[Effects of physical stimulation of spontaneous arteriolar vasomotion on microcirculation and the immune system in diabetes and impaired wound healing]. / Wirkungen einer physikalischen Stimulierung der spontanen arteriolären Vasomotion auf Mikrozirkulation und Immunsystem bei Diabetes und Wundheilungsstörungen.

BACKGROUND: Whether and to what extent the complementary use of a biorhythm-defined physical stimulation of insufficient spontaneous arteriolar vasomotion contributes to increasing the therapeutic success of established treatment concepts were examined. MATERIALS AND METHODS: In a placebo-controlled study on a biometrically defined sample of older diabetes patients with impaired wound healing, measurements of representative features of the functional status of the microcirculation and the immune system were investigated using high-resolution methods (intravital microscopy, reflective spectrometry, white light spectroscopy combined with laser Doppler microflow measurements). The stimulation signal corresponding to physiological spontaneous arteriolar vasomotion was transmitted using an electromagnetic alternating field of low magnetic flux density. RESULTS: During the 27-day treatment and observation period, a complementary treatment effect of the applied biorhythm-defined physical vasomotion stimulation could be detected.

Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy.

OBJECTIVE: To evaluate the efficacy and safety of alpha-lipoic acid given intravenously, followed by oral treatment in type 2 diabetic patients with symptomatic polyneuropathy. RESEARCH DESIGN AND METHODS: In a multicenter randomized double-blind placebo-controlled trial (Alpha-Lipoic Acid in Diabetic Neuropathy [ALADIN] III Study), 509 outpatients were randomly assigned to sequential treatment with 600 mg alpha-lipoic acid once daily intravenously for 3 weeks, followed by 600 mg alpha-lipoic acid three times a day orally for 6 months (A-A; n = 167); 600 mg alpha-lipoic acid once daily intravenously for 3 weeks, followed by placebo three times a day orally for 6 months (A-P; n = 174); and placebo once daily intravenously for 3 weeks, followed by placebo three times a day orally for 6 months (P-P; n = 168). Outcome measures included the Total Symptom Score (TSS) for neuropathic symptoms (pain, burning, paresthesias, and numbness) in the feet, and the Neuropathy Impairment Score (NIS). Data analysis was based on the intention to treat. RESULTS: No significant differences between the groups were noted for the demographic variables and the nerve function parameters at baseline. The TSS in the feet decreased from baseline to day 19 (median [range]) by -3.7 (-12.6 to 5.0) points in the group given alpha-lipoic acid intravenously and by -3.0 (-12.3 to 8.0) points in the placebo group (P = 0.447), but the area under curve on a daily basis was significantly smaller in the active as compared with the placebo group (85.6 [0-219] vs. 95.9 [5.5-220]); P = 0.033). After 7 months, the changes in the TSS from baseline were not significantly different between the three groups studied, which could be due to increasing intercenter variability in the TSS during the trial. The NIS decreased after 19 days by -4.34+/-0.35 points (mean +/- SEM) in A-A and A-P and -3.49+/-0.58 points in P-P (P = 0.02 for alpha-lipoic acid versus placebo) and after 7 months by -5.82+/-0.73 points in A-A, -5.76+/-0.69 points in A-P, and -4.37+/-0.83 points in P-P (P = 0.09 for A-A vs. P-P). The rates of adverse events were not different between the groups throughout the study. CONCLUSIONS: These findings indicate that a 3-week intravenous treatment with alpha-lipoic acid, followed by a 6-month oral treatment, had no effect on neuropathic symptoms distinguishable from placebo to a clinically meaningful degree, possibly due to increasing intercenter variability in symptom scoring during the study. However, this treatment was associated with a favorable effect on neuropathic deficits without causing significant adverse reactions. Long-term trials that focus on neuropathic deficits rather than symptoms as the primary criterion of efficacy are needed to see whether oral treatment with alpha-lipoic acid over several years may slow or reverse the progression of diabetic neuropathy.

Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy.

AIMS: To evaluate the efficacy and safety of short-term oral treatment with the antioxidant thioctic acid (TA) on neuropathic symptoms and deficits in patients with Type 2 diabetes mellitus with symptomatic polyneuropathy. METHODS: Patients were randomly assigned to oral treatment with 600 mg of TA t.i.d. (n = 12) or placebo (n = 12) for 3 weeks. Neuropathic symptoms (pain, burning, paraesthesiae, and numbness) in the feet were scored at weekly intervals and summarized as a Total Symptom Score (TSS). The Hamburg Pain Adjective List (HPAL) and the Neuropathy Disability Score (NDS) were assessed at baseline and day 19. RESULTS: At baseline the TSS, HPAL, and NDS were not significantly different between the groups. The TSS in the foot decreased from baseline to day 19 by -3.75 +/- 1.88 points (-47%) in the TA group and by -1.94 +/- 1.50 points (-24%) in the placebo group (P= 0.021 for TA vs. placebo). The total HPAL score decreased from baseline to day 19 by -2.20 +/- 1.65 points (-60%) in the TA group and by -0.96 +/- 1.32 points (-29%) in the placebo group (P = 0.072 for TA vs. placebo). The NDS decreased by -0.27 +/- 0.47 points in the TA group, whereas it slightly increased by +0.18 +/- 0.4 points in the placebo group (P = 0.025 for TA vs. placebo). No differences between the groups were noted regarding the rates of adverse events. CONCLUSIONS: These preliminary findings indicate that oral treatment with 600 mg of TA t.i.d. for 3 weeks may improve symptoms and deficits resulting from polyneuropathy in Type 2 diabetic patients, without causing significant adverse reactions.

Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study).

Anti-oxidant treatment has been shown to prevent nerve dysfunction in experimental diabetes mellitus, thus providing a rationale of potential therapeutic value for diabetic patients. The effects of the anti-oxidant alpha-lipoic acid (thioctic acid) were studied in a 3-week multicentre, randomized, double-blind placebo-controlled trial (Alpha-Lipoic Acid in Diabetic Neuropathy; ALADIN) in 328 non-insulin-dependent diabetic patients with symptomatic peripheral neuropathy who were randomly assigned to treatment with intravenous infusion of alpha-lipoic acid using three doses (1200, 600, or 100 mg ALA) or placebo (PLAC). Neuropathic symptoms (pain, burning, paraesthesiae, and numbness) were scored at baseline and at each visit (days 2-5, 8-12, and 15-19) prior to infusion. In addition, the Hamburg Pain Adjective List, a multidimensional specific pain questionnaire, and the Neuropathy Symptom and Disability Scores were assessed at baseline and day 19. According to the protocol 260 (65/63/66/66) patients completed the study. The total symptom score in the feet decreased from baseline to day 19 by -4.5 +/- 3.7 (-58.6%) points (mean +/- SD) in ALA 1200, -5.0 +/- 4.1 (-63.5%) points in ALA 600, -3.3 +/- 2.8 (-43.2%) points in ALA 100, and -2.6 +/- 3.2 (-38.4%) points in PLAC (ALA 1200 vs PLAC: p = 0.003; ALA 600 vs PLAC: p < 0.001). The response rates after 19 days, defined as an improvement in the total symptom score of at least 30%, were 70.8% in ALA 1200, 82.5% in ALA 600, 65.2% in ALA 100, and 57.6% in PLAC (ALA 600 vs PLAC; p = 0.002). The total scale of the Pain Adjective List was significantly reduced in ALA 1200 and ALA 600 as compared with PLAC after 19 days (both p < 0.01). The rates of adverse events were 32.6% in ALA 1200, 18.2% in ALA 600, 13.6% in ALA 100, and 20.7% in PLAC. These findings substantiate that intravenous treatment with alpha-lipoic acid using a dose of 600 mg/day over 3 weeks is superior to placebo in reducing symptoms of diabetic peripheral neuropathy, without causing significant adverse reactions.

[Internal medicine--status and perspectives]. / Die Innere Medizin--Stand und Perspektiven.

Catalysed by the scientific progress in medicine an increasing specialisation in internal medicine developed with the danger of a disunion of the specialty. Nowadays, the internal medicine is tripartite with the basis internal specialists and the subspecialist as the two poles of the care of patients in the field of internal medicine. The description of the status quo in internal medicine shows reserves in training and education of the students as well as of the physicians during the period of specialisation which must be closed. It is essential for a qualification of the physician's work that basis internal specialists and proper specialists unite in the sense of a partnership and formulate professional and health-political aims for internal medicine.

[Management of elderly citizens dependent on outside help from the clinical viewpoint]. / Die Betreuung auf fremde Hilfe angewiesener älterer Bürger aus klinischer Sicht.

The increase of life expectancy has led to a higher percentage of the oldest and requiring help people. The present paper described the possibilities and situation of care for this part of the population on the basis of an analysis of a district of Berlin. It must be stated that the cooperation between social organizations and ambulatory institutions and hospitals can be improved. The hospitalisation of older people requiring help should be an exception and is ethically legitimated only then, when it is performed with the intention of the patient. The willingness for care on the side of the members of the patients' families is analysed and discussed in the sense of improvement.

[What attitude to dying do we have today?]. / Welche Haltung zum Sterben haben wir heute?

Deficient care and unfounded loneliness increasingly form the fate of dying patients. A change under the aspects of socialist norms is the task of the whole society.

[Helping to die--helping to live in the boundary between life and death]. / Sterbehilfe--Lebenshilfe im Grenzbereich zwischen Leben und Tod.

Help for the dying patient is a matter of the physician's duty in the sense of the help for life in a border-line situation of human life. Even if the activity of the physician is no more determined by the thought of the preservation of life, the aims in the care for dying patients are on principle to be compared with those in the care for other patients and contain essential principles of the activity of the physician: somatic area (treatment and care) psycho-social area (aid, care and communication). While the hospital in the somatic field has prerequisites for a careful treatment and care, the domestic milieu has advantages in the psycho-social area. It is recommended a flexible and individually adapted performance of the care of dying patients in the hospital and the domestic milieu.