Insulin-Like Peptide 5 Interacts with Sex Hormones and Metabolic Parameters in a Gender and Adiposity Dependent Manner in Humans.

Insulin-like peptide 5 (INSL5) is a gut hormone produced by L-cells in the colorectal epithelium and may play a role in the regulation of metabolic processes. The biological role of INSL5 is poorly investigated and nothing is known about the role of this hormone in obese and lean humans. Two cohorts were analyzed in the study. In the first cohort (n=76) the relationship between serum levels of INSL5 and different metabolic and hormonal parameters in obese and lean men and women were investigated. In the second cohort 14 male subjects underwent bariatric surgery. Circulating levels of INSL5 were then measured before and after interventions.We report for the first time that circulating INSL5 interacts with multiple metabolic and hormonal variables in lean and obese men and women and is affected by bariatric surgery. Serum levels of INSL5 negatively correlated with testosterone and blood lipids but positively with cortisol in obese men. In contrast to males, obese women had a strong negative correlation of plasma levels of INSL5 with C-reactive protein (CRP). We observed that adipose tissue loss after bariatric surgery significantly reduced serum levels of INSL5 in obese men with and without Type 2 Diabetes Mellitus (T2DM) that was associated with the restoration of circulating levels of testosterone. All together, our data demonstrated that INSL5 may interact with some metabolic parameters in obese humans and this process is dependent of gender and obesity state.

Diurnal rythm of Nampt is gender and weight dependent.

RESEARCH AIM: Nicotinamide phosphoribosyltransferase (Nampt) is an adipocytokine that is elevated in obesity, type 2 diabetes and increased levels are associated with inflammatory processes. Nampt serum concentrations have been suggested to follow a diurnal rhythm peaking in the afternoon in lean males. However, no data exists regarding the effects of gender and body weight. MATERIAL AND METHODS: We measured Nampt serum levels over 24 h in a cohort of healthy individuals living with either normal weight or obesity. Furthermore, effects of meals, oral glucose tolerance test and physical exercise on Nampt concentrations were evaluated. Correlation analyses to other hormonal- and lab parameters and anthropometric measurements were performed. RESULTS: Nampt showed a diurnal rhythm with increased levels at daytime and a peak in the early afternoon. This diurnal rhythm was significant for all groups but obese males. The Nampt amplitude, measured both relatively and absolutely, was significantly higher in females than in males. Meals did not influence Nampt serum levels, whereas physical exercise and an OGTT did significantly influence Nampt serum levels. CONCLUSION: In conclusion, we found gender specific differences in Nampt amplitude and coefficient variation with both being higher in females. The circadian rhythm of Nampt was independent of gender in healthy lean individuals, whereas it was disturbed in men with obesity.

[Practical aspects of voice prosthesis use after laryngectomy]. / Praktische Aspekte der prothetischen Stimmrehabilitation nach Laryngektomie.

Since the last decade of the last century, surgical voice restoration with the use of voice prostheses has become a standard after total laryngectomy. About 80-90 % of the patients are capable to speak well or even very well with a voice prosthesis. Although severe complications have become rare since special pharynx protectors are in use for the implantation of the voice prostheses, minor problems are quite common. Primarily, these are frequent leakages through the prosthesis caused by fast wear and tear of the material and biofilms on the surface of the prosthesis, granulation tissue around the prosthesis, loss of the prosthesis with either aspiration or ingestion and migration or enlargement of the fistula. This paper explains the application of the most common kinds of voice prostheses and the management of the most frequent problems.

[Ackerman's tumor of the larynx and occupational exposure to asbestos]. / Ackerman-Tumor des Larynx und berufliche Asbestexposition.

The so-called "Ackerman's tumor" is a neoplasm of uncertain dignity. Aim of this paper is to clarify, whether this is an asbestos-induced tumor of the larynx in accordance with German regulations for occupational diseases. A 43-year old male presented the clinical picture of a stenosing laryngeal tumor. A verrucous neoplasm without a proven malignity in the sense of an Ackerman's tumor was diagnosed through several sequential biopsies. Approximately 2 years later a total laryngectomy was performed, because of a squamous cell carcinoma of the larynx. An occupational disease in accordance with 4104 BKV was claimed in connection with an asbestos exposition of 28,3 fibre years (fibres/m3 x years). An Ackerman's tumor is--in accordance with its definition in the German-speaking area--not conclusively malignant, there is no indication of a relation between asbestos and such a tumor in literature, there is no specific benign disorder of the larynx caused by asbestos. This brings us to the conclusion that the Ackerman's tumor of the larynx is no asbestos-induced laryngeal tumor as per German occupational disease regulations.

[Perforation of the esophagus with a mediastinal abscess]. / Osophagusperforation mit Mediastinalabszess. Eine Spätkomplikation der chirurgischen Stimmrehabilitation nach Laryngektomie.

INTRODUCTION: Surgical voice rehabilitation after total laryngectomy is still only a partially solved problem. Because of easy handling and rare complications, the Provox voice prosthesis has become common in voice rehabilitation. CASE REPORT: The 69 year old patient underwent laryngectomy, selective bilateral neck dissection and the implantation of a Provox voice prosthesis because of a glottic squamous cell carcinoma (pT(4), pN(0), M(0)). Postoperative healing ensued without any complications. During adjuvant radiochemotherapy, the patient developed distinctive cervical edema which led to a tilting of the Provox prosthesis. Due to a perforation of the posterior esophageal wall, the patient developed a pronounced mediastinal abscess which was relieved through a transcervical mediastinotomy. Antibiotic therapy led to a partial remission of the symptoms. CONCLUSION: Severe complications may not only occur during the early phase of surgical voice rehabilitation, but also at a much later stage, after completion of the healing process. A voice prosthesis which is too long or generates pressure from a radiogenic edema, cannula and finger pressure used to close the tracheostoma is transmitted through the prosthesis and may lead to a perforation of the posterior esophageal wall. In particular, when the tissue is injured during the course of radiotherapy, this type of complication should be taken into consideration.

Midwifery in Germany. Its past and present.

This article introduces midwifery in Germany to the North American midwife. The development of the midwifery profession since the 12th century is presented. Some regulations that govern midwifery practice today were initiated by the clergy, city government, and physicians during past centuries. Present-day midwifery training and professional opportunities are described. The organization and peculiarities of the German health care system and some effects of German reunification that are relevant to midwifery practice are also discussed. Midwives work in several areas and are regulated by federal and state laws which support and secure their practice. The promotion of midwifery interests frequently encounters resistance by obstetricians. There is a long-standing conflict related to an overlap of skills and services that both professions claim as their own. In recent years, more women have demanded and used midwifery services. In 1992, 811,774 deliveries were performed by midwives in 1,176 German hospitals with varying styles of labor management. This variety ranged from university hospitals, which emphasized modern technologies, to institutions that supported a comprehensive midwifery approach. The author challenges the classical practice of midwifery and contrasts it with a delivery that incorporates several features in a comprehensive approach.

[Paraneoplastic syndromes in ENT surgery]. / Paraneoplastische Syndrome in der HNO-Heilkunde.

Paraneoplastic syndromes are extremely rare in otolaryngology.However, they can significantly influence both the therapy and outcome of patients with oncologic disease. This report deals with two cases of paraneoplastic syndromes associated with malignant tumors of the head and neck region. A 45-year-old male presented with a polymyalgia rheumatica, which was identified as a synchronous feature of a hypopharyngeal carcinoma. The symptoms disappeared after successful surgical treatment of the carcinoma. No analogous report has been published as yet. As demonstrated in a second case of a 54-year-old male, leukocytosis can be paraneoplastically associated with a squamous cell carcinoma of the tongue. The international literature is reviewed in order to analyze the incidence of different paraneoplastic syndromes related to malignancies of the upper aerodigestive tract including the rare neuroendocrine oat cell carcinoma of the larynx.

Development and in vitro efficacy of novel MMP2 and MMP9 specific doxorubicin albumin conjugates.

Two doxorubicin albumin conjugates (A-DP1 and A-DP2), which differ in their substrate specificity for the matrix metalloproteinases MMP2 and MMP9, were prepared by binding maleimide doxorubicin peptide derivatives to the cysteine-34 position of human serum albumin. The incorporated octapeptide, Gly-Pro-Gln-Arg-Ile-Ala-Gly-Gln, in A-DP2 is not cleaved by activated MMP2 and MMP9 in contrast to Gly-Pro-Leu-Gly-Ile-Ala-Gly-Gln incorporated in A-DP1 that is cleaved efficiently by activated MMP2 and MMP9 liberating a doxorubicin tetrapeptide. A-DP1 showed antiproliferative activity in a murine renal cell carcinoma line in the low micromolar range (IC(50) value approximately 0.2 microM).