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Biomedical subjects

R Schiel

Publications and source records attributed to R Schiel.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prevalence of sexual disorders in a selection-free diabetic population (JEVIN).

There is an extensive literature on sexual disorders among diabetic patients, but a shortage of studies on their prevalence in selection-free populations. In the present trial (JEVIN), 90% of all insulin-treated diabetic patients (IDDM/NIDDM, n = 127/117) aged 16-60 years and living in the city of Jena (100247 inhabitants) were studied. Each subject underwent a structured interview followed by a clinical and laboratory examination. The prevalence of sexual disorders was 32% in IDDM and 46% in NIDDM male patients. Patients with sexual disorders were older (IDDM 47.5 +/- 9.8 vs. 37.7 +/- 11.6, P = 0.0004; NIDDM 53.4 +/- 4.3 vs. 49.5 +/- 8.2 years, P = 0.04) and had longer diabetes duration (IDDM 23.1 +/- 13.8 vs. 13.5 +/- 11.1, P = 0.001; NIDDM 12.4 +/- 7.5 vs. 8.4 +/- 5.8 years, P = 0.03) than patients without sexual disorders. There were no significant differences (P < 0.05) between the groups as regards HbA1c, body-mass index and insulin dose/kg body weight. The prevalence of diabetes long-term complications in men with versus men without sexual disorders (IDDM/NIDDM): retinopathy, 65/53% vs. 50/18% (P = 0.34/0.03); neuropathy, 58/48% vs. 9/34% (P = 0.001/0.47); nephropathy, 65/50% vs. 12/36% (P = 0.001/0.45). In addition, all the patients completed standardized questionnaires according to Bradley et al. and Lewis et al. to assess quality of life and treatment satisfaction, and one question concerning sexual disorders. The quality of life of IDDM patients with sexual disorders was lower than that of patients without sexual disorders (42.2 +/- 11.4 vs. 54.2 +/- 8.5, P = 0.0005), but there were no differences (P < 0.05) in NIDDM patients. In women, the prevalence of sexual disorders was 18/42% in IDDM and NIDDM. Comparing these data with the literature and with reports from healthy controls, mostly there is clearly an underestimation of the prevalence of sexual disorders in diabetic populations. Physicians must make more efforts to detect and treat sexual disorders, which may result in an improvement of patients' quality of life.

Adolescent↗
PubMed1999

Therapeutic plasma exchange and cyclosporine in the treatment of systemic lupus erythematosus.

Despite treatment with intensive immunosuppressive drug regimens, often the prognosis of patients suffering from systemic lupus erythematosus (SLE) is poor. Side effects such as infections and malignant tumors often occur. In the present trial, 21 patients (4 male and 17 female, aged 37.9 +/- 12.8 years) suffering from SLE for 9.4 +/- 2.6 years, were treated for 2.3 +/- 1.8 years with drug regimens of corticosteroids, azathioprine and/or cyclophosphamide. Then, over a period of up to 8 years, in addition to conventional therapies, especially in active stages of the disease with extremely high concentrations of anti-DNA-, antinuclear antibodies and circulating immunocomplexes, therapeutic plasma exchange (TPE) sessions were carried out depending on symptomatology. In addition patients received 2.5 +/- 0.6 mg cyclosporine/kg body weight/day. Compared to previous treatment modalities, clinical symptoms improved more quickly and more effectively (p = 0.046). After 5 to 48 (17.5 +/- 13.8) months, cyclosporine was established as a monotherapy for 8 of 21 patients. In the other cases, corticosteroids, azathioprine and cyclophosphamide were reduced by 40 to 100%. No severe side effects were seen. In acute stages of SLE and in forms with persistently high antibody levels, the addition of TPE sessions and cyclosporine as the basic immunosuppressive drug is usually very effective with regard to improving clinical symptomatology.

Adult↗
PubMed1999

Intensive or conventional insulin therapy in type 2 diabetic patients? A population-based study on metabolic control and quality of life (The JEVIN-trial).

Long-term micro- and macrovascular complications cause major morbidity and mortality in patients with type 2 diabetes mellitus. Up to the present it is not clear whether intensified or conventional insulin treatment is more effective to keep blood glucose concentrations close to the normal range. In the present trial 90% (n = 117) of all insulin-treated type 2 diabetic patients aged 16 to 60 years and living in the city of Jena (100,247 inhabitants), Thuringia, Germany were examined. Fourty patients (34%) were on intensive insulin therapy (ICT, > or = 2 injections of normal- and > or = 1 injection of NPH-/mixed-insulin/day, > or = 1 insulin-dose adjustments/week, > or = 2 blood-glucose self-tests/day) and 77 patients (66%) were on conventional insulin therapy (CIT). Patients with ICT had more injections/d (4.3 +/- 0.7 vs CIT 2.4 +/- 0.7, p < 0.001), more insulin-dose adjustments/week < or = 11.5 +/- 8.2 vs 2.2 +/- 5.2, p < 0.001) and more blood-glucose self-tests/week (25.2 +/- 5.7 vs 9.6 +/- 8.8, p < 0.001). Patients with ICT had higher insulin doses (0.71 +/- 0.32 vs 0.47 +/- 0.2 IU/kg body wt/d, p < 0.001), were younger (50.5 +/-6.7 vs 54.0 +/- 5.9 years, p = 0.004) and they had a non-significant tendency to a better HbAlc (8.7 +/- 2.2 vs 9.2 +/- 2.0%, p = 0.23, HPLC, Diamat, normal range 4.4-5,9%). There was a negative correlation between HbAlc and the frequency of blood-glucose self-tests/week (r = -0.23, p = 0.019) and the number of insulin-dose adjustments/week (r = -0.33, p < 0.001). There were no differences between the groups as regards body-mass index (29.7 +/-4.9 vs 28.0 +/- 4.5 kg/m2, p = 0.06), diabetes duration (12.3 +/- 6.9 vs 12.2 +/- 7.5 years, p = 0.96), duration of insulin therapy (4.2 +/-3.5 versus 4.5 +/- 4.8 years, p = 0.67), incidence of acute complications (severe hypoglycaemia, diabetic coma), prevalence of retino-, nephro- and neuropathy (assessed according to Young et al.) and education or socio-economic factors. Also, in respect of quality of life and treatment satisfaction, assessed with standardized questionnaires according to Bradley et al. and Lewis et al., there were no differences between the two groups. In conclusion, in type 2 diabetic patients, ICT seems to be indicated in a second step in "problem-patients" with bad metabolic control under CIT and/or individual's need for more flexibility. Perhaps, in these patients ICT leads to an improvement in the quality of metabolic control.

Adolescent↗
PubMed1999

Blood-glucose self-monitoring in insulin treated type 2 diabetes mellitus a cross-sectional study with an intervention group.

Up to the present there is controversy about blood-glucose self-monitoring in type 2 diabetes. In 842 insulin-treated type 2 diabetic patients (age 60.1 +/- 10.9, diabetes duration since diagnosis 12.6 +/- 7.6 years, relative HbA1c 1.83 +/- 0.39% [relative HbA1c = HbA1c/mean normal, HPLC, Diamat]) a cross-sectional study was conducted to assess blood-glucose self-monitoring and interactions with quality of diabetes care. There was a negative correlation (r = -0.17, p < 0.001) between the frequency of blood-glucose self-tests/week and HbA1c. Performing multivariate analysis the most important parameters associated with HbA1c (R-square = 0.10) were: The frequency of blood-glucose self-tests/week (c = -0.005, p < 0.001), the insulin-dosage/kg body weight (c = 0.001, p = 0.0032) and the participation in a 5-day structured treatment and teaching programme for patients with conventional insulin therapy (5-TTP, c = 0.085, p < 0.0001). Other factors investigated in the model (age, diabetes duration, number of insulin injections/day, sex) showed no associations. Performing a sub-group analysis in patients older than 60 years (n = 396) parameters associated with HbA1c (R-square = 0.16) were the participation in a 5-TTP (c = 0.09, p = 0.002) and the frequency of blood-glucose self-tests/week (c = -0.006, p = 0.0018) too. In an further subgroup analysis patients (n = 249) were investigated who have not participated in a 5-TTP. In this cohort there were no correlations and no associations between the frequency of blood-glucose self-monitoring and HbA1c. Then, an intervention was started: 33 out of the 249 patients participated in a 5-TTP. At the time of re-examination 1 year after participating in the 5-TTP, the relative HbA1c decreased from 1.84 +/- 0.38% to 1.61 +/- 0.30% (p = 0.007) and there was a strong association between the frequency of blood-glucose self-tests/week and HbA1c (c = -0.016, p = 0.0032, R-square = 0.25). Daily blood-glucose self-monitoring was statistically associated with better quality of metabolic control. Participation in a 5-TTP and regularly blood-glucose self-monitoring is mandatory for all insulin-treated patients with type 2 diabetes mellitus.

Adult↗
PubMed1998

Should insulin therapy in type 2 diabetic patients be started on an out- or inpatient basis? Results of a prospective controlled trial using the same treatment and teaching programme in ambulatory care and a university hospital.

The aim of this study was to determine whether Type 2 diabetic patients should be hospitalised to start insulin therapy. The same structured diabetes treatment and teaching programme (DTTP) was used in outpatients in 10 private practices after postgraduate training of physicians and teaching staff as well as in the Diabetes Department of the University Hospital of Jena, Germany. Seventy-two consecutive Type 2 diabetic patients (ambulatory group) participated in the outpatient DTTP. After one year, 70 patients were re-evaluated and compared with 70 other patients (matched pairs) who were referred to the University Hospital of Jena to start insulin treatment and participated in the same programme during hospitalisation. Initially there were no significant differences between the groups for age, gender, HbA1c, body mass index (BMI), and the time since diagnosis of diabetes. HbA1c (mean normal value 5%) decreased in both groups within the 12 months of follow-up (ambulatory group from 10.3 +/- 2.2 to 8.1 +/- 1.7, p < 0.0001; inpatient group from 10.4 +/- 1.6 to 8.4 +/- 1.7, P = 0.0001). At follow-up there were no significant differences between the groups concerning insulin dosage, HbA1c, severe hypoglycaemia, BMI, and hospitalisation. In combination with a DTTP, the initiation of insulin therapy on an ambulatory basis was as safe and effective as in the inpatient programme. Cost-benefit analysis demonstrated substantial savings in direct costs in the ambulatory programme.

Aged↗
PubMed1998

Quality of diabetes care, diabetes knowledge and risk of severe hypoglycaemia one and four years after participation in a 5-day structured treatment and teaching programme for intensified insulin therapy.

Intensification of insulin therapy in the Diabetes Control and Complications Trial led to an improvement in the quality of diabetes care, which was accompanied, however, by a threefold increase in the risk of severe hypoglycaemia. The present trial, a long-term evaluation of a structured 5-day treatment and teaching programme (DTTP) for intensified insulin therapy, was performed to clarify factors determining HbA1c, the incidence of severe hypoglycaemia, diabetes knowledge and quality of life. Ninety-four Type 1 diabetic patients were examined at baseline and 4 years after participation in a DTTP. Comparison of baseline data with measurements at the 4-year follow-up examination showed that relative HbA1c (= HbA1c/mean normal) improved (1.9 +/- 0.51 vs 1.55 +/- 0.3*, p < 0.001, *excluding 4 patients with diabetes manifestation at baseline) and that frequencies of daily insulin injections (3.73 +/- 1.23 vs 4.9 +/- 0.69*, p < 0.001) and weekly blood glucose self-tests (6.6 +/- 10.1 vs 25.5 +/- 8.7*, p < 0.001) increased, whereas the incidence of severe hypoglycaemia (intravenous glucose, glucagon injection) remained stable (0.19 vs 0.24, p = 0.48). Patients with less diabetes knowledge had higher HbA1c levels and a higher incidence of severe hypoglycaemia. In the group of patients with severe hypoglycaemia, certain crucial gaps in diabetes knowledge were identified concerning the effects of physical activity, nutrition and long-term complications of diabetes. In multivariate analysis. The most important factor associated with HbA1c was diabetes knowledge which, however, was not influenced by educational level or other factors. Interventions, such as the identification of psychosocial factors which may interact with diabetes knowledge, quality of life and successful self-management of diabetes by patients, are needed to improve the efficacy of DTTPs and to prevent severe side effects such as hypoglycaemia.

Adult↗
PubMed1997

The JEVIN trial: a population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990.

Since 1990 in most Eastern European countries health care systems have been decentralized or are undergoing the processes of decentralization. Increasingly, diabetic patients are no longer treated by diabetologists but by non-specialized physicians. During the same period structured treatment and teaching programmes have been introduced and health care is increasingly influenced by the St. Vincent declaration. To show the effect of these changes on the quality of diabetes care 90% (n = 244) of all insulin-treated diabetic patients aged 16 to 60 years and living in the city of Jena (100247 inhabitants) were studied in 1994/1995. The results were compared with the baseline examination of 1989/1990 (n = 190). HbA1c (HbA1c/mean normal) in IDDM patients under specialized care was similar in 1994/1995 (1.54 +/- 0.27, n = 47) to 1989/1990 (1.52 +/- 0.31, n = 131, p = 0.0018), but higher under non-specialized care (1.71 +/- 0.38, n = 80, p = 0.0087). In the total group of NIDDM patients there was no significant change in HbA1c (1994/1995: 1.75 +/- 0.4, n = 117, vs 1989/1990: 1.78 +/- 0.4, n = 59, p = 0.67), but with a tendency to higher HbA1c under non-specialized (1.81 +/- 0.4, n = 79) compared to specialized care (1.66 +/- 0.39, n = 38, p = 0.06). Incidence of severe hypoglycaemia (IDDM 0.13; NIDDM 0.04), ketoacidosis (0.02; 0.01) and the prevalence of nephropathy (21%; 35%) and neuropathy (24%; 38%) remained unchanged in comparison to 1989/1990, whereas there was an increase in the prevalence of diabetic retinopathy. Specialized care is mandatory for patients with IDDM.

Adult↗
PubMed1997

Long-term efficacy of a 5-day structured teaching and treatment programme for intensified conventional insulin therapy and risk for severe hypoglycemia.

In the DCCT, intensification of insulin therapy led to a threefold increase in the risk of severe hypoglycemia (defined as the need for third party assistance). The reasons for this strong exponential relationship appears to be unclear to date. The present trial, a long-term evaluation of a 5-day structured teaching and treatment programme (5-DTTP) for intensified conventional insulin therapy (ICT), was performed to elucidate factors determining HbA1c and the incidence of severe hypoglycemia. A total of 71 patients were examined at baseline and 45.5 +/- 4.2 months following participation in a 5-DTTP. Comparing the data at follow-up examination with baseline measurements. HbA1c improved (8.52 +/- 2.29% vs. 8.0 +/- 1.43%, P = 0.04), the frequency of daily insulin injections (3.1 +/- 1.6 vs. 4.8 +/- 0.8, P < 0.001) and weekly blood-glucose self-tests (5.2 +/- 8.9 vs. 25.5 +/- 9.6, P < 0.001) increased, and the incidence of severe hypoglycemia (glucose i.v., glucagon injection) remained stable (0.18 vs. 0.17, P = 0.99). But, comparing the 21 patients who suffered from severe hypoglycemia during the follow-up period with the 50 patients without hypoglycemia, no differences between the two groups were found with respect to metabolic control (7.70 +/- 1.48% vs. 8.21 +/- 1.43%, P = 0.17), quality of life or treatment satisfaction. However differences arose with respect to diabetes knowledge. In the group of 21 patients with severe hypoglycemia we identified certain crucial gaps in diabetes knowledge: insulin self-adjustment; dietary aspects; hypo- and hyperglycemia. Performing multiple regression analysis, strong correlations were found between HbA1c and diabetes knowledge (r = -0.58. P = 0.002 for 50 patients without hypoglycemia and r = -0.63, P = 0.05 for 21 patients with hypoglycemia). In the total group, the most important factors determining HbA1c, were diabetes knowledge (r = -0.055, P = 0.007) and daily insulin dosage/kg body weight (r = 2.13, P = 0.0008, R2 = 0.26). Intervention like education of patients on a continuous basis and modifications of the DTTP's with more information and training in the recognition and treatment of hypoglycemic episodes seems to be essential to prevent hypoglycemia and to improve the efficacy of DTTP's over longer periods of time.

Adult↗
PubMed1997

Cyclosporin and plasmapheresis in treatment of progressive systemic lupus erythematosus (pSLE).

The prognosis of patients suffering from progressive systemic lupus erythematosus (pSLE) is poor, despite treatment with intensive drug regimens with combinations of corticosteroids, azathioprine and cyclophosphamide. Side-effects such as infections and malignomas often occur. In the present trial, 21 patients (four male, 17 female, aged 37.9 +/- 12.8) suffering from pSLE for 9.4 +/- 2.6 years, were treated for 2.3 +/- 1.8 years with drug regimens as mentioned above. Then, over a period of 6.4 +/- 2.6 (range 1-8) years, in addition to conventional therapies, cyclosporin (2.5 +/- 0.6 mg/kg body wt/d) and, in active stages of the disease with extremely high concentrations of anti-ds-DNA-, anti-nuclear antibodies and circulating immunocomplexes, plasmapheresis (therapeutic plasma exchange (TPE)) have been applied. Compared with previous treatment modalities, significantly (P < 0.05) more effective and rapid reduction of antibodies was achieved. Clinical symptoms improved within 2 to 4 weeks. Under the new therapeutic regimen all patients reported increased performance and a better quality of life. After 5 to 48 (17.5 +/- 13.8) months, cyclosporin was established as mono-therapy for 8/21 patients. In] the other cases, corticosteroids, azathioprine and cyclophosphamide were reduced by 40 to 100%. No severe side-effects were seen. In acute stages of pSLE and in forms with persistently high antibody levels, the addition of TPE to conventional therapy was very effective, with regard to improving both clinical and laboratory parameters.

Adolescent↗
PubMed1997

Cyclosporine and therapeutic plasma exchange in treatment of progressive autoimmune diseases.

Despite treatment with intensive immunosuppressive drug regimens, the prognosis of patients suffering from severe progressive autoimmune diseases like systemic lupus erythematosus (SLE), nephrotic syndrome (NS), and Behçet's disease is poor. Side effects (infections and malignant tumors) often occur. In the present trial, 35 patients suffering from autoimmune diseases (SLE, n = 21; NS, n = 10; and Behçet's disease, n = 4) were treated for 3.7 +/- 2.0 years with 2.5 +/- 0.6 mg cyclosporine/kg body weight/day in addition to corticosteroids alone or in combination with azathioprine and/or cyclophosphamide. In active stages of the diseases with extremely high concentrations of anti-ds-DNA-antibodies, antinuclear antibodies, circulating immunocomplexes, and reduced complement concentrations, therapeutic plasma exchange (TPE) has been applied. Compared with previous treatment modalities, significantly (p < 0.05) more effective and rapid reductions of the antibodies were reached. Clinical disorders improved within 1-6 weeks. All patients reported increased performance and a better quality of life. After 1-12 months, the previously required doses of immunosuppressive drugs and the frequency of TPE could be reduced by 40-100%. After 13.4 +/- 11.8 months in 17 of 35 patients (8 with SLE, 5 with NS, 4 with Behçet's disease), cyclosporine was established as the monotherapy. No severe side effects were registered. In treating active stages of severe progressive autoimmune diseases and forms with persistent high antibody levels, the addition of TPE to conventional therapy was very effective, as observed in both clinical and laboratory parameters.

Adrenal Cortex Hormones↗
PubMed1997

Surface-treated catheters with ion beam-based process evaluation in rats.

Ion beam-based processes such as ion implantation (silicone rubber) and ion beam-assisted deposition (silver-based coatings) affect the outer micron layers of catheter surfaces. These processes were used on the common catheter materials of silicone and polyurethane. In 56 rats, surface (Spi-Silicone and Spi-Argent I and II) catheter segments were implanted for 1, 3, and 6 weeks. After removal, these pieces were investigated for bacterial colonization and fixed for scanning electron microscopic evaluation. As controls, untreated catheter segments were implanted in 28 rats. Bacterial colonization was found in 2.4% in the surface treated catheter pieces versus 7.1% in the control group. The scanning electron microscope investigations showed low thrombogenicity in all of the treated catheters independent of the implantation times.

Animals↗
PubMed1997

LDL apheresis in clinical practice: long-term treatment of severe hyperlipidemia.

Thirty patients (13 males, 17 females) suffering from familial hypercholesterolemia resistant to diet and lipid-lowering drugs were treated for 48.7 +/- 19.2 months (range, 2-87 months) with low density lipoprotein (LDL) apheresis. Three different systems (dextran sulfate adsorption for 27 of 30 [Kaneka, Liposorber, Japan], immunoadsorption system for 2 of 30 [Baxter, Therasorb, Germany], immunoadsorption system with special lipoprotein a [Lp(a)] columns for 1 of 30 patients [Lipopak, Pocard, Russia]) were applied. Before LDL apheresis 24 of 30 patients suffered from coronary heart disease (CHD) with angina symptoms. With LDL apheresis, reductions of 46% for total cholesterol, 49% for LDL, 30% for Lp(a), and 38% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.5%). In the course of treatment, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A 60 to 100% reduction of nitrate medication was observed in 17 of 24 patients. Regarding the different apheresis systems used, at the end of the trial there were no significant differences with respect to the clinical outcome experienced by the patients and concerning total cholesterol, LDL, high density lipoprotein, and triglyceride concentrations. But to reduce high Lp(a) levels, the immunoadsorption method with special Lp(a) columns seems to be the most effective (-57% versus 25% [Kaneka] and 23% [Baxter]). The present data clearly demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia, resistant to maximum conservative therapy, is very effective and safe, even in long-term application.

Adult↗
PubMed1997

Plasmapheresis in treatment of adrenoleukodystrophy.

Adrenoleukodystrophy (ALD) is an X-linked disorder of metabolism of very long chain fatty acids (VLCFAs) with a frequency of up to 1:20,000 in males. VLCFAs C24:0 and C26:0 accumulate in the cholesterol ester and ganglioside fraction in plasma and red cells. Symptoms of ALD are ataxia, loss of visual and auditory functions, and cerebral convulsions. Up to the present, no sure therapeutic approaches have been established. Efforts were reported by dietary regimens with VLCFA restriction and glyceroltrioleate and glyceroltrierucate intake. In the present trial, we report a 55-year-old Caucasian male suffering from progressive ALD with spastic paraparesis. He has had a positive family history since the eighteenth century. In this patient treated with maximum dietary therapy over a period of 60 months, no normalization of C24:0 and C26:0 was reached, and neurological disorders were progressive. As a result, plasmapheresis was applied during the period 1990-1994 and since then for more selective adsorption of VLCFAs, dextran sulfate adsorption (Liposorber, Kaneka, Japan). During this period (64 months), C24:0 and C26:0 levels were reduced by 54.5% and 51.8%, respectively (p = 0.0001). The patient experienced a significant improvement in performance and general well-being. There has been no further progression of neuronal disorders to document.

Adrenoleukodystrophy↗
PubMed1996

Low-density lipoprotein-apheresis in two patients with extremely elevated lipoprotein (a) levels.

Two male caucasian patients (36 and 42 years old) with heterozygous familial hypercholesterolemia and extremely elevated lipoprotein Lp(a) concentrations, resistant to diet and lipid-lowering drugs, were treated with low-density lipoprotein (LDL)-apheresis for 55 months (liposorber system, Kaneka, Japan) and 15 months (immunoadsorption system, special Lp(a) columns, Lipopak, Pocard, Russia). Lp(a) dropped on average by 50%, total cholesterol by 27%, LDL-cholesterol by 42%, triglycerides by 43%, and the fibrinogen concentration by 16%.

Adult↗
PubMed1996

Low-density lipoprotein apheresis versus lipid lowering drugs in the treatment of severe hypercholesterolemia: four years' experience.

Elevated lipoprotein concentrations seem to be linked strongly in a dose dependent manner to an increased incidence of atherosclerosis. A total of 47 patients suffering from severe hyperlipidemia were matched to treatment with LDL apheresis (Baxter, Kaneka, Lipopak; 24 patients, aged 50.2 + or - 11.5 years), diet, and/or lipid-lowering drugs or with diet and lipid-lowering drugs only (23 patients, aged 48.8 + or - 11.8 years). After treatment periods of 49.8 + or - 13.4 months (apheresis group, 2,396 treatment sessions) and 38.6 + or - 15.1 months (drug group), the ensuing results revealed significant differences (p < 0.0001): -47.3% versus -12.1% for total cholesterol, -46.9% versus -21.8% for LDL, +8.4% versus +0.9% for HDL, -52.0% versus -13.1% for the LDL/HDL ratio, -36.4% versus - 16.2% for triglycerides, and -25.9% versus + 1.5% for lipoprotein (a). In the apheresis group, one patient died of myocardial infarction; in the drug group, there was one nonfatal myocardial infarction and the manifestation of coronary heart disease in 3 cases. There were no severe side effects in either group. All patients in the apheresis group responded to therapy. The present trial suggests that a continuing reduction in serum lipid concentrations may lower, in a dose dependent manner, the risk for development and progression of coronary heart disease. Regarding clinical and laboratory results, LDL apheresis seems to be safe, effective therapy for treatment of severe hyperlipidemia.

Adolescent↗
PubMed1996

Treatment of severe hyperlipidemia: six years' experience with low-density lipoprotein apheresis.

In total, 30 patients suffering from familial hypercholesterolemia, resistant to diet and lipid-lowering drugs, were treated for up to 6 years (3.6 + or - 1.6; range, 0.2-6.8 years) with low-density lipoprotein (LDL) apheresis. Three different systems were used; the dextran sulfate adsorption system (Kaneka) for 27 of 30 patients, the immunoadsorption system from Baxter for 2 of 30 patients, and the immunoadsorption system with special lipoprotein(a) (Lp[a]) columns from Lipopak for one patient. Prior to the LDL apheresis, 23 of 30 patients suffered from coronary heart disease. Twenty of 23 patients suffered intermittently from symptoms of angina, excertional dyspnea, and claudication. With LDL apheresis, reductions of 47% for total cholesterol, 49% for LDL, 26% for Lp(a), and 40% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.55%). In the course of treatment with LDL apheresis, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A reduction of nitrate medication between 60 and 100% was observed in 17 of 23 patients. The present data clearly demonstrate that treatment with LDL apheresis in patients suffering from severe familial hyperlipidemia, resistant to maximum conservative therapy, is very effective and safe even over long periods of time.

Adsorption↗
PubMed1996

Low-density lipoprotein apheresis in the treatment of two patients with coronary heart disease and extremely elevated lipoprotein (a) levels.

Hyperlipidemia and elevated lipoprotein (a) (Lp[a]) levels have been linked to the development and progression of premature atherosclerosis. Our study concerned 2 white male patients (aged 36 and 42 years) with heterozygous familial hypercholesterolemia and extremely elevated Lp(a) concentrations that were resistant to diet regimens and lipid-lowering drugs. The patients were treated with low-density lipoprotein (LDL) apheresis for 59 months (Liposorber system, Kaneka, Japan) and 19 months (immunoadsorption system, special Lp(a) columns; Lipopak; Pocard, Russia), respectively. The concentration of Lp(a) decreased on average by 50%, total cholesterol by 27%, LDL cholesterol by 41%, triglycerides by 43%, and fibrinogen by 16%. High-density lipoprotein (HDL) cholesterol increased by approximately 4%. Before treatment with LDL apheresis, each patient had suffered 3 myocardial infarctions, and had had 4 and 6 coronary angiographies with 2 and 4 percutaneous transluminal angioplasties (PTCAs), respectively. Since treatment with LDL apheresis, no myocardial infarctions or cardiac complaints were observed. In the course of treatment, both patients reported an increased performance. Available data suggest that LDL apheresis may be effective in the treatment of patients, the only risk factor for premature atherosclerosis being extremely elevated Lp(a) concentrations.

Adult↗