Hyperlipidemias: Germany

Dietz R, Rauch B, Anonymous00264, Anonymous00265, Anonymous00266. · Kardiologie Campus Berlin-Buch, Universitätsklinikum Charité, Medizinische Fakultät der Humboldt Universität zu Berlin, Germany. · Z Kardiol. · Pubmed #12905980 No free full text.

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Schuster H, Anonymous00170. · Humboldt University Berlin, Droysenstr. 1, 10629 Berlin, Germany. · Atheroscler Suppl. · Pubmed #12714033 No free full text.

Abstract: Populations of patients at high risk of coronary heart disease (CHD) include those with type 2 diabetes and those with heterozygous familial hypercholesterolemia (HeFH). Despite benefits of statin lipid-lowering therapy in reducing CHD risk in diabetic patients, screening for dyslipidemia in such patients is inadequate, and patients frequently fail to achieve recommended low-density lipoprotein goals. Diagnosis of HeFH is also suboptimal, despite the reliability of family lipid screening in confirming clinical diagnosis and utility of screening in identifying other family members who are at risk. Patients with HeFH frequently require large reductions in low-density lipoprotein (LDL) cholesterol to achieve target levels. In both of these populations, statins that produce large reductions in LDL cholesterol offer advantages in achieving lipid-lowering goals and in simplifying medical therapy to reduce CHD risk.

Fudickar A, Bein B. · Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. · Minerva Anestesiol. · Pubmed #19412155 links to  free full text

Abstract: Propofol infusion syndrome (PRIS) is defined as acute bradycardia progressing to asystole combined with lipemic plasma, fatty liver enlargement, metabolic acidosis with negative base excess >10 mmol l(-1), rhabdomyolysis or myoglobinuria associated with propofol infusion. The purpose of this review was to provide a new update of reported case reports and to describe recent retrospective studies and animal research relevant for the pathophysiology and clinical presentation of PRIS. New case reports of PRIS have confirmed previously identified risk factors, and have also further revealed the incidence of PRIS in patients previously not estimated to be at risk for this syndrome. Retrospective studies contributed new evidence to the incidence of PRIS and development of PRIS even at propofol doses commonly used for surgical anesthesia. An animal study confirmed potential pathophysiological pathways and showed new organ manifestations possibly associated with propofol infusion. Further clinical and experimental evidence has confirmed the existence of PRIS as a rare but highly lethal complication of propofol use not limited to prolonged use of propofol. PRIS has to be kept in mind if propofol is used for anesthesia or sedation. Recommendations for the limitation of propofol use have to be adhered to. Early warning signs must prompt immediate cessation of propofol infusion and adequate treatment.

Ott C, Schmieder RE. · Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. · Curr Hypertens Rep. · Pubmed #19278604 No free full text.

Abstract: The metabolic syndrome is a cluster of cardiometabolic risk factors associated with higher risk for atherosclerotic cardiovascular (CV) disease and diabetes. Its prevalence is about 20% to 30% among adults worldwide and is increasing. The primary goal is reduction of CV risk through lifestyle changes and drug therapy if required. Post hoc analyses of prospective trials showed the benefit of lowering low-density lipoprotein (LDL) cholesterol in patients with the metabolic syndrome. Statin therapy exerts beneficial effects not only by lowering LDL cholesterol but also via its so-called pleiotropic effects. These effects seem particularly important for reducing risk of CV disease in patients with the metabolic syndrome. Thus, evidence is accumulating that statins are very effective therapeutic agents in the treatment of individuals with the metabolic syndrome.

Wanner C, Ritz E. · Department of Internal Medicine, University of Würzburg, Würzburg, Germany. · Kidney Int Suppl. · Pubmed #19034322 No free full text.

Abstract: Lipid parameters are altered in the earliest stages of primary kidney disease, some even when measured glomerular filtration rate (GFR) is still normal. The main problem is that routinely measured lipid parameters are deceivingly normal except low high-density lipoprotein (HDL) and moderately elevated triglycerides (TGs) (>150 mg per 100 ml). Behind this unimpressive spectrum, serious anomalies are hidden: increased very low-density lipoprotein (VLDL) and chylomicron remnants, accumulation of delipidated small dense low-density lipoprotein (LDL), post translational modification of lipoproteins, abnormal concentrations of Lp(a) and nonprotective HDL. A routine parameter with some predictive value is the concentration of non-HDL cholesterol. Several of these abnormal lipoprotein particles stimulate cellular free oxygen radical formation which in turn induce inflammation and impact on endothelial function.A bone of contention is the indication for treatment with statins in endstage renal disease. Poor survival is paradoxically predicted by low cholesterol. This appears to be the result of confounding by microinflammation. One controlled interventional study in hemodialysed type 2 diabetics, the 4-D study, failed to show a significant benefit on the primary cardiovascular endpoint. We discuss potential explanations for this 'negative' outcome and the implications for statin treatment.

Münzel T. · II. Medizinische Klinik, Johannes Gutenberg Universität Mainz, Mainz. · Dtsch Med Wochenschr. · Pubmed #19006047 No free full text.

Abstract: The endothelium plays a crucial role in the regulation of vascular tone. Recent studies have indicated that endothelial dysfunction develops in the presence of cardiovascular risk factors such as hypertension, diabetes mellitus, hypercholesterolemia and in chronic smokers, as well as in patients with a family history of cardiovascular disease. It has now been established that endothelial dysfunction represents the first indicator of vascular damage. Endothelial function can be assessed in coronary and peripheral conductance and resistance vessels by means of invasive and noninvasive (ultrasound-guided) methods such as intracoronary infusion of acetylcholine, the endothelium-dependent vasodilator. It is interesting that endothelial dysfunction in the presence of cardiovascular risk factors can be almost completely corrected by the acute administration of antioxidants such as vitamin C, pointing to a crucial role of reactive oxygen species in mediating this phenomenon. Superoxide producing enzymes involved in the increased production of reactive oxygen species include NADPH oxidase, nitric oxide synthase in the uncoupled state, mitochondrial superoxide sources, cyclooxygenase and xanthine oxidase. Recent studies indicate that the endothelial dysfunction found in coronary and peripheral conductance and resistance vessels provide prognostic information about future cardiovascular events. The role of endothelial dysfunction in the setting of primary prevention is not yet clear, but is being investigated in the current Gutenberg Heart Study.

Schmieder RE, Ruilope LM. · Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany. · J Clin Hypertens (Greenwich). · Pubmed #18772645 No free full text.

Abstract: Hypertension frequently coexists with obesity, diabetes, hyperlipidemia, or the metabolic syndrome; their association with cardiovascular disease is well established. The identification and management of these risk factors is an important part of the overall management of hypertensive patients. Because patients in these special populations are more predisposed to target organ damage (TOD), stringent targets for blood pressure (BP) control have been set in clinical guidelines. However, clinical trial and real-life evidence suggest that these targets are difficult to achieve. Patients with these comorbidities are more likely to require combination therapy, yet physicians are often reluctant to adjust the number and doses of medications to achieve target BP. There is a particular need for effective 24-hour BP control in these patients, due to the increased likelihood of nondipping status, which is a risk factor for TOD and mortality. Not all available antihypertensives are equally effective in controlling BP over 24 hours, and some may exacerbate underlying metabolic abnormalities.

Hoppe UC, Erdmann E. · Klinik III für Innere Medizin, Universität zu KölnKerpener Strasse 6250937 Köln. · Dtsch Med Wochenschr. · Pubmed #18553258 No free full text.

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Julius U, Frind A, Tselmin S, Kopprasch S, Poberschin I, Siegert G. · University Hospital Dresden, Medical Clinic III, Fetscherstr. 74, 01307 Dresden, Germany. · Expert Rev Cardiovasc Ther. · Pubmed #18510481 No free full text.

Abstract: This article presents the generally accepted indications for LDL apheresis treatment. The available LDL apheresis methods differ with respect to acute relative reductions of LDL cholesterol; mean values after the LDL apheresis treatments are not different. Serum triglycerides, HDL-cholesterol, and lipoprotein(a) are also acutely reduced. Available LDL apheresis methods differ with respect to their impact on the coagulation system, on C-reactive protein and on leukocyte count. Cardiovascular events are clearly reduced by the LDL apheresis methods. There is an urgent need to prospectively compare the different LDL apheresis methods taking into account hard end points. The lower target values for LDL cholesterol suggested by international guidelines for high-risk patients will certainly require a more widespread use of LDL apheresis.

Gille A, Bodor ET, Ahmed K, Offermanns S. · Institute of Pharmacology, University of Heidelberg, Heidelberg, Germany. · Annu Rev Pharmacol Toxicol. · Pubmed #17705685 No free full text.

Abstract: Pharmacological doses of nicotinic acid induce a profound change in the plasma levels of various lipids and lipoproteins. The ability of nicotinic acid to strongly increase the plasma concentration of high-density lipoprotein (HDL) cholesterol has in recent years led to an increased interest in the pharmacological potential of nicotinic acid. There is increasing evidence that nicotinic acid alone or in addition to LDL cholesterol-lowering drugs can reduce the progression of atherosclerosis and reduce the risk of cardiovascular events. The clinical use of nicotinic acid is, however, hindered by harmless but unpleasant side effects, especially by a strong cutaneous vasodilation called flushing. The recent discovery of the G protein-coupled receptor GPR109A (HM74A or PUMA-G) as a receptor for nicotinic acid has allowed for better understanding of the mechanisms underlying the metabolic and vascular effects of nicotinic acid. On the basis of recent progress in understanding the pharmacological effects of nicotinic acid, new strategies are in development to better exploit the pharmacological potential of nicotinic acid. New drugs acting via the nicotinic acid receptor or related receptors, as well as new co-medications that suppress unwanted effects of nicotinic acid, will most likely be introduced as new therapeutic options in the treatment of dyslipidemia and the prevention of cardiovascular diseases.

Kuhl H, Wiegratz I. · Department of Obstetrics & Gynecology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany. · Climacteric. · Pubmed #17653961 No free full text.

Abstract: CONTEXT: Previous studies in postmenopausal women have demonstrated that, after oral administration of norethisterone, a small proportion of the compound is rapidly converted into ethinylestradiol. The shape of the concentration - time curve suggested that this occurred in the liver. The results were confirmed by in vitro investigations with adult human liver tissue. In 2002, it was shown that, after oral treatment of women with tibolone, aromatization of the compound occurred, resulting in the formation of a potent estrogen, 7 alpha-methyl-ethinylestradiol. The result has been called into question, because the adult human liver does not express cytochrome P450 aromatase, which is encoded by the CYP 19 gene. Moreover, it has been claimed that the serum level of 7 alpha-methyl-ethinylestradiol measured by gas chromatography/mass spectrometry was an artifact. REPLY: Aromatization of steroids is a complex process of consecutive oxidation reactions which are catalyzed by cytochrome P450 enzymes. The conversion of the natural C19 steroids, testosterone and androstenedione, into estradiol-17beta and estrone is dependent on the oxidative elimination of the angular C19-methyl group. This complex key reaction is catalyzed by the cytochrome P450 aromatase, which is expressed in many tissues of the adult human (e.g. ovary, fat tissue), but not in the liver. However, 19-nortestosterone derivatives are characterized by the lack of the C19-methyl group. Therefore, for the aromatization of these synthetic steroids, the action of the cytochrome P450 aromatase is not necessary and the oxidative introduction of double bonds into the A-ring can be catalyzed by other hepatic cytochrome P450 enzymes. The final key process in the formation of a phenolic A-ring, both in natural androgens and 19-nortestosterone derivatives, is the enolization of a 3-keto group to the C2-C3-enol or the C3-C4-enol moiety, which occurs without the action of enzymes. CONCLUSION: 19-nortestosterone derivatives (norethisterone, norethynodrel, tibolone) can readily be aromatized in the adult human liver. This leads to the formation of the potent estrogens ethinylestradiol from norethisterone or norethynodrel and 7 alpha-methyl-ethinylestradiol from tibolone. This may have clinical consequences, e.g. the elevated risk of venous thromboembolic disease in premenopausal women treated with high doses of norethisterone for bleeding disorders, or the elevated risk of stroke or endometrial disease in postmenopausal women treated with tibolone.

Schmitz G, Grandl M. · Institute for Clinical Chemistry and Laboratory Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. · Antioxid Redox Signal. · Pubmed #17600463 No free full text.

Abstract: Hyperlipidemias and small dense LDLs in patients with high-triglyceride low-HDL syndromes lead to a prolonged half life of apoB-containing particles. This is associated with reactive oxygen species (ROS) activation and leads to formation of oxidized LDL (Ox-LDL). Generators of ROS in macrophages (MACs) include myeloperoxidase (MPO)-mediated respiratory burst and raft-associated NADPH-oxidase. The intracellular oxidant milieu is involved in cellular signaling pathways, like ion-transport systems, protein phosphorylation, and gene expression. Lipid oxidation through ROS can amplify foam cell formation through Ox-LDL uptake, leading to formation of ceramide (Cer)-rich lipid membrane microdomains, and is associated with expansion of the lysosomal compartment and an upregulation of ABCA1 and other genes of the AP3 secretory pathway. Ox-LDL may also affect cell-surface turnover of Cer-backbone sphingolipids and apoE-mediated uptake by LRP-family members. In contrast, HDL-mediated lipid efflux causes disruption of lipid membrane microdomains and prevents foam cell formation. Oxidation of HDL through MPO leads to a failure of lipid efflux and enhancement of MAC loading. Therefore, lipid rafts and oxidation processes are important in regulation of MAC foam cell formation and atherosclerosis, and the balance between oxidant and antioxidant intracellular systems is critically important for efficient MAC function.

Hanefeld M. · Centre for Clinical Studies, GWT Technical University, Dresden, Germany. · Int J Clin Pract Suppl. · Pubmed #17594390 links to  free full text

Abstract: Type 2 diabetes is characterised by a gradual decline in glycaemic control and progression from oral glucose-lowering monotherapy to combination therapy and exogenous insulin therapy. Functional decline of the insulin-secreting beta-cells is largely responsible for the deterioration in glycaemic control. Preservation of beta-cell functionality, in addition to maintaining glycaemic control and reducing insulin resistance, is now regarded as a key target for long-term management strategies. Early, aggressive intervention with combination therapy is emerging as a valid approach to optimise long-term outcomes and combining agents with differing modes of action and secondary effect profiles should prove valuable. Sulfonylureas and thiazolidinediones exert their glucose-lowering effect through differing mechanisms of action - the sulfonylureas by stimulating insulin secretion, whereas the thiazolidinediones are insulin sensitisers. Both agents offer excellent improvements in glycaemic control when given as monotherapy or in combination. The thiazolidinediones protect beta-cell structural and functional integrity and functionality and complement the sulfonylureas by inducing and maintaining improvements in insulin resistance, the abnormal lipid profile associated with type 2 diabetes and other cardiovascular risk factors. Thus, there is a strong rationale to support the addition of thiazolidinediones to sulfonylureas as a treatment option for type 2 diabetes. This combination may be particularly effective in the early stages of the disease when beta-cell function is at its highest, allowing maximal benefit to be obtained from the insulin secretion-promoting abilities of the sulfonylureas and the beta-cell-protective effects of the thiazolidinediones.

Schettler V, Wieland E. · Nephrologisches Zentrum Göttingen, Göttingen. · Dtsch Med Wochenschr. · Pubmed #17342636 No free full text.

Abstract: LDL apheresis is a safe and very effective extracorporeal treatment of refractory hypercholesterolemia. LDL cholesterol levels can be reduced with this procedure by more than 60%. C-reactive protein (CRP) is a known marker of inflammation in atherosclerosis. Interestingly CRP can be effectively removed by a single LDL apheresis, but further studies are needed to substantiate the effect of extracorporeal reduction of CRP on the progression of atherosclerosis. However, adhesion molecules and activities of inflammatory cells were also found to be reduced after a single LDL apheresis. The biochemical composition of newly formed LDL particles after apheresis is altered: LDL particles isolated after LDL apheresis had an increased resistance to oxidative stress in vitro. In addition, antioxidants are not depleted by LDL apheresis. The extracorporal method itself does not have a negative impact on the oxidative/antioxidative balance. A recent investigation showed that LDL-cholesterol had a more pronounced effect on blood rheology than fibrinogen. This observation may explain why a single LDL apheresis leads to better myocardial perfusion, as demonstrated by PET in patients with hypercholesterolemia. These additional effects have so far only been known with statins. Further investigations are needed to substantiate the observed potentially beneficial effects of LDLapheresis beyond its effect of lowering LDL.

Schuster H. · INFOGEN, Xantener Strasse 10, 10707 Berlin, Germany. · Expert Rev Cardiovasc Ther. · Pubmed #17338663 No free full text.

Abstract: The GALAXY Program is a series of clinical studies investigating the efficacy and tolerability of rosuvastatin in line with the hypothesis that the statin with the greatest efficacy for improving the atherogenic lipid profile and beneficially modifying inflammatory markers will also slow progression of atherosclerosis and improve cardiovascular outcomes. Completed studies report that rosuvastatin is more effective than comparator statins in reducing low-density lipoprotein cholesterol, improving the lipid profile and enabling patients to achieve lipid goals, including revised, more stringent goals, even in high-risk patients. Studies have also reported that rosuvastatin can arrest and even regress atherosclerosis. Ongoing outcomes studies will determine whether these beneficial effects of rosuvastatin translate into reduced morbidity and mortality.

März W, Grammer TB. · Synlab Medizinisches Versorgungszentrum für Labordiagnostik Heidelberg, Heidelberg, Deutschland. · Internist (Berl). · Pubmed #17333056 No free full text.

Abstract: Reducing cholesterol and LDL cholesterol (LDL-C) is one of the few clearly demonstrated principles in the prevention and treatment of arteriosclerosis. LDL-C reduction over a number of years to ca. 70 mg/dl can reduce the risk of coronary events by about two thirds. Lipid lowering pharmacotherapy is the more effective the higher the individual risk of the patient is. The therapeutic decision is based on the total risk of the patient. For coronary patients after acute coronary syndrome and/or with diabetes mellitus, a reduction of LDL-C to 70 mg/dl is justified. For patients with "stable" coronary heart disease, a LDL-C level of 100 mg/dl or less should be strived for. Whether diabetes mellitus always indicates a "coronary risk equivalent" and thus justifies a reduction in LDL-C to 100 ml/dl or less, is questionable.

Puspa J, Klör HU. · Institut für Betriebslehre der Agrar- und Ernährungswirtschaft der Justus-Liebig-Universität, Giessen, Germany. · Ther Umsch. · Pubmed #17323287 No free full text.

Abstract: Plant sterols and stanols are similar in chemical structure to cholesterol, differing in their side chain configuration. The mechanism by which they lower cholesterol is thought to involve inhibition of cholesterol absorption. A number of products containing plant sterols are now available. A limitation on the development of such products is the poor water solubility of plant sterols. The most common solution is to esterify plant stanols or sterols with fatty acids to enhance availability in food fats such as margarines and salad dressings. A number of studies have shown the efficacy of plant stanol- and sterol-enriched margarines for lowering cholesterol. However, there have been no studies demonstrating that consumption of these stanol ester-containing margarines influences the incidence of coronary heart disease.

Pfeuffer M, Schrezenmeir J. · Institute for Physiology and Biochemistry of Nutrition, Federal Research Centre for Nutrition and Food, Kiel, Germany. · Obes Rev. · Pubmed #17300277 No free full text.

Abstract: The metabolic syndrome is a cluster of metabolic disorders, namely dyslipidaemia, hypertension, obesity and glucose intolerance. Insulin resistance is the core phenomenon. Co-occurrence is associated with increased cardiovascular disease (CVD) risk. Observational studies found no increased CVD risk with increasing consumption of milk and other dairy products. In several studies dairy consumption was inversely associated with the occurrence of one or several facets of the metabolic syndrome. Many dairy components may contribute to the beneficial effects. Milk and particularly whey appeared insulinotropic when given in a single meal, but not in longer-term intervention. Medium chain fatty acids improve insulin sensitivity. Whey proteins, amino acids, medium chain fatty acids and in particular calcium and other minerals may contribute to the beneficial effect of dairy products on body weight and body fat. Peptides, calcium and other minerals reduce blood pressure. Fermented products and probiotic bacteria decrease absorption of cholesterol, sphingomyelin of cholesterol and fat, calcium of cholesterol, bile acids and fat. Proteins, peptides and bacteria may also reduce plasma cholesterol. Lactose, citrate, proteins and peptides improve weight control, blood pressure and plasma lipids indirectly, by improving calcium bioavailability. Furthermore, dairy consumption improves the bioavailability of folate and other secondary plant components.

Ringleb P, Hacke W. · Neurologische Klinik der Ruprecht-Karls-Universität, Im Neuenheimer Feld 400, 69120 Heidelberg. · Hamostaseologie. · Pubmed #17146547 No free full text.

Abstract: Patients suffering a transient ischaemic attack (TIA) or ischaemic stroke (IS) have a high recurrence risk. Secondary prevention aims to prevent not only further strokes but also cardiac events. Important parts of secondary prevention regimens are the modification of vascular risk factors and the inhibition of platelet function or anticoagulation if indicated. The inhibition of platelet function is effective in the reduction of secondary vascular events in patients with TIA or stroke. This is true for acetylsalicylic acid (ASA), clopidogrel, and the combination of ASA plus slow-release dipyridamole. A prediction model which allows to identify patients in whom clopidogrel or dipyridamol plus ASA is superior to ASA for the secondary prevention of stroke is presented.

Gouni-Berthold I, Krone W. · Klinik II und Poliklinik für Innere Medizin der Universität zu Köln, Köln, Germany. · Dtsch Med Wochenschr. · Pubmed #17139581 No free full text.

Abstract: Patients with diabetes mellitus are patients at high risk for cardiovascular events. There is only limited number of studies examining the effects of lipid lowering specifically in diabetics. The majority of evidence is derived from subgroup analyses of large intervention trials. Patients with diabetes mellitus benefit from a therapy with statins, independently from the starting LDL cholesterol concentrations. Furthermore, recent studies strongly suggest that for high risk patients such as diabetics regarding LDL "the lower is the better" The data for the benefits of fibrate therapy is not as robust as those available for statins. Therefore, at present no specific recommendation for treatment of diabetics with fibrates can be made.

Hamm CW, Hamann A. · Kerckhoff-Klinik, Herzzentrum, Bad Nauheim. · Dtsch Med Wochenschr. · Pubmed #17109250 No free full text.

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Steinmetz OM, Panzer U, Stahl RA, Wenzel UO. · Department of Medicine, Division of Nephrology, University Hospital of Hamburg Eppendorf, Hamburg, Germany. · Eur J Clin Invest. · Pubmed #16893373 No free full text.

Abstract: Dyslipdemia is a common complication of chronic kidney disease (CKD) and contributes to high cardiovascular morbidity and mortality of CKD patients. Experimental studies have demonstrated that lipids induce glomerular and tubulointerstitial injury and that lipid-lowering treatments ameliorate renal injury. Therapy with statins not only has the potential to lower cardiovascular morbidity and mortality in patients with CKD but also to slow progression of renal disease. Whereas the guidelines for treatment of hyperlipidaemia in nonrenal patients are based on prospective, randomized, placebo-controlled mega-trials, such data are not available for CKD patients. This review outlines the limited information currently available on the effect of statins among patients with CKD and summarizes the ongoing randomized trials designed to address this question.

Assaf C, Bagot M, Dummer R, Duvic M, Gniadecki R, Knobler R, Ranki A, Schwandt P, Whittaker S. · Department of Dermatology and Allergy, Skin Cancer Center Charité, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany. · Br J Dermatol. · Pubmed #16882161 No free full text.

Abstract: Bexarotene is an oral retinoid therapy that is effective for the treatment of early and advanced-stage cutaneous T-cell lymphoma (CTCL) in patients who have failed on other therapies. However, bexarotene treatment is associated with unavoidable side-effects, in particular hypertriglyceridaemia and hypothyroidism, which are manageable with adequate concomitant medications and are reversible on cessation of treatment. A pragmatic strategy for minimizing bexarotene-associated hypertriglyceridaemia and hypothyroidism is suggested, based on data from the studies with bexarotene in CTCL and on day-to-day experience with this agent in the clinical setting. The strategy anticipates that these common adverse events are likely to occur and recommends the early use of preventive therapy to lower triglycerides and elevate thyroid hormone levels in the blood, followed by subsequent monitoring, dose adjustment during bexarotene treatment, and titration of the daily bexarotene dose from 150 to 300 mg m(-2), which is optimal for most patients. When further information becomes available on how bexarotene interacts with lipid metabolism and thyroid function, the management approach suggested here may need to be changed.

Fudickar A, Bein B, Tonner PH. · Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. · Curr Opin Anaesthesiol. · Pubmed #16829722 No free full text.

Abstract: PURPOSE OF REVIEW: Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactacidosis, lipaemic plasma and cardiac failure, associated with propofol infusion over prolonged periods of time. As propofol is used worldwide, knowledge of propofol infusion syndrome is essential for all anaesthesiologists and intensive care physicians. This review will provide an update on reported cases, and describe recent findings relevant to the pathophysiology and clinical presentation of propofol infusion syndrome. RECENT FINDINGS: Case reports of propofol infusion syndrome have contributed new pathophysiological evidence. Reported cases of similar syndromes may represent initial propofol infusion syndrome, and may help to identify further risk factors such as low carbohydrate supply and early warning signs such as lactacidosis. Newly identified gene defects mimicking propofol infusion syndrome may elicit the underlying genetic susceptibility. Recommendations for the limitation of propofol use have been devised by various institutions. SUMMARY: Propofol infusion syndrome must be kept in mind as a rare but highly lethal complication of propofol use, not necessarily confined to the prolonged use of propofol. Dose limitations must be adhered to, and early warning signs such as lactacidosis should lead to the immediate cessation of propofol infusion.

May P. · Abteilung Innere Medizin II, Zentrum für Neurowissenschaften, Medizinische Universitätsklinik Freiburg im Breisgau. · Dtsch Med Wochenschr. · Pubmed #16761203 No free full text.

This publication has no abstract.