Universitatsklinik Und Poliklinik For Innere Medizin Iii

Halle (Saale), Germany

Universitatsklinik Und Poliklinik For Innere Medizin Iii

Halle (Saale), Germany
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Werdan K.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Rub M.,Amper Kliniken AG | Delle-Karth G.,Vienna University Hospital | Geppert A.,Intensive Care Unit | Schondube F.A.,University of Gottingen
Deutsches Arzteblatt International | Year: 2012

Introduction: Infarction-related cardiogenic shock (ICS) is usually due to leftventricular pump failure. With a mortality of 30% to 80%, ICS is the most common cause of death from acute myocardial infarction. The S3 guideline presented here characterizes the current evidence-based treatment of ICS: early revascularization, treatment of shock, and intensive care treatment of multi-organ dysfunction syndrome (MODS) if it arises. The success or failure of treatment for MODS determines the outcome in ICS. Methods: Experts from eight German and Austrian specialty societies analyzed approximately 3600 publications that had been retrieved by a systematic literature search. Three interdisciplinary consensus conferences were held, resulting in the issuing of 111 recommendations and algorithms for this S3 guideline. Results: Early revascularization of the occluded vessel, usually with a percu - taneous coronary intervention (PCI), is of paramount importance. The medical treatment of shock consists of dobutamine as the inotropic agent and norepinephrine as the vasopressor of choice and is guided by a combination of pres - sure and flow values, or by the cardiac power index. Levosimendan can be given in addition to treat catecholamine-resistant shock. For patients with ICS who are treated with PCI, the current S3 guideline differs from the European and American myocardial infarction guidelines with respect to the recommendation for intra-aortic balloon pulsation (IABP): Whereas the former guidelines give a class I recommendation for IABP, this S3 guideline states only that IABP "can" be used in this situation, in view of the poor state of the evidence. Only for patients being treated with systemic fibrinolysis is IABP weakly recommended (IABP "should" be used in such cases). With regard to the optimal intensive- care interventions for the prevention and treatment of MODS, recommendations are given concerning ventilation, nutrition, erythrocyte-concentrate transfusion, prevention of thrombosis and stress ulcers, follow-up care, and rehabilitation. Discussion: The goal of this S3 guideline is to bring together the types of treatment for ICS that lie in the disciplines of cardiology and intensive-care medicine, as patients with ICS die not only of pump failure, but also (and even more frequently) of MODS. This is the first guideline that adequately emphasizes the significance of MODS as a determinant of the outcome of ICS.


Unverdorben M.,Institute For Klinische Forschung | Kleber F.X.,Charité - Medical University of Berlin | Heuer H.,St Johannes Hospital | Figulla H.-R.,Universitatsklinikum Jena | And 9 more authors.
Clinical Research in Cardiology | Year: 2010

Background: Treatment of lesions in small coronary arteries by percutaneous transluminal coronary intervention is limited by a high recurrence rate. We assessed the use of a paclitaxel-coated balloon in this indication. Methods: One-hundred eighteen patients with stenoses in small coronary vessels were treated by a paclitaxel-coated balloon (3 μg/mm2). The main inclusion criteria encompassed diameter stenosis of ≥70% and ≤22 mm in length with a vessel diameter of 2.25-2.8 mm. Follow-up angiography was performed at scheduled 6-month post-intervention or whenever driven by clinical or electrocardiographic signs of ischemia. The primary endpoint was angiographic in-segment late lumen loss. Results: Eighty-two of 118 patients (70%) with a vessel diameter of 2.35 ± 0.19 mm were treated with the drug-coated balloon only, while 32 patients required additional stent deployment. The mean in-segment late lumen loss was 0.28 ± 0.53 mm. In patients treated with the drug-coated balloon only, the in-segment late lumen loss was 0.16 ± 0.38 mm. At 12 months, the rate of major adverse cardiac events was 15% which was primarily due to the need for target lesion revascularization in 14 patients (12%). In those with additional bare metal stent implantation geographical mismatch between coated-balloon dilatation and stent implantation was significantly associated with the occurrence of restenosis. Conclusion: Treatment of coronary stenosis in small coronary vessels with the paclitaxel-coated balloon was well tolerated. It may offer an alternative to the implantation of a drug-eluting stent (ClinicalTrials.gov Identifier: NCT00404144). © 2010 Springer-Verlag.


Nahrendorf M.,Harvard University | Frantz S.,Universitatsklinikum Wurzburg | Frantz S.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Swirski F.K.,Harvard University | And 10 more authors.
Journal of the American College of Cardiology | Year: 2015

While acute myocardial infarction mortality declines, patients continue to face reinfarction and/or heart failure. The immune system, which intimately interacts with healthy and diseased tissues through resident and recruited leukocytes, is a central interface for a global host response to ischemia. Pathways that enhance the systemic leukocyte supply may be potential therapeutic targets. Pre-clinically, imaging helps to identify immunity's decision nodes, which may serve as such targets. In translating the rapidly-expanding pre-clinical data on immune activity, the difficulty of obtaining multiple clinical tissue samples from involved organs is an obstacle that whole-body imaging can help overcome. In patients, molecular and cellular imaging can be integrated with blood-based diagnostics to assess the translatability of discoveries, including the activation of hematopoietic tissues after myocardial infarction, and serve as an endpoint in clinical trials. In this review, we discuss these concepts while focusing on imaging immune activity in organs involved in ischemic heart disease. © 2015 American College of Cardiology Foundation.


Hofmann U.,University of Würzburg | Frantz S.,Universitatsklinik Und Poliklinik For Innere Medizin Iii
Circulation Research | Year: 2015

A large body of evidence produced during decades of research indicates that myocardial injury activates innate immunity. On the one hand, innate immunity both aggravates ischemic injury and impedes remodeling after myocardial infarction (MI). On the other hand, innate immunity activation contributes to myocardial healing, as exemplified by monocytes' central role in the formation of a stable scar and protection against intraventricular thrombi after acute infarction. Although innate leukocytes can recognize a wide array of self-antigens via pattern recognition receptors, adaptive immunity activation requires highly specific cooperation between antigen-presenting cells and distinct antigen-specific receptors on lymphocytes. We have only recently begun to examine lymphocyte activation's relationship to adaptive immunity and significance in the context of ischemic myocardial injury. There is some experimental evidence that CD4+ T-cells contribute to ischemia-reperfusion injury. Several studies have shown that CD4+ T-cells, especially CD4+ T-regulatory cells, improve wound healing after MI, whereas depleting B-cells is beneficial post MI. That T-cell activation after MI is induced by T-cell receptor signaling implicates autoantigens that have not yet been identified in this context. Also, the significance of lymphocytes in humans post MI remains unclear, primarily as a result of methodology. This review summarizes current experimental evidence of lymphocytes' activation, functional role, and crosstalk with innate leukocytes in myocardial ischemia-reperfusion injury, wound healing, and remodeling after myocardial infarction. © 2014 American Heart Association, Inc.


Shinagawa H.,Kitasato University | Shinagawa H.,University of Würzburg | Frantz S.,University of Würzburg | Frantz S.,Universitatsklinik Und Poliklinik For Innere Medizin Iii
Current Heart Failure Reports | Year: 2015

Today, innate immunity is recognized as an important pathophysiologic factor and therapeutic target for cardiac remodeling after myocardial infarction (MI). The innate immune system exerts its function via soluble and cellular components. Recently, function and kinetics of immune cells after MI have been clarified using new innovative technology. Therefore, herein, we will discuss the function of neutrophils, monocytes, and macrophages in the pathophysiology of cardiac remodeling after MI in basic as well as clinical science. © 2015, Springer Science+Business Media New York.


Vogel B.,Universitatsklinikum Wurzburg | Frantz S.,Universitatsklinik Und Poliklinik For Innere Medizin Iii
Analytical biochemistry | Year: 2015

The long known toxicity of free chromatin mediated by histones regained attention after discovery of neutrophil extracellular traps (NETs). Free histones from necrotic cells or NETs can damage prokaryotic and eukaryotic cells and are responsible for the aggravation of a growing list of diseases. DNases degrade the toxic chromatin polymer to nucleosomes and efficiently reduce local high histone concentrations. Therefore, DNase activity as a biomarker is of growing interest in basic and clinical research. Here a detailed one-step protocol is presented that allows rapid and sensitive detection of DNases down to 400 fg/μl per reaction based on the detection of fluorescent ethidium bromide/DNA complexes in a 96-well plate reader. The flexible protocol uses an internal standard for background correction and allows convenient and reliable data analysis using common laboratory equipment and chemicals without elaborate preparations. The DNase activity of a sample is clearly defined by substrate amount, incubation time, and (if appropriate) a DNase standard for absolute quantification in Kunitz units per milligram sample protein. Quantitative kinetic determination is possible within less than 1h down to 5 pg DNases/μl per reaction. Copyright © 2014 Elsevier Inc. All rights reserved.


Taute B.-M.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Melnyk H.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Podhaisky H.,Universitatsklinik Und Poliklinik For Innere Medizin Iii
Medizinische Klinik | Year: 2010

Background and Purpose: Unclear extremity complaints are common symptoms of inpatients. In a subset of these patients, a clinical suspicion of deep vein thrombosis (DVT) results; this needs to be quickly and definitively clarified by a vascular physician. The question arose of how often a clinical suspicion of DVT was confirmed in an inpatient population and which alternative diagnoses were able to be made by angiologists. Patients and Methods: In a retrospective analysis, all inpatients in the Angiologic Vascular Diagnostics Center of the University Hospital Halle, Germany, examined in 2007 for a suspicion of DVT were evaluated with respect to the definitively made diagnosis. Results: In 213 (28.6%) of 745 suspected cases of DVT, a DVT was confirmed. In 532 patients (71.4%), DVT was excluded. In 314 of these patients, 436 alternative diagnoses were recorded in the diagnostic reports of angiologic examinations. In 38.6% (n = 168), other venous causes could be confirmed as the most common alternative diagnosis. There were chronic venous diseases in 28% (n = 122), superficial thrombophlebitis (n = 27), and tumor-related pelvic vein compression (n = 19). 17.4% (n = 76) exhibited lymphedema. In 13.3% (n = 58), a generalized edema was diagnosed. Arthrogenic causes followed with 12.8% (n = 56). Lipedema (5.3%) and hematoma (5%) could be verified as other important differential diagnoses. Rare causes were symptomatic or ruptured Baker's cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle tears, and tumors. Conclusion: The variety of alternative diagnoses in patients with clinical suspicion of DVT is high. The knowledge and systematic examination of potential, even rare differential diagnoses after exclusion of DVT are part of the repertoire of the vascular physician. Unnecessary and expensive, as well as onerous, diagnostic procedures on the patient can be avoided. Anticoagulation that was begun as a result of the suspicion of DVT can quickly be stopped. © 2010 Urban & Vogel.


Hoke R.S.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Werdan K.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Muller-Werdan U.,Universitatsklinik Und Poliklinik For Innere Medizin Iii | Ebelt H.,Universitatsklinik Und Poliklinik For Innere Medizin Iii
Intensiv- und Notfallbehandlung | Year: 2010

This is an update on the most influential publications in critical care medicine between April 2008 and March 2009 with a focus on medical intensive care. The following topics are discussed: glucocorticoids in acute respiratory distress syndrome (ARDS), positive end-expiratory pressure in ARDS, silvercoated endotracheal tubes, ventilator-associated tracheobronchitis, procalcitonin as a diagnostic tool for ventilator-associated pneumonia (VAP), glucocorticoids for extubation, tight glucose control in critical care, comparison of jugular and femoral access for shortterm dialysis catheters, echocardiographic estimation of left-ventricular filling pressures, PiCCO monitoring in acute heart failure, sodium nitroprusside in acutely decompensated heart failure, non-invasive ventilation in acute pulmonary edema, levosimendan in cardiogenic shock, intra-aortic balloon pump (IABP), ventricular assist devices in cardiogenic shock, candidiasis, fever, corticosteroid insufficiency, post-resuscitation care, systemic thrombolysis during cardiopulmonary resuscitation (CPR), international resuscitation guidelines 2005, cardio-cerebral resuscitation (CCr), medication errors in critical care, coronary angiography and angioplasty after cardiac arrest, mild therapeutic hypothermia, sepsis and systemic inflammatory response syndrome (SIRS), early goal directed therapy (EGDT). © 2010 Dustri-Verlag Dr. Karl Feistle.


PubMed | Universitatsklinik Und Poliklinik For Innere Medizin Iii
Type: Clinical Trial | Journal: Medizinische Klinik, Intensivmedizin und Notfallmedizin | Year: 2014

The aim of our clinical study was to correlate liver function measured by indocyanine green (ICG) elimination and clinical outcomes in patients with an early stage of community-acquired sepsis (CAS).A total of 341 patients (18 years) presenting with suspicion of CAS or evidence of an infection and fulfillment of 2 systemic inflammatory response syndrome (SIRS) criteria were included in the observational studyPrognosis of early sepsis 2 (Prognose der frhen Sepsis 2, ProFS 2). Patients who had been hospitalized within the last 7 days were excluded. In a subgroup of these patients (n=72) who were transferred to an intensive or intermediate care unit according to the clinical judgment of the treating physicians, ICG elimination (plasma disappearance rate, ICG-PDR; 15 min retention rate, ICG-R15) was assessed by using a noninvasive monitoring system (LiMON, PULSION Medical Systems, Germany). ICG-PDR and -R15 were determined on the day of admission (n=72) and after 96 h (n=34). The primary end point of the study was defined as death within 30 days. Secondary endpoints were need for renal replacement therapy, requirement for invasive mechanical ventilation, and length of stay in an intermediate or intensive care unit.In contrast to patients with sepsis or severe sepsis, ICG elimination was found to be significantly impaired in patients with septic shock. Furthermore, a significant predictive value of ICG-PDR and -R15 on the day of admission for the need for subsequent renal replacement therapy (n=12) was observed. In addition, reduced ICG elimination was associated with a longer stay in an intermediate or intensive care unit. However, ICG elimination on admission could not predict 30-day mortality (n=14) or requirement of mechanical ventilation (n=20).


PubMed | Universitatsklinik Und Poliklinik For Innere Medizin Iii
Type: Journal Article | Journal: Zeitschrift fur Gerontologie und Geriatrie | Year: 2013

The aim of this study was to investigate factors influencing mortality after percutaneous coronary intervention (PCI) in patients aged 75years compared to younger patients.A total of 1,809 coronary heart disease (CHD) patients after PCI with stent implantation in our hospital were assessed. Kaplan-Meier analyses with log-rank test and Cox regression analyses were performed on three predefined models concerning primary endpoint of all-cause mortality. Model1 was a univariate analysis of the influence of age dichotomized by age 75years on the primary endpoint. Model2 included age and classical cardiovascular risk factors (CVRFs, e.g., body mass index (BMI), smoking, diabetes, and hypertension). Model3 consisted of age, classical CVRFs, and additional factors (e.g., medication; hemoglobin, peripheral arterial disease (PAD), low-density lipoprotein cholesterol (LDL-C) and creatinine levels, and left ventricular ejection fraction (LVEF)).In the mean follow-up of 13761weeks 375patients died. Age 75years was significantly related to mortality in all models. In model3, previous stroke, PAD, diabetes, elevated levels of serum creatinine, and increased LDL-C were related to elevated mortality, higher hemoglobin levels, and LVEF >50% were associated with decreased mortality in all patients and in patients <75years. In patients 75years arterial hypertension was associated with poor outcome (hazard ratio (HR) 7.989, p =0.040), previous antiplatelet therapy showed reduced mortality (HR 0.098, p =0.039).Although risk factors such as previous stroke, PAD, diabetes, renal insufficiency, and anemia were predictors for death in all patients and patients <75years, in the elderly only arterial hypertension increased, whereas treatment with platelet inhibitors decreased mortality.

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