Impaired dexamethasone resorption in two patients with pseudo-Cushing after bariatric surgery: Implications for immunosuppressive treatment.

Two cases of middle-aged female patients treated by gastric bypass surgery for weight loss presented to our clinic for a follow-up examination 3-6 months after the surgical procedure (a mini gastric bypass and a modified single anastomosis sleeve-ileostomy). In both patients increased ACTH levels and either high serum cortisol or an increased urinary cortisol excretion was apparent and triggered further endocrine testing. Serum cortisol could not be suppressed adequately by 2 and 4 mg dexamethasone in the standardized oral overnight suppression test while midnight salivary cortisol dropped well below the desired cut-off. This led to the hypothesis of an impaired dexamethasone resorption and could be further substantiated by suppression of serum cortisol below the cut-off by an intravenous dexamethasone application. The data presented point to an impairment of enteral synthetic corticosteroid resorption in patients after gastric bypass surgery and could be of importance for individuals in need for immunosuppressive treatment. In view of the growing number of bariatric procedures, pharmacokinetics of corticosteroids and other drugs should be tested in clinical trials.

Identical LDL-cholesterol lowering but non-identical effects on NF-κB activity: High dose simvastatin vs combination therapy with ezetimibe.

OBJECTIVE: Lowering LDL-cholesterol by statins has been proven to be associated with reduction of proinflammatory regulators e.g. activation of the transcription factor NF-κB. To our knowledge, anti-inflammatory potential of newer cholesterol lowering agents such as ezetimibe is less intensively studied. Therefore we analyzed the effects of equipotent LDL-lowering therapy with simvastatin alone compared to a combination with ezetimibe on NF-κB activation in peripheral blood mononuclear cells (PBMCs) of patients with type 2 diabetes. METHODS: Thirty-one patients with type 2 diabetes were included in a double-blind, randomized trial receiving either 80 mg simvastatin (sim80; n = 10) or a combination of 10 mg simvastatin and 10 mg ezetimibe (sim10eze10; n = 11) or placebo (n = 9) for eight weeks. NF-κB binding activity and inflammatory markers (IL-6, hsCRP) were analyzed at baseline and after eight weeks of treatment. NF-κB binding activity was analyzed by electrophoretic mobility shift assay. IL-6 and hsCRP were measured by ELISA. RESULTS: After eight weeks of treatment LDL-cholesterol was lowered to the same extent in both treatment groups (p = 0.40) but not in placebo. However, patients taking sim80 showed a significant reduction of mononuclear NF-κB binding activity compared to baseline (p = 0.009) while no effect was observed in the sim10eze10 group (p = 0.79). Similar differences in anti-inflammatory effects were also observed when analyzing hsCRP (sim80: p = 0.03; sim10eze10: p = 0.40) and IL-6 levels (sim80: p = 0.15; sim10eze10: p = 0.95). CONCLUSION: High dose simvastatin therapy reduces proinflammatory transcription factor NF-κB binding activity and hsCRP levels, while combination of low dose simvastatin with ezetimibe resulting in a similar LDL-reduction does not affect these inflammatory markers.

Alcopops, alcohol consumption and alcohol-related problems in a sample of German adolescents: is there an alcopop-specific effect?

AIMS: The objective of the present analysis was to investigate the impact of alcopops on drinking behaviour and alcohol-related negative consequences by controlling for alcohol consumption and the share of alcopops in total ethanol intake. METHODS: Data from the 2003 European School Survey Project on Alcohol and other Drugs (ESPAD) in Germany were used. The final dataset comprised students aged 15-17 years who reported to have drunk alcohol in the past 7 days (n=5509). MEASUREMENTS: Alcohol consumption was assessed by beverage-specific quantity measures for the last 7 days. Individuals were categorised into "non-alcopop" and "alcopop consumers"; according to the share in total ethanol intake, alcopop users were further divided into "only-alcopop", "mix-alcopop" and "mix-consumers". Analogous groups were constructed for the other beverages. Outcome measures were age of first alcohol use and drunkenness, frequency of drinking, binge drinking and drunkenness and alcohol-related problems. Hypotheses were tested using proportional hazard models, linear and logistic regressions. FINDINGS: Controlling for overall volume few differences in consumption and problem measures were found when alcopop and non-alcopop users were compared. Further differentiation of the alcopop group also revealed only few differences. Similar associations were found for the other beverages. Only-alcopop and only-wine drinking was associated with less risky consumption patterns and negative consequences. CONCLUSIONS: An alcopop-specific effect on problematic drinking behaviour and negative consequences could not be identified. Concerted preventive actions tackling alcohol as a whole are needed in order to gain substantial effects on alcohol use and alcohol-related problems in adolescents.

Transient post-operative thyrotoxicosis after parathyroidectomy.

BACKGROUND: Secondary and tertiary hyperparathyroidism are features of chronic renal disease. Although pharmacological options are available, parathyroid surgery remains the treatment of choice in these patients with worsening renal osteodystrophy or hypercalcemia. The development of thyrotoxicosis after parathyroid surgery in these patients has been rarely reported. CASE REPORT: We report a 33 years old woman who developed transient symptomatic thyrotoxicosis following parathyroid surgery for tertiary hyperparathyroidism. Laboratory and imaging studies were consistent with postoperative hyperthyroidism due to thyroiditis. CONCLUSIONS: Transient hyperthyroidism may occur after parathyroidectomy presumably due to a traumatic thyroiditis as a result of manipulation of the thyroid gland during surgery. As it is transient, thyrostatic therapy is not indicated but patients may require short-term treatment with beta-blockers for symptomatic relief.

Calcium-phosphate and polymethylmethacrylate cement in long-term outcome after kyphoplasty of painful osteoporotic vertebral fractures.

STUDY DESIGN: A comparative prospective trial evaluating 3-year outcome. OBJECTIVE: To compare clinical and morphologic outcomes as well as follow-up fractures after kyphoplasty of painful osteoporotic vertebral fractures with calcium-phosphate (CaP) cement (group 1) and with polymethylmethacrylate (PMMA)-cement (group 2). SUMMARY OF BACKGROUND DATA: CaP cements seem to be an alternative material for usage in kyphoplasty of vertebral fractures. CaP cements are biodegradable and replaceable by newly formed bone after implantation. Concerns have been raised with regard to the stability of resorbable CaP-cements after implantation into vertebrae post kyphoplasty. Calcibon is a possible CaP cement, which exhibited adequate stability in short-term observations. MATERIALS AND METHODS: Kyphoplasty was performed in 40 consecutive patients with primary osteoporosis and painful vertebral fractures, 20 received CaP-cement, 20 were treated with PMMA-cement. All patients received a pharmacological antiosteoporosis treatment (1000 mg calcium, 1000 IU vitamin D3, and oral aminobisphosphonate), pain medication, and physiotherapy. Pain (visual analog scale [VAS]; range, 0-100), mobility (EVOS-score; range, 0-100) and radiomorphologic measurements were assessed at baseline and after 6, 12, and 36 months. RESULTS: There were no statistically significant differences between the CaP and PMMA-cement group regarding VAS-scores, EVOS-scores, or height-restoration at any time point. Furthermore, there was no significant difference in the occurrence of vertebral follow-up fractures between both groups during the 3-year follow-up period. CONCLUSION: CaP cement, e.g., Calcibon, is as effective and safe as conventional PMMA-cement with regard to immediate and sustained pain reduction and improvement of mobility after kyphoplasty of patients with painful osteoporotic vertebral fractures. CaP cement has the potential of being resorbed and replaced by newly formed bone tissue; thus, it seems to be a promising alternative for PMMA also in younger patients with painful vertebral fractures.

The impact of alcopops on adolescent drinking: a literature review.

AIMS: The growing consumption of alcopops (highly sweetened pre-mixed spirit-based drinks especially designed and marketed for adolescents and young adults) among adolescents below the minimum age has given rise to the suspicion that these designer drinks are conducive to encouraging young people to prematurely drink alcohol. Increasing concern with regard to the health of young people has prompted several countries to respond to the growing consumption of alcopops with the introduction of special taxes. The present review aims to analyse the relationship between alcopop consumption and expected negative consequences, in particular, with regard to the frequency and quantity of alcohol consumed, the number of negative alcohol-related consequences, the consumption of other drugs, and engagement in further risk behaviours. METHODS: Systematic computer-assisted literature searches in Pub Med, PsycINFO, and Addiction Abstracts used the keywords 'alcopop', 'alcopops', 'designer drink', or 'designer drinks'. All publications relating to alcopops and their impact on adolescent drinking were included. RESULTS: An analysis of existing studies shows that on the grounds of methodological limitations, such as not controlling for total alcohol consumption, evidence of an association between the consumption of alcopops and the effects mentioned above is scarce. Results rather indicate a clear relationship between the quantity of alcohol consumed and alcohol-related negative consequences. CONCLUSIONS: In place of beverage-specific interventions, a successful alcohol policy should look to implement evidence-based measures for the reduction of total alcohol consumption.

[Therapeutic management of acromegaly]. / Therapeutisches Management bei der Akromegalie.

BACKGROUND: Only 60% of the patients with acromegaly are biochemically cured (growth hormone [GH] nadir < 1.0 microg/l after an oral glucose load, normalized age- and gender-matched insulin-like growth factor-1 [IGF-1] levels) after transsphenoidal surgery of the pituitary gland. In the absence of a remission there are effective pharmacological treatment regimens available which are able to lower GH and IGF-1 serum levels. THERAPEUTIC STRATEGIES: Somatostatin analogs, a GH receptor antagonist and dopamine agonists have been shown to alleviate the comorbid features and to normalize GH and IGF-1 levels. CASE REPORTS: In this overview six case reports are presented to highlight the current pharmacological treatment options and to propose an algorithm for the clinical routine in patients with persisting acromegaly. CONCLUSION: Transsphenoidal surgery is the treatment of choice for the initial management of acromegaly. In the absence of a remission there are effective pharmacological treatment regimens available among which somatostatin analogs are recommended as the first-line treatment.