Background. The aim of this study was to evaluate whether a single preoperative limited oral inta... more Background. The aim of this study was to evaluate whether a single preoperative limited oral intake of a carbohydrate drink could improve perioperative patient comfort and satisfaction with anesthesia care in elective day-stay ophthalmologic surgery. Methods. A single-center, prospective, randomized clinical trial was conducted in a university hospital. The study included ASA I-III patients undergoing ophthalmologic surgery. Patients undergoing both general anesthesia and local anesthesia were included in the study. The control group fasted in accordance to nil per os after midnight, while patients in the experimental group received 200 mL of a carbohydrate drink 2 h before the operation. Both groups were allowed to drink and eat until midnight ad libitum. Patient characteristics, subjective perceptions, taste of the drink, and satisfaction with anesthesia care were ascertained using a questionnaire administered three times: after the anesthesiologist's visit, before surgery and before discharge from the ward to assess patient comfort. An analysis of variance and the Mann-Whitney U-test were used for statistical analysis. Results. A total of 123 patients were included and 109 patients were randomly assigned to one of two preoperative fasting regimens. Patients drinking 200 mL 2 h before surgery were not as hungry (P<0.05), not as thirsty preoperatively (P<0.001) and not as thirsty after surgery (P<0.05), resulting in increased postoperative satisfaction with anesthesia care (P<0.05). Conclusion. Standardized limited oral preoperative fluid intake increases patient comfort and satisfaction with anesthesia care and should be a part of modern day-stay ophthalmologic surgery.
Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft... more Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft fulminant. Sie sind für etwa 25% aller peripartalen maternalen Sterbefälle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hämostaseologischen Veränderungen, wie das erhöhte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivität und starke Alterationen des fibrinolytischen Systems müssen dem interdisziplinären Behandlungsteam bekannt sein, um eine zielgerichtete und konsequente Therapie durchführen zu können.
Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft... more Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft fulminant. Sie sind für etwa 25% aller peripartalen maternalen Sterbefälle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hämostaseologischen Veränderungen, wie das erhöhte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivität und starke Alterationen des fibrinolytischen Systems müssen dem interdisziplinären Behandlungsteam bekannt sein, um eine zielgerichtete und konsequente Therapie durchführen zu können.
The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke... more The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke a variety of consequences for the entire organism and influence the inflammatory response in particular. In perioperative medicine, nutrition, prokinetics, peridural anesthesia, catecholamines and volume therapy can be applied in order to improve the gastrointestinal functional or at least to avoid further aggravation. Early enteral nutrition is especially important in the reduction of postsurgical ileus and infectious complications. Also, prokinetics and thoracic peridural anesthesia favorably affect postsurgical ileus. Norepinephrine, if necessary in combination with dobutamine, seems to have fewer negative effects on splanchnic perfusion than epinephrine. The data on volume therapy remain controversial but fluid balance has to be calculated very carefully also considering enteral loss of fluids. Thus, in order to treat and avoid gastrointestinal problems after surgery and to prevent negative effects for the complete organism, multimodal concepts with regard to detail are required.
Background: Sepsis is well known to lead to the activation of multiple pro-inflammatory markers, ... more Background: Sepsis is well known to lead to the activation of multiple pro-inflammatory markers, like MCP-1 (Monocyte chemotactic protein 1), TNF-alpha (Tumor necrosis factor alpha), while the underlying genetic changes still remain poorly studied.Methods: We used human umbilical vein endothelial cells to test the reactions to nicotine or acetylcholine/pyridostigmine administration in regards to MCP-1 levels, gene regulation and RNR expression. Results: Pyridostigmine and Acetylcholine (Ach) lead to a significant decrease of MCP-1 levels in TNF-alpha stimulated human umbilical vein endothelial cells, while nicotine had no effect. Interestingly nicotine and acetylcholine lead to different gene expression (nicotine up-regulates epidermal growth factor and down-regulates matrix metalloproteinase-8, while Ach/pyridostigmine up-regulates thioredoxin interacting protein and down-regulates insulin like growth factor 1). Furthermore RNA levels and gene activation were similar after nicotine...
Endothelial leakage with accompanying tissue edema and increased leukocyte adhesion are character... more Endothelial leakage with accompanying tissue edema and increased leukocyte adhesion are characteristics of the vascular inflammatory response. Tissue edema formation is a key mechanism in sepsis pathophysiology contributing to impaired tissue oxygenation and the development of shock. Sepsis mortality is directly associated with the severity of these microcirculatory alterations. Dysfunction of the sympathetic nervous system can have deleterious effects in generalized inflammation. This study evaluated the effect of the adrenergic alpha 2 agonist clonidine on microvascular permeability and leukocyte adhesion during endotoxemia. Macromolecular leakage, leukocyte adhesion, and venular wall shear rate were examined in mesenteric postcapillary venules of rats by using intravital microscopy (IVM). Lipopolysaccharide (LPS) (4mg/kg/h) or equivalent volumes of saline were continuously infused following baseline IVM at 0min. IVM was repeated after 60 and 120min in endotoxemic and nonendotoxem...
World journal of experimental medicine, Jan 20, 2015
Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death ... more Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects - i.e., sepsis induced immunosuppression - but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under inten...
2006 IEEE International Symposium on Geoscience and Remote Sensing, 2006
accurate, quantitative information about the evolution of terrestrial ecosystems. With its hypers... more accurate, quantitative information about the evolution of terrestrial ecosystems. With its hyperspectral capabilities covering the visible, near-and short-wave infrared wavelengths, EnMAP will provide high quality, standardized, and consistent data on a timely and frequent basis. Its primary focus will be on the considerable improvement of already standardized products and the development of new quantitative and subsequently highly informative data and its derivatives. Only an imaging spectrometer, such as the EnMAP, can resolve and detect biophysical, biochemical, and geochemical variables in distinct detail. This will tremendously increase our understanding of coupled biospheric and geospheric processes and thus, enable the management and ensure the sustainability of our vital resources.
This single-centre retrospective cohort study evaluated the incidence and outcome of mycoses in c... more This single-centre retrospective cohort study evaluated the incidence and outcome of mycoses in critical ill patients (n = 283) with sepsis due to peritonitis. Overall mortality was 41.3%, and the 28-day mortality was 29.3%. Fungal pathogens were found in 51.9%. The common first location was the respiratory tract (66.6%), followed by the abdominal site (19.7%). Candida colonisation was found in 64.6%, and invasive Candida infection in 34.0%. Identified fungi were Candida spp. in 98.6% and Aspergillus spp. in 6.1%. Patients with fungal pathogens showed a higher rate of postoperative peritonitis, APACHE II and tracheotomy. In comparison to patients without fungal pathogens, these patients showed a longer duration on mechanical ventilation, and a higher overall mortality. Patients with Candida-positive swabs from abdominal sites had more fascia dehiscence and anastomosis leakage. Seventy-two patients (48.9%) received antifungal therapy, 26 patients were treated empirically. Antifungal therapy was not associated with a decrease in mortality. Age and renal replacement therapy were associated with mortality. In conclusion, fungi are common pathogens in critically ill patients with peritonitis, and detection of fungi is associated with an increase in overall mortality. Particularly, Candida-positive abdominal swabs are associated with an increase in morbidity. However, we were not able to demonstrate a survival benefit for antifungal therapy in peritonitis patients.
IGARSS 2008 - 2008 IEEE International Geoscience and Remote Sensing Symposium, 2008
The Environmental Mapping and Analysis Program (EnMAP) is a German built hyperspectral space sens... more The Environmental Mapping and Analysis Program (EnMAP) is a German built hyperspectral space sensor scheduled for launch in 2012. EnMAP will measure over the 420-2450 nm spectral range at a varying spectral sampling of 5-10 nm. Images will covered 30 kmtimes30 km areas at approximate pixel sizes of 30 m. The primary goal of EnMAP is the exploitation of hyperspectral data for the derivation of high-spectral resolution observations of biophysical, biochemical and geochemical variables from a range of surface covers, such as vegetation canopies, rock and soil targets and coastal waters, on a global scale. General descriptions of the EnMAP instrument, the satellite operation concept, the data processing and archiving structures and current project development activities are provided in this paper.
Sepsis is a frequently fatal condition characterized by an uncontrolled and harmful host reaction... more Sepsis is a frequently fatal condition characterized by an uncontrolled and harmful host reaction to microbial infection. Despite the prevalence and severity of sepsis, we lack a fundamental grasp of its pathophysiology. Here we report that the cytokine interleukin-3 (IL-3) potentiates inflammation in sepsis. Using a mouse model of abdominal sepsis, we showed that innate response activator B cells produce IL-3, which induces myelopoiesis of Ly-6C(high) monocytes and neutrophils and fuels a cytokine storm. IL-3 deficiency protects mice against sepsis. In humans with sepsis, high plasma IL-3 levels are associated with high mortality even after adjusting for prognostic indicators. This study deepens our understanding of immune activation, identifies IL-3 as an orchestrator of emergency myelopoiesis, and reveals a new therapeutic target for treating sepsis.
Systemic inflammation is an immune response to a nonspecific insult of either infectious or nonin... more Systemic inflammation is an immune response to a nonspecific insult of either infectious or noninfectious origin and remains a challenge in the intensive care units with high mortality rate. Cholinergic neurotransmission plays an important role in the regulation of the immune response during inflammation. We hypothesized that the activity of butyrylcholinesterase (BChE) might serve as a marker to identify and prognose systemic inflammation. By using a point-of-care-testing (POCT) approach we measured BChE activity in patients with severe systemic inflammation and healthy volunteers. We observed a decreased BChE activity in patients with systemic inflammation, as compared to that of healthy individuals. Furthermore, BChE activity showed an inverse correlation with the severity of the disease. Although hepatic function has previously been found essential for BChE production, we show here that the reduced BChE activity associated with systemic inflammation occurs independently of and i...
Sepsis and related complications are a challenge for intensive care medicine. Despite many advanc... more Sepsis and related complications are a challenge for intensive care medicine. Despite many advances in antibiotic therapy sepsis remains one of the most common diseases of patients in intensive care units and is designated as the main cause of death in critically ill patients. Persisting sepsis leads to impaired immunity, resulting in immunosuppression. Unspecific predictive signs complicate an early diagnosis; however, an early initiation of adequate therapy is of crucial importance for the prognosis. Scoring systems can be applied for the initial evaluation but are controversially discussed concerning the monitoring of disease progression and therapy as well as outcome prediction. Biomarkers are considered as a complementary approach.
Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 ... more Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 of every 100 000 deliveries. With a mortality of 11% to 44%, it is among the leading direct causes of maternal death. This entity is an interdisciplinary challenge because of its presentation with sudden cardiac arrest without any immediately obvious cause, the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, including cardio - pulmonary resuscitation. We selectively reviewed pertinent literature published from 2000 to May 2013 that was retrieved by a PubMed search. The identified risk factors for AFE are maternal age 35 and above (odds ratio [OR] 1.86), Cesarean section (OR 12.4), placenta previa (OR 10.5), and multiple pregnancy (OR 8.5). AFE is diagnosed on clinical grounds after the exclusion of other causes of acute cardiovascular decompensation during delivery, such as pulmonary th...
In patients following orthotopic liver transplantation from deceased donors, total keratin 18 (K1... more In patients following orthotopic liver transplantation from deceased donors, total keratin 18 (K18) measurement was recently shown to be favourable in terms of its prognostic value for early identification of a complicated course in comparison to routine markers of liver impairment (e.g., aspartate-amino-transferase, alanine-amino-transferase, lactate-dehydrogenase). 1 In this investigation, the M65 enzyme linked immunosorbent assay (ELISA) kit (#10 020; Peviva AB, Bromma, Sweden) was used for quantitative determination of total K18. In the meantime, the manufacturer (Peviva AB, Bromma, Sweden) launched the M65 EpiDeath ELISA (#10 040) as a new tool for total K18 monitoring, which was intended for the same applications as for the M65 ELISA. The M65 EpiDeath ELISA provides improved measuring characteristics with regard to dilution linearity and spiking recovery. Moreover, it is suspected to allow for a better discrimination between patients with very low and very high levels of K18 due to an extended measuring range of 5000 U/l, compared to 2000 U/l of the M65 ELISA and lower baseline values in healthy controls.
Background. The aim of this study was to evaluate whether a single preoperative limited oral inta... more Background. The aim of this study was to evaluate whether a single preoperative limited oral intake of a carbohydrate drink could improve perioperative patient comfort and satisfaction with anesthesia care in elective day-stay ophthalmologic surgery. Methods. A single-center, prospective, randomized clinical trial was conducted in a university hospital. The study included ASA I-III patients undergoing ophthalmologic surgery. Patients undergoing both general anesthesia and local anesthesia were included in the study. The control group fasted in accordance to nil per os after midnight, while patients in the experimental group received 200 mL of a carbohydrate drink 2 h before the operation. Both groups were allowed to drink and eat until midnight ad libitum. Patient characteristics, subjective perceptions, taste of the drink, and satisfaction with anesthesia care were ascertained using a questionnaire administered three times: after the anesthesiologist's visit, before surgery and before discharge from the ward to assess patient comfort. An analysis of variance and the Mann-Whitney U-test were used for statistical analysis. Results. A total of 123 patients were included and 109 patients were randomly assigned to one of two preoperative fasting regimens. Patients drinking 200 mL 2 h before surgery were not as hungry (P<0.05), not as thirsty preoperatively (P<0.001) and not as thirsty after surgery (P<0.05), resulting in increased postoperative satisfaction with anesthesia care (P<0.05). Conclusion. Standardized limited oral preoperative fluid intake increases patient comfort and satisfaction with anesthesia care and should be a part of modern day-stay ophthalmologic surgery.
Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft... more Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft fulminant. Sie sind für etwa 25% aller peripartalen maternalen Sterbefälle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hämostaseologischen Veränderungen, wie das erhöhte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivität und starke Alterationen des fibrinolytischen Systems müssen dem interdisziplinären Behandlungsteam bekannt sein, um eine zielgerichtete und konsequente Therapie durchführen zu können.
Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft... more Blutungen während der Schwangerschaft sind für Mutter und Kind vital bedrohlich und verlaufen oft fulminant. Sie sind für etwa 25% aller peripartalen maternalen Sterbefälle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hämostaseologischen Veränderungen, wie das erhöhte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivität und starke Alterationen des fibrinolytischen Systems müssen dem interdisziplinären Behandlungsteam bekannt sein, um eine zielgerichtete und konsequente Therapie durchführen zu können.
The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke... more The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke a variety of consequences for the entire organism and influence the inflammatory response in particular. In perioperative medicine, nutrition, prokinetics, peridural anesthesia, catecholamines and volume therapy can be applied in order to improve the gastrointestinal functional or at least to avoid further aggravation. Early enteral nutrition is especially important in the reduction of postsurgical ileus and infectious complications. Also, prokinetics and thoracic peridural anesthesia favorably affect postsurgical ileus. Norepinephrine, if necessary in combination with dobutamine, seems to have fewer negative effects on splanchnic perfusion than epinephrine. The data on volume therapy remain controversial but fluid balance has to be calculated very carefully also considering enteral loss of fluids. Thus, in order to treat and avoid gastrointestinal problems after surgery and to prevent negative effects for the complete organism, multimodal concepts with regard to detail are required.
Background: Sepsis is well known to lead to the activation of multiple pro-inflammatory markers, ... more Background: Sepsis is well known to lead to the activation of multiple pro-inflammatory markers, like MCP-1 (Monocyte chemotactic protein 1), TNF-alpha (Tumor necrosis factor alpha), while the underlying genetic changes still remain poorly studied.Methods: We used human umbilical vein endothelial cells to test the reactions to nicotine or acetylcholine/pyridostigmine administration in regards to MCP-1 levels, gene regulation and RNR expression. Results: Pyridostigmine and Acetylcholine (Ach) lead to a significant decrease of MCP-1 levels in TNF-alpha stimulated human umbilical vein endothelial cells, while nicotine had no effect. Interestingly nicotine and acetylcholine lead to different gene expression (nicotine up-regulates epidermal growth factor and down-regulates matrix metalloproteinase-8, while Ach/pyridostigmine up-regulates thioredoxin interacting protein and down-regulates insulin like growth factor 1). Furthermore RNA levels and gene activation were similar after nicotine...
Endothelial leakage with accompanying tissue edema and increased leukocyte adhesion are character... more Endothelial leakage with accompanying tissue edema and increased leukocyte adhesion are characteristics of the vascular inflammatory response. Tissue edema formation is a key mechanism in sepsis pathophysiology contributing to impaired tissue oxygenation and the development of shock. Sepsis mortality is directly associated with the severity of these microcirculatory alterations. Dysfunction of the sympathetic nervous system can have deleterious effects in generalized inflammation. This study evaluated the effect of the adrenergic alpha 2 agonist clonidine on microvascular permeability and leukocyte adhesion during endotoxemia. Macromolecular leakage, leukocyte adhesion, and venular wall shear rate were examined in mesenteric postcapillary venules of rats by using intravital microscopy (IVM). Lipopolysaccharide (LPS) (4mg/kg/h) or equivalent volumes of saline were continuously infused following baseline IVM at 0min. IVM was repeated after 60 and 120min in endotoxemic and nonendotoxem...
World journal of experimental medicine, Jan 20, 2015
Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death ... more Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects - i.e., sepsis induced immunosuppression - but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under inten...
2006 IEEE International Symposium on Geoscience and Remote Sensing, 2006
accurate, quantitative information about the evolution of terrestrial ecosystems. With its hypers... more accurate, quantitative information about the evolution of terrestrial ecosystems. With its hyperspectral capabilities covering the visible, near-and short-wave infrared wavelengths, EnMAP will provide high quality, standardized, and consistent data on a timely and frequent basis. Its primary focus will be on the considerable improvement of already standardized products and the development of new quantitative and subsequently highly informative data and its derivatives. Only an imaging spectrometer, such as the EnMAP, can resolve and detect biophysical, biochemical, and geochemical variables in distinct detail. This will tremendously increase our understanding of coupled biospheric and geospheric processes and thus, enable the management and ensure the sustainability of our vital resources.
This single-centre retrospective cohort study evaluated the incidence and outcome of mycoses in c... more This single-centre retrospective cohort study evaluated the incidence and outcome of mycoses in critical ill patients (n = 283) with sepsis due to peritonitis. Overall mortality was 41.3%, and the 28-day mortality was 29.3%. Fungal pathogens were found in 51.9%. The common first location was the respiratory tract (66.6%), followed by the abdominal site (19.7%). Candida colonisation was found in 64.6%, and invasive Candida infection in 34.0%. Identified fungi were Candida spp. in 98.6% and Aspergillus spp. in 6.1%. Patients with fungal pathogens showed a higher rate of postoperative peritonitis, APACHE II and tracheotomy. In comparison to patients without fungal pathogens, these patients showed a longer duration on mechanical ventilation, and a higher overall mortality. Patients with Candida-positive swabs from abdominal sites had more fascia dehiscence and anastomosis leakage. Seventy-two patients (48.9%) received antifungal therapy, 26 patients were treated empirically. Antifungal therapy was not associated with a decrease in mortality. Age and renal replacement therapy were associated with mortality. In conclusion, fungi are common pathogens in critically ill patients with peritonitis, and detection of fungi is associated with an increase in overall mortality. Particularly, Candida-positive abdominal swabs are associated with an increase in morbidity. However, we were not able to demonstrate a survival benefit for antifungal therapy in peritonitis patients.
IGARSS 2008 - 2008 IEEE International Geoscience and Remote Sensing Symposium, 2008
The Environmental Mapping and Analysis Program (EnMAP) is a German built hyperspectral space sens... more The Environmental Mapping and Analysis Program (EnMAP) is a German built hyperspectral space sensor scheduled for launch in 2012. EnMAP will measure over the 420-2450 nm spectral range at a varying spectral sampling of 5-10 nm. Images will covered 30 kmtimes30 km areas at approximate pixel sizes of 30 m. The primary goal of EnMAP is the exploitation of hyperspectral data for the derivation of high-spectral resolution observations of biophysical, biochemical and geochemical variables from a range of surface covers, such as vegetation canopies, rock and soil targets and coastal waters, on a global scale. General descriptions of the EnMAP instrument, the satellite operation concept, the data processing and archiving structures and current project development activities are provided in this paper.
Sepsis is a frequently fatal condition characterized by an uncontrolled and harmful host reaction... more Sepsis is a frequently fatal condition characterized by an uncontrolled and harmful host reaction to microbial infection. Despite the prevalence and severity of sepsis, we lack a fundamental grasp of its pathophysiology. Here we report that the cytokine interleukin-3 (IL-3) potentiates inflammation in sepsis. Using a mouse model of abdominal sepsis, we showed that innate response activator B cells produce IL-3, which induces myelopoiesis of Ly-6C(high) monocytes and neutrophils and fuels a cytokine storm. IL-3 deficiency protects mice against sepsis. In humans with sepsis, high plasma IL-3 levels are associated with high mortality even after adjusting for prognostic indicators. This study deepens our understanding of immune activation, identifies IL-3 as an orchestrator of emergency myelopoiesis, and reveals a new therapeutic target for treating sepsis.
Systemic inflammation is an immune response to a nonspecific insult of either infectious or nonin... more Systemic inflammation is an immune response to a nonspecific insult of either infectious or noninfectious origin and remains a challenge in the intensive care units with high mortality rate. Cholinergic neurotransmission plays an important role in the regulation of the immune response during inflammation. We hypothesized that the activity of butyrylcholinesterase (BChE) might serve as a marker to identify and prognose systemic inflammation. By using a point-of-care-testing (POCT) approach we measured BChE activity in patients with severe systemic inflammation and healthy volunteers. We observed a decreased BChE activity in patients with systemic inflammation, as compared to that of healthy individuals. Furthermore, BChE activity showed an inverse correlation with the severity of the disease. Although hepatic function has previously been found essential for BChE production, we show here that the reduced BChE activity associated with systemic inflammation occurs independently of and i...
Sepsis and related complications are a challenge for intensive care medicine. Despite many advanc... more Sepsis and related complications are a challenge for intensive care medicine. Despite many advances in antibiotic therapy sepsis remains one of the most common diseases of patients in intensive care units and is designated as the main cause of death in critically ill patients. Persisting sepsis leads to impaired immunity, resulting in immunosuppression. Unspecific predictive signs complicate an early diagnosis; however, an early initiation of adequate therapy is of crucial importance for the prognosis. Scoring systems can be applied for the initial evaluation but are controversially discussed concerning the monitoring of disease progression and therapy as well as outcome prediction. Biomarkers are considered as a complementary approach.
Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 ... more Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 of every 100 000 deliveries. With a mortality of 11% to 44%, it is among the leading direct causes of maternal death. This entity is an interdisciplinary challenge because of its presentation with sudden cardiac arrest without any immediately obvious cause, the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, including cardio - pulmonary resuscitation. We selectively reviewed pertinent literature published from 2000 to May 2013 that was retrieved by a PubMed search. The identified risk factors for AFE are maternal age 35 and above (odds ratio [OR] 1.86), Cesarean section (OR 12.4), placenta previa (OR 10.5), and multiple pregnancy (OR 8.5). AFE is diagnosed on clinical grounds after the exclusion of other causes of acute cardiovascular decompensation during delivery, such as pulmonary th...
In patients following orthotopic liver transplantation from deceased donors, total keratin 18 (K1... more In patients following orthotopic liver transplantation from deceased donors, total keratin 18 (K18) measurement was recently shown to be favourable in terms of its prognostic value for early identification of a complicated course in comparison to routine markers of liver impairment (e.g., aspartate-amino-transferase, alanine-amino-transferase, lactate-dehydrogenase). 1 In this investigation, the M65 enzyme linked immunosorbent assay (ELISA) kit (#10 020; Peviva AB, Bromma, Sweden) was used for quantitative determination of total K18. In the meantime, the manufacturer (Peviva AB, Bromma, Sweden) launched the M65 EpiDeath ELISA (#10 040) as a new tool for total K18 monitoring, which was intended for the same applications as for the M65 ELISA. The M65 EpiDeath ELISA provides improved measuring characteristics with regard to dilution linearity and spiking recovery. Moreover, it is suspected to allow for a better discrimination between patients with very low and very high levels of K18 due to an extended measuring range of 5000 U/l, compared to 2000 U/l of the M65 ELISA and lower baseline values in healthy controls.
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Papers by Stefan Höfer