24 results on '"Andreas Heibges"'
Search Results
2. Hypertriglyzeridämie mit Pankreatitis
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Andreas Heibges, Reinhard Klingel, and Cordula Fassbender
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03 medical and health sciences ,0302 clinical medicine ,030211 gastroenterology & hepatology ,030204 cardiovascular system & hematology - Abstract
ZUSAMMENFASSUNGInsbesondere die schwere Hypertriglyzeridämie (SHTG) führt zu einem erhöhten Risiko für eine besonders schwer verlaufende Pankreatitis. In der Akutsituation einer SHTG-Pankreatitis müssen die Triglyzeride sehr rasch gesenkt werden, um einen weiteren Organschaden zu verhindern. Mithilfe der therapeutischen Apherese in Form des Plasmaaustausches oder der Doppelfiltrations-Plasmapherese (DFPP) gelingt dies effektiv und sicher. Für Patienten mit rezidivierender SHTG-Pankreatitis kann eine Langzeittherapie mit Apherese zusätzlich zu Diät, Lebensstilmaßnahmen und medikamentöser Therapie ein wichtiges Therapiemodul zur Prävention erneuter Ereignisse sein. In der Schwangerschaft ist jede zweite Pankreatitis durch zu hohe Triglyzeride verursacht. Bei fortbestehender Fettstoffwechselstörung kann die therapeutische Apherese eine Therapieoption sein, um ein solches für den Fötus und die Mutter lebensbedrohliches Ereignis zu verhindern.
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- 2021
3. Therapeutische Apherese
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Cordula Fassbender, Volker Schettler, Reinhard Klingel, and Andreas Heibges
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ZUSAMMENFASSUNGIn Deutschland ist der Einsatz der therapeutischen Apherese (TA) vorrangig ein nephrologisches Therapieangebot. International ist der Fachbezug heterogener. Abhängig von Zulassungsstatus und Erfahrungswerten werden bei gleicher Indikation unterschiedliche Methoden bevorzugt. Der unselektive Plasmaaustausch ist in weiten Teilen der Welt unverändert das Standardverfahren. Deutschland und Japan sind die Pioniere der selektiven Verfahren wie der Immunadsorption und Doppelfiltrations-Plasmapherese. Unter den interdisziplinären Leitlinien zum Einsatz der TA sind für die Praxis in Deutschland der Apherese-Standard der Deutschen Gesellschaft für Nephrologie (DGfN) und die Leitlinien der American Society for Apheresis (ASFA) hervorzuheben. Die Leitlinien der Deutschen Gesellschaft für Neurologie e. V. (DGN) sind als nationale fachbezogene Leitlinien zu erwähnen, da die TA bei vielen neurologischen Erkrankungen zum Einsatz kommt und sehr differenziert empfohlen wird. Das neurologische Konsensuspapier zur TA fasst dies aktuell zusammen. Im Jahr 2019 wurden die 3 Werke aktualisiert bzw. erstmals vorgelegt.
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- 2020
4. Homozygous familial hypercholesterolemia with severe involvement of the aortic valve—A sibling‐controlled case study on the efficacy of lipoprotein apheresis
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Julia Moosmann, Matthias Galiano, Reinhard Klingel, Martin Schöber, Katja Sauerstein, Ariawan Purbojo, Johanna Hammersen, Holger Blessing, Gunter Raffelsbauer, Andreas Heibges, and Petra Rümmele
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Adult ,Male ,Aortic valve ,medicine.medical_specialty ,Genotype ,Biopsy ,Lipoproteins ,Familial hypercholesterolemia ,030204 cardiovascular system & hematology ,Hyperlipoproteinemia Type II ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Ezetimibe ,Internal medicine ,Xanthomatosis ,Humans ,Medicine ,Sibling ,Child ,Aorta ,Retrospective Studies ,Family Health ,business.industry ,Cholesterol ,Siblings ,PCSK9 ,Homozygote ,Mechanical Aortic Valve ,Cholesterol, LDL ,Hematology ,General Medicine ,medicine.disease ,Lipids ,Phenotype ,medicine.anatomical_structure ,chemistry ,Echocardiography ,Aortic Valve ,Case-Control Studies ,Child, Preschool ,Aortic valve stenosis ,Blood Component Removal ,Female ,lipids (amino acids, peptides, and proteins) ,Proprotein Convertase 9 ,business ,030215 immunology ,medicine.drug - Abstract
Background Homozygous familial hypercholesterolemia (hoFH) can cause severe atherosclerotic cardiovascular disease (ASCVD) in early infancy. Diagnosis and initiation of effective lipid-lowering therapy (LLT) are recommended as early as possible to prevent ASCVD-related morbidity and mortality. Methods The clinical courses of a pair of siblings with an identical hoFH genotype, who exhibited major similarities of their clinical phenotype were analyzed in a case-control fashion including the family. Results The older sibling was diagnosed with hoFH at the age of 4. Untreated LDL-cholesterol (LDL-C) was 17 mmol/L (660 mg/dL). LLT including lipoprotein apheresis (LA) was initiated and has been successful for 8 years now. A reduction of estimated cholesterol burden by 74% was achieved by LA and combined drug therapy including statins and ezetimibe. The efficacy of escalation of drug therapy was limited because the underlying LDL receptor (LDLR) mutation in the family resulted in substantially reduced receptor function. Treatment with proprotein convertase subtilisin-kexin type 9 (PCSK9)-antibodies failed. His younger brother died at the age of 2 years shortly after the hoFH diagnosis of the elder sibling. Postmortem examination revealed advanced aortic root atheroma and aortic valve stenosis. In the older sibling, aortic valve stenosis and insufficiency were treated at the age of 9 years with mechanical aortic valve replacement. Conclusions LLT including LA should be initiated as early as possible following the diagnosis of hoFH with very high LDL-C levels. With the same genotype, the phenotype of hoFH can exhibit similar patterns but outcome is substantially related to treatment.
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- 2020
5. Lipoprotein(a) – Marker for cardiovascular risk and target for lipoprotein apheresis
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Volker Schettler, P. Grützmacher, Bernd Hohenstein, Ulrich Julius, Andreas Heibges, E. Roeseler, Franz Heigl, Reinhard Klingel, Anja Vogt, and Cordula Fassbender
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Oncology ,medicine.medical_specialty ,Apolipoprotein B ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Germany ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Medical history ,030212 general & internal medicine ,Family history ,Risk factor ,biology ,medicine.diagnostic_test ,business.industry ,Cholesterol ,Patient Selection ,General Medicine ,Lipoprotein(a) ,Atherosclerosis ,chemistry ,Cardiovascular Diseases ,Blood Component Removal ,biology.protein ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,business ,Lipid profile ,Biomarkers ,Lipoprotein - Abstract
Lipoprotein(a) (Lp(a)) consists of an LDL particle whose apolipoprotein B (apoB) is covalently bound to apolipoprotein(a) (apo[a]). An increased Lp(a) concentration is a causal, independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and a predictor of incident or recurrent cardiovascular events. Although Lp(a) was first described as early as 1963, only the more recent results of epidemiological, molecular, and genetic studies have led to this unequivocal conclusion. More than 20% of Western populations have elevated Lp(a) values. Lp(a) concentrations should be always part of the lipid profile when ASCVD risk is assessed. However, presence of other risk factors, laboratory findings, medical history and family history must be considered to conclude on its clinical relevance in an individual patient. Early or progressive ASCVD or a familial predisposition are key findings which can be associated with elevated Lp(a). The cholesterol portion contained in Lp(a) is also included in the various methods of LDL-C measurement. To assess proximity to the cardiovascular risk related target value for LDL-C, appropriate correction should be applied when high Lp(a) values are obtained to estimate the LDL-C that can actually be treated by lipid lowering drugs. Initial study data show that antisense oligonucleotides, which selectively decrease apolipoprotein(a), are promising as future treatment options. Currently, lipoprotein apheresis, which has a reimbursement guideline in Germany, is the therapy of choice for patients with Lp(a)-associated progressive ASCVD, with the aim of sustained prevention of further cardiovascular events.
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- 2019
6. Cardiovascular Outcome of Pediatric Patients With Bi-Allelic (Homozygous) Familial Hypercholesterolemia Before and After Initiation of Multimodal Lipid Lowering Therapy Including Lipoprotein Apheresis
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Holger Stein, Carsten Schürfeld, Tobias A Marsen, Juergen R. Schaefer, Günter Klaus, Christina Taylan, Lars Pape, Matthias Galiano, Jens König, Joenna Driemeyer, Jun Oh, Andreas Heibges, Lutz T. Weber, Reinhard Klingel, Michael Koziolek, Ralf Spitthöver, Axel Versen, Rainer Büscher, and Claus Peter Schmitt
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Aortic valve ,Male ,medicine.medical_specialty ,Adolescent ,Lipoproteins ,Medizin ,Familial hypercholesterolemia ,030204 cardiovascular system & hematology ,Gastroenterology ,Lipid-lowering therapy ,Hyperlipoproteinemia Type II ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Allele ,Child ,Subclinical infection ,Retrospective Studies ,business.industry ,Anticholesteremic Agents ,Homozygote ,Cholesterol, LDL ,Aortic surgery ,medicine.disease ,Combined Modality Therapy ,3. Good health ,medicine.anatomical_structure ,Child, Preschool ,Cardiology ,Blood Component Removal ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lipoprotein apheresis ,Lipoprotein ,Follow-Up Studies - Abstract
Twenty-four patients with bi-allelic familial hypercholesterolemia commencing chronic lipoprotein apheresis (LA) at a mean age of 8.5 ± 3.1 years were analysed retrospectively and in part prospectively with a mean follow-up of 17.2 ± 5.6 years. Mean age at diagnosis was 6.3 ± 3.4 years. Untreated mean LDL-C concentrations were 752 mg/dl ± 193 mg/dl (19.5 mmol/l ± 5.0 mmol/l). Multimodal lipid lowering therapy including LA resulted in a mean LDL-C concentration of 184 mg/dl (4.8 mmol/l), which represents a 75.5% mean reduction. Proprotein convertase subtilisin/kexin type 9-antibodies contributed in 3 patients to LDL-C lowering with 5 patients remaining to be tested. After commencing chronic LA, 16 patients (67%) remained clinically stable with only subclinical findings of atherosclerotic cardiovascular disease (ASCVD), and neither cardiovascular events, nor need for vascular interventions or surgery. In 19 patients (79%), pathologic findings were detected at the aortic valve (AV), which in the majority were mild. AV replacement was required in 2 patients. Mean Lipoprotein(a) concentration was 42.4 mg/dl, 38% had >50 mg/dl. There was no overt correlation of AV pathologies with other ASCVD complications, or Lipoprotein(a) concentration. Physicochemical elimination of LDL particles by LA appears indispensable for patients with bi-allelic familial hypercholesterolemia and severe hypercholesterolemia to maximize the reduction of LDL-C. In conclusion, in this rare patient group regular assessment of both the AV, as well as all arteries accessible by ultrasound should be performed to adjust the intensity of multimodal lipid lowering therapy with the goal to prevent ASCVD events and aortic surgery.
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- 2020
7. Multimodal lipid-lowering treatment in pediatric patients with homozygous familial hypercholesterolemia—target attainment requires further increase of intensity
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Jun Oh, Carsten Schürfeld, Joenna Driemeyer, Claus Peter Schmitt, Andreas Heibges, Juergen R. Schaefer, Günter Klaus, Matthias Galiano, Christina Taylan, Lutz T. Weber, Ralf Spitthöver, Reinhard Klingel, Jens König, Lars Pape, and Rainer Büscher
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Counseling ,Male ,Nephrology ,Heterozygote ,medicine.medical_specialty ,Adolescent ,Medizin ,Disease ,Familial hypercholesterolemia ,030204 cardiovascular system & hematology ,Compound heterozygosity ,Hyperlipoproteinemia Type II ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Risk Factors ,Germany ,Internal medicine ,medicine ,Humans ,Healthy Lifestyle ,030212 general & internal medicine ,Child ,Retrospective Studies ,business.industry ,Anticholesteremic Agents ,PCSK9 ,Cholesterol, LDL ,medicine.disease ,Combined Modality Therapy ,Treatment Outcome ,Receptors, LDL ,Cardiovascular Diseases ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Target attainment ,Blood Component Removal ,Female ,Lipid lowering ,business - Abstract
Familial hypercholesterolemia (FH) causes premature cardiovascular disease (CVD). Lipoprotein apheresis (LA) is recommended as first-line lipid-lowering treatment (LLT) for homozygous (ho) FH. Efficacy of multimodal LLT including lifestyle counseling, drug treatment, and LA was analyzed in 17 pediatric hoFH or compound heterozygous (c-het) FH patients, who commenced chronic LA in Germany before the age of 18. At time of diagnosis, mean low-density lipoprotein cholesterol (LDL-C) concentration was 19.6 mmol/l (756 mg/dl). Multimodal LLT resulted in 73% reduction of mean LDL-C concentration including a 62% contribution of LA. Only three children (18%) achieved mean LDL-C concentrations below the recommended pediatric target of 3.5 mmol/l (135 mg/dl). In 13 patients (76%) during chronic LA, neither cardiovascular events occurred nor was CVD progression detected clinically or by routine imaging techniques. In four patients (24%), cardiovascular events documented progression of CVD despite weekly LA, including one death due to coronary and cerebrovascular CVD which was not stabilized after commencing LA. Based on the mutational status, only 6 out of the 17 children were candidates for proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibition. Two already responded with further LDL-C decrease by 40%. Next to drug therapy, regular LA is an essential component of LLT for approaching LDL-C targets in children with hoFH or c-hetFH, which was successful only in a minority of children. Progression of CVD morbidity and resulting mortality remain unresolved issues. Early and intensified multimodal LLT guided by risk factors beyond LDL-C concentration is needed to improve outcome.
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- 2018
8. Prevention of cardiovascular complications in patients with Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease by long-term lipoprotein apheresis according to German national guidelines
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Reinhard Klingel, Cordula Fassbender, and Andreas Heibges
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0301 basic medicine ,Hyperlipoproteinemias ,medicine.medical_specialty ,Time Factors ,Apolipoprotein B ,030204 cardiovascular system & hematology ,Coronary artery disease ,Article ,03 medical and health sciences ,Lipoprotein apheresis ,0302 clinical medicine ,Risk Factors ,Structural Biology ,Lipoprotein (a) ,Germany ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Risk factor ,Molecular Biology ,Retrospective Studies ,Angiology ,Polymorphism, Genetic ,biology ,business.industry ,Prevention ,Incidence ,Therapeutic effect ,General Medicine ,Lipoprotein(a) ,Cardiovascular disease ,medicine.disease ,Treatment Outcome ,030104 developmental biology ,Endocrinology ,Cardiovascular Diseases ,Practice Guidelines as Topic ,Blood Component Removal ,biology.protein ,Guideline Adherence ,business ,Biomarkers ,Mace ,Lipoprotein - Abstract
Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor playing a causal role for atherosclerotic cardiovascular disease (CVD). Lipoprotein apheresis (LA) is a safe well-tolerated outpatient treatment to lower LDL-C and Lp(a) by 60–70%, and is the ultimate escalating therapeutic option in patients with hyperlipoproteinemias (HLP) involving LDL particles. Major therapeutic effect of LA is preventing cardiovascular events. Lp(a)-HLP associated with progressive CVD has been approved as indication for regular LA in Germany since 2008. The Pro(a)LiFe-study investigated with a prospective multicenter design the long-term preventive effect of LA on incidence rates of cardiovascular events prospectively over a period of 5 years in 170 consecutive patients who commenced regular LA. During a median period of 4.7 years of the pre-LA period, Lp(a) associated progressive CVD became apparent. Apolipoprotein(a) (apo(a)) isoforms and polymorphisms at the apo(a) gene (LPA) were analyzed to assess hypothetical clinical correlations. 154 patients (90.6%) completed 5‑years follow-up. Significant decline of the mean annual major adverse cardiac event (MACE) rate was observed from 0.41 ± 0.45 two years prior to regular LA to 0.06 ± 0.11 during 5 years with regular LA (p < 0.0001). 95.3% of patients expressed at least one small apo(a) isoform. Calculation of isoform specific concentrations allowed to confirm the equivalence of 60 mg/dl or 120 nmol/l as Lp(a) thresholds of the German LA guideline. Results of 5 years prospective follow-up confirmed that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)-HLP and afore progressive CVD.
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- 2017
9. Lipoprotein(a) and mortality-a high risk relationship
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Reinhard Klingel, Andreas Heibges, and Cordula Fassbender
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medicine.medical_specialty ,Population ,Context (language use) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Structural Biology ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Risk factor ,education ,Molecular Biology ,Angiology ,education.field_of_study ,biology ,business.industry ,Patient Selection ,030229 sport sciences ,General Medicine ,Guideline ,Lipoprotein(a) ,Cholesterol, LDL ,Atherosclerosis ,Cardiovascular Diseases ,Concomitant ,Practice Guidelines as Topic ,biology.protein ,Cardiology ,Blood Component Removal ,Disease Progression ,business ,Lipoprotein - Abstract
Lipoprotein(a) (Lp(a)) is an independent cardiovascular risk factor playing a causal role for atherosclerotic cardiovascular disease (ASCVD). Early or progressive ASCVD or a familial predisposition are key findings which can be associated with Lp(a)-hyperlipoproteinemia (Lp(a)-HLP). The German guideline for the indication of lipoprotein apheresis in patients with Lp(a)-HLP has proved to be of value to identify patients at highest risk, using the composite of a Lp(a) threshold >60 mg/dl (>120 nmol/l) and clinical ASCVD progression despite effective LDL-C lowering therapy. In particular for such patients it appears to be plausible that Lp(a)-associated risk would increase cardiovascular mortality as the most important part of total mortality in Western populations. By the majority of existing investigations an association of Lp(a) concentration on total or cardiovascular mortality was demonstrated. However, inconsistency in the findings between studies exists without a clear trend for any study feature to explain this. Genetic homogeneity of the population, long-term follow-up, and clinically guided selection of patients might be important to further clarify the impact of Lp(a) concentration on progression of ASCVD, and finally total or cardiovascular mortality. LDL and Lp(a) particles exhibit a mutual effect modification on related ASCVD risk. Therefore, LDL-C levels and concomitant LDL-C lowering treatment must be considered in this context. Prospective evaluation is needed to document that specific Lp(a)-lowering additional to targeted LDL-C lowering will in fact reduce cardiovascular or total mortality.
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- 2019
10. Real-world study: Escalating targeted lipid-lowering treatment with PCSK9-inhibitors and lipoprotein apheresis
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Franz Heigl, Markus Ketteler, Andrea Raabe, Reinhard Klingel, Michael Moesenthin, Volker Schettler, Wanja M. Bernhardt, Ulrich Julius, Ralf Kühn, Markus Knittel, Andreas Heibges, Josef Leebmann, Tilmann Röseler, Ralf Spitthöver, Eberhard Röseler, and Carsten Schürfeld
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Male ,medicine.medical_specialty ,medicine.drug_class ,Lipoproteins ,Hypercholesterolemia ,030204 cardiovascular system & hematology ,Monoclonal antibody ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Enzyme Inhibitors ,Adverse effect ,biology ,business.industry ,PCSK9 ,PCSK9 Inhibitors ,Antibodies, Monoclonal ,Hematology ,General Medicine ,Lipoprotein(a) ,Cholesterol, LDL ,Middle Aged ,Atherosclerosis ,Combined Modality Therapy ,Lipids ,Discontinuation ,Concomitant ,Cohort ,biology.protein ,Blood Component Removal ,Female ,Antibody ,Proprotein Convertase 9 ,business ,030215 immunology - Abstract
INTRODUCTION Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition with monoclonal antibodies has complemented the armamentarium of lipid-lowering therapy (LLT) before the final step of commencing chronic lipoprotein apheresis (LA). Data are scarce on patients who, after escalation of LLT with PCSK9 antibodies, have commenced chronic LA or PCSK9 antibody treatment during ongoing long-term LA. PATIENTS AND METHODS In this study, a cohort of 110 patients with established atherosclerotic cardiovascular disease (ASCVD) due to hypercholesterolemia or concomitant lipoprotein(a)-hyperlipoproteinemia, who received PCSK9 antibodies for the first time during routine care, were consecutively identified. RESULTS Mean LDL-C concentration prior to initiation of LA or PCSK9 antibody treatment was 5.3 ± 2.6 mmol/L (205 ± 102 mg/dL). Due to established ASCVD, the risk-adjusted LDL-C target value was
- Published
- 2018
11. Use of plasma exchange or double filtration plasmapheresis to reduce body burden of polychlorinated biphenyls: A pilot trial
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Andreas Heibges, Reinhard Klingel, Jewgeni Jacobson, Christian Schikowsky, Thomas Kraus, Christian Hoffmann, André Esser, Monika Gube, Andreas Wiemeyer, and Thomas Schettgen
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Adult ,Male ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Pilot Projects ,010501 environmental sciences ,030501 epidemiology ,Toxicology ,01 natural sciences ,Comparative evaluation ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,Germany ,Occupational Exposure ,Internal medicine ,medicine ,Humans ,Recycling ,reproductive and urinary physiology ,0105 earth and related environmental sciences ,Therapeutic apheresis ,Analysis of Variance ,Plasma Exchange ,Waste management ,business.industry ,organic chemicals ,Pilot trial ,Public Health, Environmental and Occupational Health ,food and beverages ,Polychlorinated biphenyl ,Plasmapheresis ,Middle Aged ,Polychlorinated Biphenyls ,Pollution ,Double filtration plasmapheresis ,stomatognathic diseases ,Treatment Outcome ,chemistry ,Cohort ,Body Burden ,0305 other medical science ,business ,Environmental Monitoring ,Cohort study - Abstract
The aim of the study was to examine whether plasma exchange (PE) or selective double filtration plasmapheresis (DFPP) is able to reduce the internal Polychlorinated biphenyl (PCB) burden of highly exposed participants of the health effects in high-level exposure to PCB (HELPcB) cohort. HELPcB is a surveillance program for former PCB-exposed workers of a German capacitor recycling company. After comparative evaluation of PE and DFPP in a phase I, DFPP was chosen as method for further treatment. In phase II, five participants underwent DFPP at weekly intervals for the duration of 12 weeks. Six PCB species were selected as indicators and were analyzed in the plasma before and after each treatment and 4 weeks after the last treatment. The PCB levels before and after each DFPP treatment showed a significant reduction in PCB blood levels; however, there was no significant change in PCB levels within the samples collected before each treatment as compared with the samples collected in the following week before treatment. Even the difference between PCB levels at the onset of the study and 4 weeks after the last treatment was not significant. The results of this pilot trial do not encourage further investigations in using therapeutic apheresis to reduce the PCB body burden.
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- 2016
12. Andere Umstände: Apherese in der Schwangerschaft – Therapieoption bei vielen Krankheitsbildern
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Reinhard Klingel, Cordula Fassbender, and Andreas Heibges
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business ,Therapeutic apheresis - Abstract
In der Schwangerschaft kann die therapeutische Apherese eine rasch wirksame, risikoarme Option zur Behandlung von akuten therapierefraktaren Verlaufen bestimmter Erkrankungen darstellen oder als primare Therapiealternative dienen, wenn die regularen Medikamente aufgrund der Schwangerschaft nicht einsetzbar sind. Selektive Verfahren wie die Immunadsorption und die Lipoproteinapherese ersetzen zunehmend bei vielen Indikationen den unspezifischen Plasmaaustausch. Dargestellt wird eine Ubersicht zum Einsatz der therapeutischen Apherese in der Schwangerschaft bei immunologischen Krankheitsbildern des Nervensystems und weiterer Organsysteme sowie bei metabolischen Erkrankungen.
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- 2015
13. Lipoprotein apheresis results in plaque stabilization and prevention of cardiovascular events: comments on the prospective Pro(a)LiFe study
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Reinhard Klingel, Andreas Heibges, and Cordula Fassbender
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Male ,Hyperlipoproteinemias ,medicine.medical_specialty ,Plaque stabilization ,Plaque Stabilisierung ,Disease ,Prävention ,Coronary artery disease ,Article ,Lipoprotein apheresis ,Structural Biology ,Germany ,Internal medicine ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Longitudinal Studies ,Risk factor ,Molecular Biology ,Aged ,Angiology ,biology ,business.industry ,Prevention ,Therapeutic effect ,General Medicine ,Lipoprotein(a) ,Guideline ,Middle Aged ,Cardiovascular disease ,Atherosclerosis ,medicine.disease ,Koronare Herzerkrankung ,Lipoprotein-Apherese ,Treatment Outcome ,Endocrinology ,Blood Component Removal ,biology.protein ,Female ,business ,Kardiovaskuläre Erkrankung ,Lipoprotein - Abstract
Elevated lipoprotein(a) (Lp(a)) has emerged as an important independent cardiovascular risk factor, and causal association has been accepted with adverse outcome in atherosclerotic disease. Lipoprotein apheresis (LA) can lower low-density lipoprotein (LDL)-cholesterol and Lp(a) by 60-70 % and is the final escalating therapeutic option in patients with hyperlipoproteinemias (HLP) involving LDL or Lp(a) particles. Major therapeutic effect of LA is preventing cardiovascular events. Stabilizing plaque morphology might be an important underlying mechanism of action. In Germany, since 2008, a reimbursement guideline has been implemented to establish the indication for LA not only for familial or severe forms of hypercholesterolemia but also for Lp(a)-HLP associated with a progressive course of cardiovascular disease, that persists despite effective treatment of other concomitant cardiovascular risk factors, i.e. isolated Lp(a)-HLP. The Pro(a)LiFe-study confirmed with a prospective multicenter design that LA can effectively reduce Lp(a) plasma levels and prevent cardiovascular events.
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- 2015
14. Therapeutische Apherese – Kostenerstattung in Deutschland
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Andreas Heibges and Cordula Fassbender
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business - Abstract
Bei der Kostenerstattung der therapeutischen Apherese mussen stationarer und ambulanter Bereich unterschieden werden. Innerhalb des G-DRG-Systems (G-DRG: German Diagnosis-Related Groups) bilden die OPS-Codes (OPS: Operationen- und Prozedurenschlussel) der Zusatzentgelte die formale Grundlage fur den stationaren Einsatz des Plasmaaustauschs und der selektiven therapeutischen Apherese. Im ambulanten Bereich gehoren die Lipidapherese (LA) fur schwere Fettstoffwechselstorungen und die Immunadsorption (IA) bei therapierefraktarer rheumatoider Arthritis zum festen Leistungskatalog der GKV, wobei letztere in der Praxis keine Rolle mehr spielt. Der daruber hinaus gehende ambulante Einsatz der Apheresetherapie bei seltenen Krankheitsbildern oder sehr speziellen Verlaufssituationen schwerer Erkrankungen erfordert eine muhsame individuelle Antragstellung bei den Kostentragern.
- Published
- 2014
15. Lipoprotein Apheresis for Lipoprotein(a)-Associated Cardiovascular Disease: Prospective 5 Years of Follow-Up and Apolipoprotein(a) Characterization
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Eberhard Roeseler, Ulrich Julius, Franz Heigl, Ralf Spitthoever, Dennis Heutling, Paul Breitenberger, Josef Leebmann, Walter Lehmacher, Pia R. Kamstrup, Børge G. Nordestgaard, Winfried Maerz, Asma Noureen, Konrad Schmidt, Florian Kronenberg, Andreas Heibges, Reinhard Klingel, Volker Schettler, Thomas Benzing, Hildegard Christ, Sabine Wehner, Ines Schulz-Merkel, Ralf Kuehn, Albrecht Wagner, Wilfried Dschietzig, Claudia Ernst, Michael Koziolek, Johannes Bunia, Peter Kulzer, Klaus-Dieter Kraenzle, Markus Toelle, Gerhard Riechers, Christine Kuehnel, Tobias Marsen, Christina Saehn, Jens Ringel, Harald Messner, Andreas Oehring, Carsten Schuerfeld, Michael Wintergalen, Falko Neumann, Harald Kaul, Martin Haesner, Juergen Passfall, Andrea Benschneider, Stefan Heidenreich, Winfried März, Ruediger Klaes, Priska Binner, Hans Dieplinger, Gertraud Erhart, and Cordula Fassbender
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Male ,medicine.medical_specialty ,Hyperlipoproteinemias ,Time Factors ,Apolipoprotein B ,Disease ,030204 cardiovascular system & hematology ,Apoprotein(a) ,Polymorphism, Single Nucleotide ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Genotype-phenotype distinction ,Risk Factors ,Internal medicine ,Germany ,medicine ,Humans ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Aged ,biology ,business.industry ,Incidence (epidemiology) ,Incidence ,Lipoprotein(a) ,Middle Aged ,Endocrinology ,Phenotype ,Treatment Outcome ,Cardiovascular Diseases ,biology.protein ,Blood Component Removal ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lipoprotein apheresis ,Biomarkers ,Lipoprotein ,Follow-Up Studies - Abstract
Objective— Lipoprotein(a)-hyperlipoproteinemia (Lp(a)-HLP) along with progressive cardiovascular disease has been approved as indication for regular lipoprotein apheresis (LA) in Germany since 2008. We aimed to study the long-term preventive effect of LA and to assess hypothetical clinical correlations of apolipoprotein(a) (apo(a)) by analyzing genotypes and phenotypes. Approach and Results— This prospective observational multicenter study included 170 patients with Lp(a)-HLP and progressive cardiovascular disease (48.9 years median age at diagnosis) despite other cardiovascular risk factors, including low-density lipoprotein cholesterol had maximally been treated (mean baseline low-density lipoprotein cholesterol: measured, 2.56 mmol/L [98.9 mg/dL] and corrected, 1.72 mmol/L [66.3 mg/dL]). Patients were prospectively investigated during a 5-year period about annual incidence rates of cardiovascular events. In addition, apo(a) isoforms and polymorphisms at the apo(a) gene ( LPA ) were characterized. One hundred fifty-four patients (90.6%) completed 5 years of follow-up. Mean Lp(a) concentration before commencing regular LA was 108.1 mg/dL. This was reduced by a single LA treatment by 68.1% on average. Significant decline of the mean annual cardiovascular event rate was observed from 0.58±0.53 2 years before regular LA to 0.11±0.15 thereafter ( P Conclusions— Results of 5 years of prospective follow-up confirm that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)-HLP. Patients clinically selected by progressive cardiovascular disease were characterized by a highly frequent expression of small apo(a) isoforms. Only Lp(a) concentration seemed to comprehensively reflect Lp(a)-associated cardiovascular risk, however.
- Published
- 2016
16. RheoNet Registry Analysis of Rheopheresis for Microcirculatory Disorders With a Focus on Age-Related Macular Degeneration
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Cordula Fassbender, Andreas Heibges, Bernard Erdtracht, Michael Meinke, Thomas Carl, Joachim Nasemann, Katrin Engelmann, Reinhard Klingel, and Frank Koch
- Subjects
medicine.medical_specialty ,Visual acuity ,genetic structures ,business.industry ,Rheopheresis ,Hematology ,Macular degeneration ,medicine.disease ,eye diseases ,Surgery ,Apheresis ,Tolerability ,Nephrology ,Age related ,Internal medicine ,medicine ,medicine.symptom ,Adverse effect ,business ,Therapeutic apheresis - Abstract
The purpose of establishing the RheoNet registry was to evaluate the safety and efficacy of rheopheresis, a specific method of therapeutic apheresis used to treat microcirculatory disorders. Apheresis centers providing rheopheresis therapy and physicians caring for the underlying disease were asked to participate in the registry, and the registry data were analyzed for safety and tolerability. Age-related macular degeneration (AMD) was selected as a model disease to evaluate efficacy. The RheoNet registry was successfully established recording 7722 rheopheresis treatments of 1110 patients, including 833 AMD patients. The mean age of patients was 72 years. Adverse events (AE) were reported in 5.67% of treatments, but termination of the treatment session was only required in 0.48%. Transient hypotension was the most frequently reported AE. No age-related increase in AE was observed. Ophthalmological data of 428 eyes (of 279 treated patients) with dry AMD could be analyzed; 85 eyes of 55 untreated AMD patients served as the control. At 6.75 +/- 5.25 months post-baseline, 42% of the treated eyes had improved visual acuity. The proportion of eyes with a decline in visual acuity was 17%, compared to 40% in the untreated controls (P < 0.01). The RheoNet registry has been successfully established and data analysis revealed that rheopheresis is a safe outpatient treatment for microcirculatory disorders. Moreover, RheoNet currently provides the largest evaluation of the efficacy of rheopheresis for dry AMD. Registry analysis contributes to a safe and appropriate use of rheopheresis in clinical practice.
- Published
- 2010
17. Rheopheresis for idiopathic sudden hearing loss: results from a large prospective, multicenter, randomized, controlled clinical trial
- Author
-
Bernard Erdtracht, Walter Lehmacher, Andreas Heibges, Ralph Mösges, Juliane Köberlein, and Reinhard Klingel
- Subjects
Adult ,Male ,medicine.medical_specialty ,Hearing loss ,Blood viscosity ,Rheopheresis ,Population ,Methylprednisolone ,law.invention ,Randomized controlled trial ,law ,otorhinolaryngologic diseases ,medicine ,Humans ,Prospective Studies ,education ,Glucocorticoids ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Microcirculation ,Recovery of Function ,General Medicine ,610 Medical sciences ,Medicine ,Hearing Loss, Sudden ,Middle Aged ,Blood Viscosity ,Surgery ,ddc: 610 ,Otorhinolaryngology ,Ear, Inner ,Anesthesia ,Blood Component Removal ,Audiometry, Pure-Tone ,Fluid Therapy ,Female ,sense organs ,Pure tone audiometry ,medicine.symptom ,Audiometry ,business ,Tinnitus - Abstract
Background: Idiopathic sudden hearing loss (ISHL) has been suggested to precipitate as final common pathway of microcirculatory impairment of the inner ear associated with a variety of etiologies and characterized by a local hyperviscosity syndrome in cochlear vessels. Therefore, we investigated the[for full text, please go to the a.m. URL], 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery
- Published
- 2008
18. Lipoprotein apheresis for Lp(a)-hyperlipoproteinemia with progressive cardiovascular disease--Additional particular aspects of the Pro(a)LiFe multicenter trial
- Author
-
Cordula Fassbender, Reinhard Klingel, and Andreas Heibges
- Subjects
medicine.medical_specialty ,Hyperlipoproteinemias ,Time Factors ,Disease ,Risk Assessment ,Coronary artery disease ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Multicenter trial ,Germany ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,Family history ,Retrospective Studies ,biology ,business.industry ,Therapeutic effect ,General Medicine ,Guideline ,Lipoprotein(a) ,medicine.disease ,Surgery ,Treatment Outcome ,Cardiovascular Diseases ,biology.protein ,Cardiology ,Blood Component Removal ,Disease Progression ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Biomarkers - Abstract
Lipoprotein apheresis (LA) can lower LDL-cholesterol and Lp(a) by 60%-70% and is the final escalating option in patients with hyperlipoproteinemias involving LDL or Lp(a) particles. Major therapeutic effect of LA is preventing cardiovascular events. In Germany since 2008 a reimbursement guideline has been implemented accepting to establish the indication for LA not only for familial or severe forms of hypercholesterolemia but also based on Lp(a)-hyperlipoproteinemia associated with a progressive course of cardiovascular disease, that persists despite effective treatment of other concomitant cardiovascular risk factors. The Pro(a)LiFe-study confirmed with a prospective multicenter design that LA can be regarded as an important therapeutic approach to effectively reduce Lp(a) plasma levels and prevent cardiovascular events in this particular high-risk patient group. Results support that Lp(a) may be a major causal factor for precipitating mechanisms of accelerated progression of cardiovascular disease (CVD). Indication for LA based on measurement of Lp(a) as part of risk assessment is supported by the following conditions: progressive CVD as assessed clinically and with imaging techniques, established maximally tolerated lipid lowering drug treatment, recent cardiovascular events despite efficient drug treatment, out of the ordinary frequency of cardiovascular events, early CVD, or positive family history of early CVD. Still existing difficulties with Lp(a) laboratory measurement require a practical approach to establish the indication for LA considering the 60 mg/dl threshold of German guidelines with selecting an Lp(a) assay which has been calibrated for mass.
- Published
- 2015
19. Determination of BOD-values of starch-containing waste water by a BOD-biosensor1This paper was presented at the fifth World Congress on Biosensors, Berlin, Germany, 3–5 June 1998.1
- Author
-
Jutta Metzger, Monika Reiss, Winfried Hartmeier, and Andreas Heibges
- Subjects
Biochemical oxygen demand ,Chromatography ,biology ,Immobilized enzyme ,Starch ,Biomedical Engineering ,Biophysics ,food and beverages ,General Medicine ,chemistry.chemical_compound ,Hydrolysis ,Adsorption ,Wastewater ,chemistry ,Electrochemistry ,biology.protein ,Amylase ,Potato starch ,Biotechnology - Abstract
The control of waste water plants is difficult or even impossible using the classical determination method for biological oxygen demand (BOD), because of its high time consumption of five days. A determination within some minutes is possible by microbial BOD-sensors. However, high molecular weight substances cannot be detected, a problem which can be overcome by the use of additional enzymes. For the application in a flow-through system to analyse starch containing waste water, α-amylase and amyloglucosidase were immobilized by adsorption to polystyrene or polypropylene carriers followed by crosslinking. Furthermore, covalent coupling to different nylon carriers, derivatives of chitin, silanized glass beads and silanized beads of foamed glass was tried. Chitin and Lewatit were the best suited carriers for the immobilization of α-amylase and amyloglucosidase. Two glass columns were filled with the immobilized enzymes and inserted into a commercial BOD-sensor containing the yeast Trichosporon cutaneum as biological component. The system was stable for more than two months under storage and one month under working conditions. A comparison of different starch types resulted in a hydrolysis of more than 80% in case of potato starch whereas grain starch was hydrolized only for 40–50%. Sensor-determined BOD-values of waste water with potato starch were nearly identical with BOD5-values resulting from the classical method.
- Published
- 1998
20. Lipoprotein apheresis in patients with maximally tolerated lipid-lowering therapy, lipoprotein(a)-hyperlipoproteinemia, and progressive cardiovascular disease: prospective observational multicenter study
- Author
-
Dennis Heutling, Winfried Maerz, Walter Lehmacher, Ulrich Julius, E. Roeseler, Ralf Spitthoever, Paul Breitenberger, Josef Leebmann, Andreas Heibges, Franz Heigl, and Reinhard Klingel
- Subjects
Male ,medicine.medical_specialty ,Hyperlipoproteinemias ,Disease ,chemistry.chemical_compound ,Risk Factors ,Physiology (medical) ,Internal medicine ,Germany ,medicine ,Humans ,Prospective Studies ,Risk factor ,Prospective cohort study ,Aged ,Hypolipidemic Agents ,Retrospective Studies ,biology ,Cholesterol ,business.industry ,Incidence (epidemiology) ,Incidence ,Retrospective cohort study ,Lipoprotein(a) ,Cholesterol, LDL ,Middle Aged ,Surgery ,Treatment Outcome ,chemistry ,Cardiovascular Diseases ,biology.protein ,Blood Component Removal ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lipoprotein ,Follow-Up Studies - Abstract
Background— Lipoprotein(a) (Lp(a)) hyperlipoproteinemia is a major risk factor for cardiovascular disease, which is not affected by treatment of other cardiovascular risk factors. This study sought to assess the effect of chronic lipoprotein apheresis (LA) on the incidence of cardiovascular events in patients with progressive cardiovascular disease receiving maximally tolerated lipid-lowering treatment. Methods and Results— In a prospective observational multicenter study, 170 patients were investigated who commenced LA because of Lp(a)-hyperlipoproteinemia and progressive cardiovascular disease. Patients were characterized regarding plasma lipid status, lipid-lowering drug treatment, and variants at the LPA gene locus. The incidence rates of cardiovascular events 2 years before (y-2 and y-1) and prospectively 2 years during LA treatment (y+1, y+2) were compared. The mean age of patients was 51 years at the first cardiovascular event and 57 years at the first LA. Before LA, mean low-density lipoprotein cholesterol and Lp(a) were 2.56±1.04 mmol·L −1 (99.0±40.1 mg·dL −1 ) and Lp(a) 3.74±1.63 µmol·L −1 (104.9±45.7 mg·dL −1 ), respectively. Mean annual rates for major adverse coronary events declined from 0.41 for 2 years before LA to 0.09 for 2 years during LA ( P P P =0.001) for y-2 to y-1 before LA, decline to 0.14 from y-1 to y+1 ( P P =0.014). Conclusions— In patients with Lp(a)-hyperlipoproteinemia, progressive cardiovascular disease, and maximally tolerated lipid-lowering medication, LA effectively lowered the incidence rate of cardiovascular events. Clinical Trial Registration— URL: https://drks-neu.uniklinik-freiburg.de . Unique identifier: DRKS00003119.
- Published
- 2013
21. RheoNet registry analysis of rheopheresis for microcirculatory disorders with a focus on age-related macular degeneration
- Author
-
Reinhard, Klingel, Cordula, Fassbender, Andreas, Heibges, Frank, Koch, Joachim, Nasemann, Katrin, Engelmann, Thomas, Carl, Michael, Meinke, and Bernard, Erdtracht
- Subjects
Aged, 80 and over ,Male ,Macular Degeneration ,Treatment Outcome ,Blood Component Removal ,Visual Acuity ,Humans ,Female ,Registries ,Hypotension ,Aged ,Follow-Up Studies - Abstract
The purpose of establishing the RheoNet registry was to evaluate the safety and efficacy of rheopheresis, a specific method of therapeutic apheresis used to treat microcirculatory disorders. Apheresis centers providing rheopheresis therapy and physicians caring for the underlying disease were asked to participate in the registry, and the registry data were analyzed for safety and tolerability. Age-related macular degeneration (AMD) was selected as a model disease to evaluate efficacy. The RheoNet registry was successfully established recording 7722 rheopheresis treatments of 1110 patients, including 833 AMD patients. The mean age of patients was 72 years. Adverse events (AE) were reported in 5.67% of treatments, but termination of the treatment session was only required in 0.48%. Transient hypotension was the most frequently reported AE. No age-related increase in AE was observed. Ophthalmological data of 428 eyes (of 279 treated patients) with dry AMD could be analyzed; 85 eyes of 55 untreated AMD patients served as the control. At 6.75 +/- 5.25 months post-baseline, 42% of the treated eyes had improved visual acuity. The proportion of eyes with a decline in visual acuity was 17%, compared to 40% in the untreated controls (P0.01). The RheoNet registry has been successfully established and data analysis revealed that rheopheresis is a safe outpatient treatment for microcirculatory disorders. Moreover, RheoNet currently provides the largest evaluation of the efficacy of rheopheresis for dry AMD. Registry analysis contributes to a safe and appropriate use of rheopheresis in clinical practice.
- Published
- 2010
22. Rheopheresis for sudden sensorineural hearing loss
- Author
-
Cordula Fassbender, Ralph Mösges, Andreas Heibges, Reinhard Klingel, and Selma Uygun-Kiehne
- Subjects
medicine.medical_specialty ,Hearing loss ,Hearing Loss, Sensorineural ,Rheopheresis ,law.invention ,Infusion therapy ,Randomized controlled trial ,law ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,Reimbursement ,Evidence-Based Medicine ,business.industry ,Vascular disease ,Standard treatment ,Microcirculation ,Fibrinogen ,General Medicine ,Evidence-based medicine ,Health Care Costs ,Hearing Loss, Sudden ,medicine.disease ,Surgery ,Cochlea ,Lipoproteins, LDL ,Treatment Outcome ,Hemorheology ,Insurance, Health, Reimbursement ,Practice Guidelines as Topic ,Blood Component Removal ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Patients suffering from sudden sensorineural hearing loss (SSHL), especially those with hearing impairment refractory to infusion therapy, need new therapeutic options. Fibrinogen-LDL-apheresis, covering Rheopheresis and HELP-apheresis for the indication of SSHL, proved to be an effective treatment option within the therapeutic armamentarium for SSHL in two randomized controlled trials including each more than 200 patients, and has also been shown to be an effective treatment option for patients refractory to the first line standard treatment. Fibrinogen-LDL-apheresis effects an immediate pulsed reduction of plasma viscosity as well as whole blood viscosity, hypothesized to lead to a sustained microcirculatory recovery, thus improving the natural course of acute microcirculatory impairment significantly. The solid body of evidence provided by investigations on fibrinogen-LDL-apheresis in recent years has been recognized by German SSHL guidelines, proposing fibrinogen-lowering treatments like this as part of a multimodality approach. Superiority of fibrinogen-LDL-apheresis over established first line standard treatments could not been shown in general. In consequence, no regular reimbursement by health insurances is available, in particular facing the current policy of health insurances for initial therapeutic nihilism at the acute onset of SSHL. Patients can apply for individual reimbursement or must pay the cost for the treatment. Refractory patients hopefully will profit by growing experiences.
- Published
- 2010
23. Plasma exchange and immunoadsorption for autoimmune neurologic diseases - current guidelines and future perspectives
- Author
-
Reinhard Klingel, Andreas Heibges, and Cordula Fassbender
- Subjects
medicine.medical_specialty ,Autoimmune Diseases of the Nervous System ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,Immunoadsorption ,Immunosorbent Techniques ,Autoantibodies ,Autoimmune disease ,Plasma Exchange ,business.industry ,Multiple sclerosis ,Patient Selection ,Therapeutic effect ,Autoantibody ,General Medicine ,medicine.disease ,Myasthenia gravis ,Regimen ,Clinical research ,Treatment Outcome ,Immunology ,Practice Guidelines as Topic ,Blood Component Removal ,Cardiology and Cardiovascular Medicine ,business - Abstract
There is increasing interest from neurologists to use therapeutic apheresis in autoimmune neurologic diseases due to growing knowledge of pathogenic relevance of autoantibodies. Developments in that field have been summarized in this review focusing on German guidelines and recent results from clinical research. Therapeutic apheresis can offer a therapeutic armamentarium with rapid response for severe acute neurologic symptoms, and a drug-free option for clinical courses being refractory to drug based strategies or complicated by drug side effects. Plasma exchange (PE) as the classical method has become part of current guidelines within basic and escalating immunomodulatory treatments of autoimmune neurologic diseases, and in daily practice gets increasingly replaced by selective immunoadsorption (IA) due to its equivalent efficacy in combination with a superior safety profile. Therapeutic effects of PE and IA in autoantibody mediated diseases can be attributed to 3 major mechanisms: immediate intravascular reduction of (auto-)antibody concentration, pulsed induction of antibody redistribution, and subsequent immunomodulatory changes. 5 treatments over a period of 8-10 days seem to be an appropriate regimen to restore neurologic function in acute flares or relapses of autoimmune neuropathies, e.g. myasthenic crisis, Guillain-Barre-syndrome, and steroid refractory relapse of multiple sclerosis. Especially in MS a better understanding is needed, who are the best candidates for IA.
- Published
- 2010
24. Dextran-sulfate-adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid-apheresis--comparison of performance characteristics with DALI and Lipidfiltration
- Author
-
Hans-Christian Geiss, Reinhard Klingel, Ulrich Julius, Stefan Kurz, Andreas Heibges, and Klaus G. Parhofer
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Acrylic Resins ,Fibrinogen ,chemistry.chemical_compound ,medicine ,Humans ,Whole blood ,business.industry ,Cholesterol ,Dextran Sulfate ,Blood Component Removal ,Hematology ,General Medicine ,Cholesterol, LDL ,Hemoperfusion ,Atherosclerosis ,Surgery ,body regions ,Apheresis ,chemistry ,LDL apheresis ,Female ,business ,Filtration ,medicine.drug ,Lipoprotein - Abstract
For many years dextran sulfate adsorption (DSA) treatment of separated plasma has been an established technology for low-density lipoprotein (LDL)-elimination. Recently a system for the treatment of whole blood based on DSA was introduced into clinical practice. To further characterize DSA treatment of whole blood, the performance characteristics of both DSA modalities were compared at two investigational sites with two alternative LDL apheresis systems being already in routine clinical use. In prospective cross-over design, DSA whole blood treatment was compared with a whole blood polyacrylate LDL adsorption system (DALI) in one study group. DSA for plasma treatment was compared with Lipidfiltration in cross-over design in a second study group. In total, 12 patients on chronic LDL apheresis received 169 treatments. Six patients were treated twice with whole blood polyacrylate adsorption and twice with whole blood DSA. LDL-cholesterol (74.9-78.0%) and lipoprotein (a) (72.1-73.3%) were reduced by both with equal efficacy. DSA achieved a significantly higher reduction rate of fibrinogen. Another six patients were treated eight times with DSA plasma adsorption followed by 16 Lipidfiltration treatments. LDL-cholesterol (67.0-70.2%) and lipoprotein (a) (69.2-73.7%) were reduced by both with equal efficacy. Fibrinogen was eliminated more efficiently by Lipidfiltration (50.2 vs. 38.5%). DSA proved to be a safe and effective in both treatment modes, for plasma as well as for whole blood. At the discretion of the apheresis specialist, depending upon the status of national approval, DSA of whole blood complements the armamentarium of powerful modalities for extracorporeal elimination of atherosclerotic lipoproteins to meet specific individual, medical, or logistic needs.
- Published
- 2007
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