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Lehmkuhl H, Bara C, Hirt S, Dengler T, Schwende H, Scheidl S, Haverich A, Hetzer R, Barten M. Incidences of incisional complications after de novo cardiac transplantation in AZA-, MMF- or everolimus-based regimens: a cross-study analysis on 1008 patients. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Puehler T, Rupprecht L, Hirt S, Schmid C, Lehle K. Improvement of human endothelial cell function during organ preservation by normothermic HTK perfusion and protein supplementation. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Haneya A, Philipp A, Schmid C, Diez C, Kobuch R, Hirt S, Zink W, Puehler T. Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients. Eur J Cardiothorac Surg 2009; 36:844-8. [PMID: 19695898 DOI: 10.1016/j.ejcts.2009.05.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 04/15/2009] [Accepted: 05/25/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard for surgical coronary re-vascularisation. Recently, minimised extracorporeal circulation system (MECC) has been postulated a safe and advantageous alternative for multi-vessel CABG. METHOD Between January 2004 and December 2007, 244 high-risk patients (logistic EuroScore (ES)>10%) underwent CABG in our institution. ECC was used in 139 (57%) and MECC in 105 (43%) patients. Demographic data including age (MECC: 73.4+/-7.4 years; ECC: 73.3+/-6.4 years), ES (MECC: 19.2+/-9.8%; ECC: 21.4+/-11.9%), left-ventricular ejection fraction (MECC: 45.6+/-16.1%; ECC: 43.1+/-15.3%), diabetes mellitus (MECC: 14.3%; ECC: 15.1%) and COPD (MECC: 6.7%; ECC: 7.9%) did not differ between the two groups. Preoperative end-stage renal failure was an exclusion criterion. The clinical course and serological/haematological parameters in the ECC and MECC patients were compared in a retrospective manner. RESULTS Although the numbers of distal anastomoses did not differ between the two groups (MECC: 3.0+/-0.9; ECC: 2.9+/-0.9), ECC time was significantly shorter in the MECC group (MECC: 96+/-33 min; ECC: 120+/-50 min, p<0.01). Creatinine kinase (CK) levels were significantly lower 6 h after surgery in the MECC group (MECC: 681+/-1505 U l(-1); ECC: 1086+/-1338 U l(-1), p<0.05) and the need of red blood cell transfusion was significantly less after MECC surgery (MECC: 3 [range: 1-6]; ECC: 5 [range: 2-9] p<0.05). Moreover, 30-day mortality was significantly lower in the MECC group as compared to the ECC group (MECC: 12.4%; ECC: 26.6, p<0.01). DISCUSSION MECC is a safe alternative for CABG surgery. A lower 30-day mortality, lower transfusion requirements and less renal and myocardial damage encourage the use of MECC systems, especially in high-risk patients.
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Puehler T, Haneya A, Philipp A, Wiebe K, Keyser A, Rupprecht L, Hirt S, Kobuch R, Diez C, Hilker M, Schmid C. Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization. Ann Thorac Surg 2009; 87:766-72. [PMID: 19231386 DOI: 10.1016/j.athoracsur.2008.11.050] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 11/12/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Coronary artery bypass surgery employing minimal extracorporeal circulation (MECC) was compared with standard extracorporeal circulation (ECC) and off-pump coronary artery bypass graft surgery (OPCABG) with regard to the perioperative course. METHODS From January 2004 to December 2007, 1,674 patients (n = 558 MECC, n = 558 ECC, n = 558 OPCABG) who underwent coronary bypass surgery were studied. The primary end point was in-hospital mortality; secondary end points were perioperative variables, intensive care, and in-hospital course. RESULTS Demographic data, comorbidity, and the European System for Cardiac Operative Risk Evaluation score (MECC 3.0%, ECC 3.5%, OPCABG 3.2%) were similar among the groups, but in-hospital mortality for elective and urgent/emergent patients was lower in the MECC and OPCABG groups (MECC 3.2%, OPCABG 3.7%, ECC 6.9%; p < 0.05). The number of distal anastomoses was lowest in the OPCABG group, but comparable for MECC and ECC patients. Postoperative ventilation time, release of creatinine kinase, catecholamine therapy, drainage loss, and transfusion requirements were lower in the MECC and OPCABG groups, whereas stay in the intensive care unit was shorter only in the latter (p < 0.05). CONCLUSIONS Minimal extracorporeal circulation is an easy and safe procedure for coronary artery bypass graft surgery. In selected patients, the advantages of MECC equal those of OPCABG. MECC should be considered as an alternative to OPCABG and standard ECC procedures.
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Haneya A, Philipp A, Foltan M, Mueller T, Camboni D, Rupprecht L, Puehler T, Hirt S, Hilker M, Kobuch R, Schmid C, Arlt M. Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution. Ann Saudi Med 2009; 29:110-4. [PMID: 19318758 PMCID: PMC2813631 DOI: 10.4103/0256-4947.51792] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation. PATIENTS AND METHODS From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4. RESULTS All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO. CONCLUSION Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care.
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Schopka S, Schmid FX, Hirt S, Birnbaum DE, Schmid C, Lehle K. Recellularization of biological heart valves with human vascular cells:In vitrohemocompatibility assessment. J Biomed Mater Res B Appl Biomater 2009; 88:130-8. [DOI: 10.1002/jbm.b.31159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoenicka M, Wiedemann L, Puehler T, Hirt S, Schmid C. Metabolic requirements in vascular tissue engineering. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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58
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Kobuch R, Puehler T, Haneya A, Philipp A, Rupprecht L, Hirt S, Hilker M, Schmid C. Does duration of extracorporal membrane oxygenation support has an influence on patient outcome? Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haneya A, Selleng S, Hirt S, Pühler T, Strobel U, Schmid C, Greinacher A. Anticoagulation management in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kobuch R, Puehler T, Haneya A, Philipp A, Diez C, Rupprecht L, Keyser A, Hirt S, Hilker M, Birnbaum DE, Schmid C. Minimized extracorporeal circulation in coronary artery bypass grafting: a 10 year single center experience. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Camboni D, Philipp A, Hirt S, Schmid C. Possibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure. Interact Cardiovasc Thorac Surg 2008; 8:168-70. [DOI: 10.1510/icvts.2008.187567] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Flörchinger B, Philipp A, Klose A, Hilker M, Kobuch R, Rupprecht L, Keyser A, Pühler T, Hirt S, Wiebe K, Müller T, Langgartner J, Lehle K, Schmid C. Pumpless extracorporeal lung assist: a 10-year institutional experience. Ann Thorac Surg 2008; 86:410-7; discussion 417. [PMID: 18640306 DOI: 10.1016/j.athoracsur.2008.04.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/07/2008] [Accepted: 04/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pumpless extracorporeal lung assist (PECLA) was developed to support pulmonary function in patients with severe respiratory insufficiency. METHODS Since 1996, 159 patients with an age ranging from 7 to 78 years were provided with a PECLA system. Fifteen patients were referred to us by air or ground transport after insertion of the system in a peripheral hospital. RESULTS Main underlying lung diseases were acute respiratory distress syndrome (70.4%) and pneumonia (28.3%). Pumpless extracorporeal lung assist lasted for 0.1 to 33 days, mean 7.0 +/- 6.2 days; cumulative experience was greater than 1,300 days. Successful weaning and survival to hospital discharge was achieved in 33.1% of patients after a mean PECLA support of 8.5 +/- 6.3 days. During PECLA therapy, 48.7% of patients died, mainly as a result of multiorgan failure after a mean interval of 4.8 +/- 5.1 days. Inability to stabilize pulmonary function was noted in 3% of patients only. After PECLA, 30-day mortality was 13.6%. In a subgroup analysis, best outcome was obtained in patients after trauma. CONCLUSIONS Pumpless extracorporeal lung assist is a simple and efficient method to support patients with deteriorating gas exchange for prolonged periods to allow the lung protective ventilation and transportation. Best indication for use of PECLA is severe hypercapnia and moderate hypoxia.
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Fitoussi O, Guichard F, Hirt S, Dohollou N, Bureau C, Auduhy F, Guichard P. Combination of estramustine, paclitaxel, and tegafur-uracil (ETU) in patients with metastatic hormone-refractory prostate cancer (mHRPC): Efficacy and safety results of a multicenter phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schmid C, Philipp A, Hirt S, Flörchinger B, Klose A, Mueller T, Lehle K, Schmid FX, Birnbaum D, Hilker M. 472: Recovery of Pulmonary Function with Pumpless Extracorporeal Lung Assist (PECLA). J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rommelsheim K, Lackner K, Westhofen P, Distelmaier W, Hirt S. Das respiratorische Distress-Syndrom des Erwachsenen (ARDS) im Computertomogramm. Anasthesiol Intensivmed Notfallmed Schmerzther 2008. [DOI: 10.1055/s-2007-1003786] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Camboni D, Haneya A, Brawanski A, Harenski K, Hirt S, Phillipp A, Schmid C. Accuracy of core temperature measurement in deep hypothermic circulatory arrest. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rothenburger M, Zuckermann A, Bara C, Hummel M, Strüber M, Hirt S, Lehmkuhl H. Recommendations for the use of everolimus (Certican) in heart transplantation: results from the second German-Austrian Certican Consensus Conference. J Heart Lung Transplant 2007; 26:305-11. [PMID: 17403469 DOI: 10.1016/j.healun.2007.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 11/08/2006] [Accepted: 01/07/2007] [Indexed: 01/10/2023] Open
Abstract
Everolimus (Certican; Novartis Pharma AG, Basel, Switzerland) represents the latest generation of proliferation signal inhibitors (PSIs). Everolimus is indicated for use as an immunosuppressive drug in renal and heart transplantation. This report reflects the recommendations of the second German-Austrian Certican Consensus Conference, held in January 2006, for the clinical use of everolimus.
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Reichenspurner H, Klepetko W, Aboyoun C, Bravo C, Estenne M, Hirt S, Aubert J, Treede H, Glanville A. 420: Final 3 year analysis of a prospective randomized international multicenter investigator driven study comparing Tac and CsA (+ MMF/steroids) after lung transplantation in 274 patients. J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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69
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Pühler T, Goepel L, Struckmeyer U, Ernst M, Tschirschnitz MV, Cremer J, Hirt S. C2 therapeutic drug monitoring of cyclosporineA (CsA) after de novo heart transplantation (HTX). Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pühler T, Lesser E, Hass C, Ernst M, Bewig B, Wottge H, Cremer J, Hirt S. Imatinib-Mesylate in combination with RAD reduces significantly chronic rejection (CR) after orthotopic lung transplantation (LTX) in an experimental rat model. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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71
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Haneya A, Tschirschnitz MV, Haake N, Pühler T, Cremer J, Hirt S. Does optimized pharmacological and invasive therapy require re-definition of the time point for heart transplantation? Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hummel M, Bara C, Hirt S, Haverich A, Hetzer R. Prevalence of CCR5Delta32 polymorphism in long-term survivors of heart transplantation. Transpl Immunol 2006; 17:223-6. [PMID: 17331851 DOI: 10.1016/j.trim.2006.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 11/13/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND CC chemokine receptor 5 (CCR5) contributes to the alloimmune response following solid organ transplantation. In individuals homozygous for the CCR5Delta32 mutation, the receptor is inactive and lymphocyte recruitment and leukocyte trafficking during rejection are inhibited. A significant improvement in graft survival following renal transplantation has been observed in homozygous CCR5Delta32 patients, although conflicting data exist. To determine whether CCR5Delta32 homozygous heart transplant recipients may also benefit compared to those with a normally functioning CCR receptor, the proportion of patients with CCR5Delta32 mutation was examined in a large cohort of patients surviving for a long period after heart transplantation. METHODS The prevalence of CCR5 genotype was identified in patients who had survived >or=7 years after heart transplantation. Genotyping was performed centrally by polymerase chain reaction (PCR). RESULTS A total of 555 patients were recruited at three heart transplant centers in Germany. Of these, 442 patients (79.6%) were homozygous for the wild-type allele, 106 (19.1%) were heterozygous for CCR5Delta32 and 7 (1.3%) were homozygous for CCR5Delta32. No statistically significantly differences were observed between the incidence of CCR5Delta32 homozygosity in the study population and the estimated incidence in the normal population. CONCLUSIONS In the absence of a control arm, it cannot be established if homozygous carriers of the CCR5Delta32 allele experience a long-term survival benefit following heart transplantation that may be masked by underrepresentation of the CCR5Delta32 allele in recipients of a heart transplant. To answer this question, the prevalence of CCR5Delta32 homozygosity needs to be established in patients awaiting heart transplantation.
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Abukishe A, Brandt M, Hedderich J, Hirt S, Lentz S, Schäfer H, Walluscheck K, Cremer J, Bruhn HD. [Mutation in factor II and factor V gene in patients with peripheral arterial occlusive disease]. Hamostaseologie 2006; 26:197-200. [PMID: 16906235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Mutations in factor-V- and factor-II-genes are correlated with an increased risk for venous thrombosis according to the literature. The significance of the mutations in factor- II- and factor-V-genes for the development of the peripheral arterial occlusive disease is not known. Therefore, we investigated the presence of these mutations in 152 patients with documented peripheral arterial occlusive disease and 318 controls without peripheral arterial occlusive disease with polymerase chain reaction (PCR). There was no association between factor-II-mutation and peripheral arterial occlusive disease. The factor-V-mutation, however, was increased in patients with peripheral arterial occlusive disease double fold (12 positive cases in 318 controls, 12 positive cases in 152 patients with peripheral arterial occlusive disease). The significance level was reached (p = 0.05) in statistical analysis but the result did not fall below the significance level as necessary to reach statistical significance (odds ratio 2.19). Nevertheless, from these data we have to discuss a biological relevance of factor-V-mutation in the pathogenesis of peripheral arterial occlusive disease.
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Pühler T, Hirt S, Ladenburger S, Cremer J, Haverich A. 36-month results of a international multicentre, randomised doppelblinded study of everolimus vs. Azathioprin in stable patients after lung transplantation. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Brandt M, Hedderich J, Hirt S, Lentz S, Schäfer H, Walluscheck K, Cremer J, Bruhn HD, Abukishe A. Chronisch-arterielle Verschlusskrankheit der Beine im Stadium IIb-IV. Hamostaseologie 2006. [DOI: 10.1055/s-0037-1617064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
ZusammenfassungDie Faktor-V- und Faktor-II-Mutationen sind nach der Literatur mit einem erhöhten Risiko für venöse Thrombosen verbunden. Die Bedeutung der Mutationen im Faktor-IIund -V-Gen für die Entstehung und das Fortschreiten der arteriellen Verschlusskrankheit ist bislang nicht geklärt. Wir untersuchten das Vorhandensein dieser Mutationen bei 152 Patienten mit dokumentierter pAVK und 318 Kontrollen (ohne pAVK) mittels Polymerase-Kettenreaktion (PCR) und RFLP-Analyse. Die Ergebnisse erbrachten keinen Hinweis auf eine Assoziation zwischen einer Faktor-II-Mutation und der Entstehung einer pAVK. Dagegen waren Faktor- V-Mutationen bei pAVK-Patienten doppelt so häufig zu beobachten wie bei Gesunden (in der Kontrollgruppe ergaben sich 12 positive Fälle bei 318 Probanden, in der Patientengruppe ergaben sich 12 positive Fälle bei 152 Patienten). In der statistischen Analyse wurde das Signifikanzniveau (p = 0,05) zwar erreicht, aber nicht unterschritten. Das Chancenverhältnis (Odds-Ratio) betrug 2,19 (Konfidenzintervall 0,96-4,99). Schlussfolgerung: Die biologische Relevanz der Faktor-V-Mutation in der Pathogenese der pAVK kann aufgrund unserer Daten diskutiert werden.
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