of the pancreas revealed a 8 x 13 and 10 x 9 mm lesion in the pancreas. THERAPY AND COURSE: Laparoscopic resection of the tumor was attempted and accomplished in both patients. The young man underwent laparoscopic enucleation of the tumor, while the 50 year old man underwent left sided laparoscopic resection of the pancreas because the tumor was adjacent to the pancreatic duct. Postoperative course was uneventful in both cases. CONCLUSION: It is to be expected, that this approach will receive increasing attention in the near future.

Adolescent↗
PubMed2005

[Growth hormone therapy in adults].

In adult patients with growth hormone deficiency due to organic hypopituitarism, substitution with growth hormone is very useful and well established. Positive influence on numerous target parameters has been investigated in randomised controlled trials (evidence level I) and could be documented. Thus, growth hormone substitution in hypopituitarism is scientifically founded and has been admitted by the authorities in the European Union. Concerning pharmacotherapy with growth hormone in healthy elderly persons without pituitary disease and also doping in sports, the situation is completely different. Use of growth hormone in these circumstances has not sufficiently been investigated concerning indications, efficacy and safety. Ethical and economical aspects have not been evaluated yet. Serious concerns about the therapeutic safety need to be considered.

Adult↗
PubMed2005

Sialadenosis of the major salivary glands in a patient with central diabetes insipidus--implications of aquaporin water channels in the pathomechanism of sialadenosis.

Sialadenosis, also referred to as sialosis, is a disease of unknown aetiology. It regularly manifests itself as a massive swelling in both parotid regions involving the major salivary glands, preferably the parotid glands and is characterized by lack of any detectable, underlying pathologies. In this case report we describe a 24-year-old white female patient with diabetes insipidus who developed sialadenosis of the major salivary glands during a period of enhanced water requirement, which the patient tried to compensate for by more frequent nasal ADH application. Since ADH acts on aquaporins (AQPs) in the kidney, we were interested if AQP expression in the patients salivary glands was affected. Surprisingly, compared to normal control tissues we observed an extensively high signal for AQP5, which is the dominant AQP found in salivary acinar cells. Interestingly, previous studies on AQP5 knock out mice found AQP5 to be required for cell volume regulation. We therefore suggest that aquaporin water channels and antidiuretic hormone together with a disturbance in the body's water household are potential key-factors in the pathophysiological events leading to the development of the disease entity called sialadenosis.

Adult↗
PubMed2005

Endoscopic ultrasound imaging of insulinomas: limitations and clinical relevance.

Compared to other imaging methods, endoscopic ultrasound is the best procedure to localize insulinomas preoperatively. Positive finding furthermore confirms endocrinological diagnosis, especially considering the differential diagnosis of hypoglycaemia factitia by oral antidiabetics. However, it always has to be considered that endoscopic ultrasound imaging may reveal false positive and false negative results, and quality of the findings obtained by endoscopic ultrasound imaging depends to a large extent on the examiner's experience. An important issue of endoscopic ultrasound imaging in insulinomas nowadays is planning surgical strategy. As illustrated by three cases, endoscopic ultrasound imaging enables to identify patients that qualify for laparoscopic, minimal invasive surgery.

Adolescent↗
PubMed2005

Clinical and laboratory evaluation of a new specific ELISA for intact proinsulin.

Intact proinsulin is a marker for pancreatic beta-islet cell secretion status, and elevated levels indicate insulin resistance of type 2 diabetic patients with a high diagnostic specificity. Determination of intact proinsulin in fasting morning plasma samples can be used to establish and/or identify the optimal anti-diabetic treatment as well as to monitor a potential protective treatment effect on beta-islet cell dysfunction. For widespread use as a routine marker, simple and reliable assays must become available for measurement in clinical laboratories. This study was performed to evaluate a new ELISA method specific for intact proinsulin determination compared with a commercial chemiluminescence test. Intra-assay imprecision was determined to be 2.4 - 5.5% (inter-assay: 3.2 - 4.3%). A sample cohort derived from non-diabetic healthy subjects (66 female, 29 male, age (median, range): 37 (19-77) years) was used to calculate a reference range for non-diabetic individuals of 1.8 - 11.0 pmol/l. The comparison of samples obtained from 7 diabetic patients (2 female, 5 male, age: 66 (44-72) years) from oral glucose tolerance tests resulted in an excellent correlation between the ELISA and the chemiluminescence assay (r = 0.989; p<0.001). A sample stability investigation with different sample specimens revealed that intact proinsulin is stable for two days at room temperature in EDTA whole blood and heparin whole blood tubes without centrifugation, while serum samples should be centrifuged immediately and frozen to retain intact proinsulin concentrations. As EDTA whole blood is the routine sample specimen for determination of HbA1c, a marker frequently measured in diabetic patients, this finding underlines the practicability of analyzing intact proinsulin from the same blood specimen. In conclusion our study revealed that the new ELISA shows excellent agreement with the commonly used chemiluminescence immunoassay. The ELISA can easily be introduced into routine laboratories and does not require any further specific instrumentation. Our additional finding that intact proinsulin is stable in EDTA whole blood samples, which can be obtained from the routine.sample for HbA1c measurement, is increasing the probability of the acceptance of this marker for routine assessment of beta-cell dysfunction and insulin resistance in type 2 diabetes.

Adult↗
PubMed2004

Clinical effects of growth hormone on bone: a review.

Growth hormone (GH) stimulates bone turnover. Deficiency of GH due to hypopituitarism is related to low bone mineral density and increased fracture risk. GH substitution increases and thus normalizes bone mineral density in these patients, which is one of a number of arguments for GH substitution in hypopituitarism. In contrast, a possible therapeutic use of GH in idiopathic osteoporosis and glucocorticoid-induced osteoporosis is speculative and not established. Reduction of osteoporosis risk is an argument brought up for a use of GH in healthy elderly persons (anti-aging medicine). However, since only very limited data are available yet, this cannot be based on scientific evidence, and there are important concerns about the safety of use of GH in healthy elderly persons.

Bone Density↗