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Fobker M.,University Hospital of Muenster
Clinical Chemistry and Laboratory Medicine | Year: 2014

Background: People with hyperglycemia, especially those who are pregnant, depend on accurate blood glucose measurements for correct diagnosis of diabetes and monitoring. Glycolysis after blood draw, however, decreases glucose concentrations in blood that is collected at room temperature in the absence of a stabilizer. Cold temperatures (4 °C) inhibit glycolysis; but prompt cooling and processing of each blood sample in the cold is difficult to achieve in routine clinical practice. Therefore, preservatives are used to stabilize glucose during blood collection and processing procedures that are performed at room temperature. This study examined the effect of different anticoagulants (EDTA, heparin, oxalate), with or without glycolysis inhibitors (NaF, citrate), on the stability of glucose in plasma samples - obtained from blood that was collected and stored at room temperature for up to 24 h. Methods: Venous blood was collected from 60 volunteers; each donor blood sample was divided into six tubes, each one containing a different anti-glycolysis-anticoagulant composition. Terumo VENOSAFE™ Glycemia tubes contained NaF/citrate buffer)/Na2EDTA; NaF/Na-heparin; and NaF/K2oxalate. Sarstedt tubes contained NaF/citrate; NaF/Na2EDTA; and K2EDTA. At 0, 2, 8 and 24 h, plasma was obtained for glucose measurements using the Glucose Hexokinase and Glucose Oxidase methods, and the ADVIA® 1800 Clinical Chemistry System. Results: Both methods demonstrated minimal glycolysis by 24 h ( <3.8%) for the three Terumo VENOSAFE™ Glycemia tubes, and the Sarstedt S-Monovette GlucoEXACT tube that contained NaF/citrate. Glycolysis was higher in tubes containing NaF/Na2EDTA-alone (11.7%) and K 2EDTAalone (85%). Conclusions: Terumo VENOSAFE™ Glycemia tubes (containing NaF/citrate buffer/Na2EDTA; NaF/Na-heparin; and NaF/K2oxalate) and the Sarstedt S-Monovette® GlucoEXACT tubes (containing NaF/citrate) are suitable for shipping venous whole blood samples to the testing laboratory within 24 h at room temperature.

Zellerhoff S.,Universitatsklinikum Munster | Lenze F.,University Hospital of Muenster | Eckardt L.,Universitatsklinikum Munster
Europace | Year: 2011

The development of an atrio-oesophageal fistula following catheter ablation for atrial fibrillation is a well known, but rare complication with a high mortality, partially due to the late fistula formation weeks after the initial procedure. Technical measurements are undertaken to avoid oesophageal damage during catheter ablation of atrial fibrillation, yet, oesophageal and mediastinal lesions occur in a substantial number of patients following pulmonary vein isolation. This has led to prophylactic use of proton pump inhibitors in many centres. Current guidelines and consensus reports list no objectives on this issue. The aim of the paper is therefore to review current clinical and experimental evidence for this treatment. © 2011 The Author.

Kahl B.C.,University Hospital of Muenster
Infection, Genetics and Evolution | Year: 2014

Small colony variants (SCVs) of Staphylococcus aureus have been implicated in chronic recurrent infections and have therefore gained renewed interest during the last decade. Moreover, SCVs have been shown to be part of the regular growth cycle, are highly dynamic or stable and can be selected during various harsh conditions. As such, the emergence of SCVs has been described not only in human, but also in veterinary medicine as well as in food microbiology. SCVs are characterized by impaired growth, down-regulation of genes for metabolism and virulence, while sigB and genes important for persistence and biofilm formation are up-regulated. Furthermore, SCVs are resistant to various antibiotics such as aminoglycosides, trimethoprim-sulfamethoxazole, fluorquinolones, fusidic acid or even to antiseptics such as triclosan. An underlying mechanism has been determined for hemin-, menadione- and thymidine-dependent SCVs as well as for SCVs which are impaired in their stress response. SCVs are optimized for persistence in the host. They are able to reverse and thereby constitute a highly dynamic subpopulation of S. aureus. Such phenotype switching constitutes an integral part of the infection process enabling the bacteria to hide inside the host cell without eliciting a strong host response. © 2013 Elsevier B.V.

Brandes M.,University of Bremen | Ringling M.,Hospital of Ingolstadt | Winter C.,University Hospital of Muenster | Hillmann A.,Hospital of Ingolstadt | Rosenbaum D.,University Hospital of Muenster
Arthritis Care and Research | Year: 2011

Objective. Despite its impact on the overall outcome and health-related quality of life (HRQOL) after knee surgery, physical activity has not been investigated directly using accelerometry or step monitoring during the first year after total knee arthroplasty (TKA) due to osteoarthritis (OA). Therefore, the present study aimed to evaluate the development of physical activity over 12 months after surgery and its relationship to clinical outcome and HRQOL. Methods. Fifty-three patients scheduled for primary TKA due to OA were measured with the DynaPort ADL monitor and a step activity monitor preoperatively and at 2, 6, and 12 months of followup. Clinical outcome and HRQOL were investigated using the American Knee Society Score (KSS) and Short Form 36 (SF-36) health survey. Results. Physical activity increased significantly within 12 months of followup (from mean ± SD 4,993 ± 2,170 gait cycles preoperatively to 5,932 ± 2,111 gait cycles; P = 0.003). Clinical outcome and HRQOL improved from baseline (mean ± SD KSS 88.9 ± 21.4, mean ± SD SF-36 43.1 ± 18.4) to 12 months of followup (mean ± SD KSS 188.6 ± 10.9; P = 0.001 and mean ± SD SF-36 82.5 ± 15.9; P = 0.001). Physical activity parameters did not correlate with clinical outcome. Conclusion. TKA offers profound improvements of physical activity for the majority of patients. Despite these improvements and the excellent clinical outcome, most patients do not reach the level of physical activity reported for healthy subjects. The activity level after treatment seems to be influenced by physical activity behavior prior to surgery rather than by the treatment itself. © 2011, American College of Rheumatology.

Schnabel A.,University Hospital of Muenster | Meyer-Friessem C.H.,Ruhr University Bochum | Zahn P.K.,Ruhr University Bochum | Pogatzki-Zahn E.M.,University Hospital of Muenster
British Journal of Anaesthesia | Year: 2013

Background. The aim of this meta-analysis was to compare the efficacy and safety of ultrasound (US) vs nerve stimulation (NS) guidance for peripheral nerve catheter placement. Methods. This meta-analysis was performed according to the PRISMA statement and the recommendations of the Cochrane Collaboration. For dichotomous outcomes relative risks [RRs; 95% confidence intervals (CIs)] were calculated, while for continuous outcomes, mean differences (MDs; 95% CI) were calculated. All statistical analyses were performed using the Revmanw statistical software (Version 5.1). Results. Fifteen randomized controlled trials including 977 patients satisfied the inclusion criteria. Peripheral nerve catheters placed under US guidance showed a higher RR of 1.14 (95% CI: 1.021.27; P0.02) for an overall successful block in comparison with NS. However, postoperative pain scales at movement (numeric rating scale: 010) were comparable between US- vs NS-guided peripheral nerve catheters 24 (MD: 0.08; 95% CI: 20.77 to 0.94; P0.85) and 48 (MD: 1.0; 95% CI: 20.3 to 2.3; P0.13) h after surgery. Patients receiving a US-guided peripheral nerve catheter had a lower RR of 0.13 (95% CI: 0.04-0.38; P0.0002) for an accidental vascular puncture. Conclusions. There is evidence that US-guided peripheral nerve catheters show a higher success rate and a lower risk for an accidental vascular puncture compared with NS guidance. However, this difference resulted only in marginally lower postoperative pain scores at rest. Nevertheless, these results were influenced by heterogeneity and should be interpreted with caution. © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

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