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Englbrecht JS, Schrader D, Kraus H, Schäfer M, Schedler D, Bach F, Soehle M. How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia. Transpl Int 2023; 36:11186. [PMID: 37252613 PMCID: PMC10211426 DOI: 10.3389/ti.2023.11186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023]
Abstract
Organ donation after brain death is constantly lower in Germany compared to other countries. Instead, representative surveys show a positive attitude towards donation. Why this does not translate into more donations remains questionable. We retrospectively analyzed all potential brain dead donors treated in the university hospitals of Aachen, Bielefeld, Bonn, Essen, Düsseldorf, Cologne and Münster between June 2020 and July 2021. 300 potential brain dead donors were identified. Donation was utilized in 69 cases (23%). Refused consent (n = 190), and failed utilization despite consent (n = 41) were reasons for a donation not realized. Consent was significantly higher in potential donors with a known attitude towards donation (n = 94) compared to a decision by family members (n = 195) (49% vs. 33%, p = 0.012). The potential donor´s age, status of interviewer, and the timing of the interview with decision-makers had no influence on consent rates, and it was comparable between hospitals. Refused consent was the predominant reason for a donation not utilized. Consent rate was lower than in surveys, only a known attitude towards donation had a significant positive influence. This indicates that survey results do not translate well into everyday clinical practice and promoting a previously documented decision on organ donation is important.
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Affiliation(s)
| | | | | | | | | | - Friedhelm Bach
- Protestant Hospital Bethel (EvKB), Bielefeld, Germany
- Medical School OWL, Bielefeld University, Bielefeld, Germany
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Englbrecht JS, Schrader D, Kraus H, Schäfer M, Schedler D, Bach F, Söhle M. Advance directives and consent to organ donation in seven university hospitals in North Rhine–Westphalia. Deutsches Ärzteblatt international 2023; 120:133-134. [PMID: 37083573 PMCID: PMC10154790 DOI: 10.3238/arztebl.m2022.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/18/2022] [Accepted: 10/28/2022] [Indexed: 02/15/2023]
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3
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van Duijn PJ, Verbrugghe W, Jorens PG, Spöhr F, Schedler D, Deja M, Rothbart A, Annane D, Lawrence C, Jereb M, Seme K, Šifrer F, Tomič V, Estevez F, Carneiro J, Harbarth S, Bonten MJM. The effects of antibiotic cycling and mixing on acquisition of antibiotic resistant bacteria in the ICU: A post-hoc individual patient analysis of a prospective cluster-randomized crossover study. PLoS One 2022; 17:e0265720. [PMID: 35503768 PMCID: PMC9064081 DOI: 10.1371/journal.pone.0265720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Repeated rotation of empiric antibiotic treatment strategies is hypothesized to reduce antibiotic resistance. Clinical rotation studies failed to change unit-wide prevalence of antibiotic resistant bacteria (ARB) carriage, including an international cluster-randomized crossover study. Unit-wide effects may differ from individual effects due to “ecological fallacy”. This post-hoc analysis of a cluster-randomized crossover study assesses differences between cycling and mixing rotation strategies in acquisition of carriage with Gram-negative ARB in individual patients. Methods This was a controlled cluster-randomized crossover study in 7 ICUs in 5 European countries. Clinical cultures taken as routine care were used for endpoint assessment. Patients with a first negative culture and at least one culture collected in total were included. Community acquisitions (2 days of admission or less) were excluded. Primary outcome was ICU-acquisition of Enterobacterales species with reduced susceptibility to: third- or fourth generation cephalosporins or piperacillin-tazobactam, and Acinetobacter species and Pseudomonas aeruginosa with reduced susceptibility for piperacillin-tazobactam or carbapenems. Cycling (altering first-line empiric therapy for Gram-negative bacteria, every other 6-weeks), to mixing (changing antibiotic type every empiric antibiotic course). Rotated antibiotics were third- or fourth generation cephalosporins, piperacillin-tazobactam and carbapenems. Results For this analysis 1,613 admissions were eligible (855 and 758 during cycling and mixing, respectively), with 16,437 microbiological cultures obtained. Incidences of acquisition with ARB during ICU-stay were 7.3% (n = 62) and 5.1% (n = 39) during cycling and mixing, respectively (p-value 0.13), after a mean of 17.7 (median 15) and 20.8 (median 13) days. Adjusted odds ratio for acquisition of ARB carriage during mixing was 0.62 (95% CI 0.38 to 1.00). Acquired carriage with ARB were Enterobacterales species (n = 61), Pseudomonas aeruginosa (n = 38) and Acinetobacter species (n = 20), with no statistically significant differences between interventions. Conclusions There was no statistically significant difference in individual patients’ risk of acquiring carriage with Gram-negative ARB during cycling and mixing. These findings substantiate the absence of difference between cycling and mixing on the epidemiology of Gram-negative ARB in ICU. Trial registration This trial is registered with ClinicalTrials.gov, registered 10 January 2011, NCT01293071.
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Affiliation(s)
- Pleun J. van Duijn
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
- * E-mail:
| | - Walter Verbrugghe
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Philippe G. Jorens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Fabian Spöhr
- Department of Anaesthesiology and Intensive Care, Sana Kliniken Stuttgart, Stuttgart, Germany
| | - Dirk Schedler
- Department of Anaesthesiology and Intensive Care, Sana Kliniken Stuttgart, Stuttgart, Germany
| | - Maria Deja
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Rothbart
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Djillali Annane
- Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Garches, France
- Laboratory of Infection & Inflammation, School of Medicine Simone Veil, University Versailles Saint Quentin & University Paris Saclay, INSERM, Montigny le Bretonneux, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) and RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Garches, France
| | | | - Matjaz Jereb
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Franc Šifrer
- Department of Intensive Care Medicine, University Hospital Golnik, Golnik, Slovenia
| | - Viktorija Tomič
- Department of Medical Microbiology, University Hospital Golnik, Golnik, Slovenia
| | - Francisco Estevez
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Jandira Carneiro
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc J. M. Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
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Augustin M, Schommers P, Suárez I, Koehler P, Gruell H, Klein F, Maurer C, Langerbeins P, Priesner V, Schmidt-Hellerau K, Malin JJ, Stecher M, Jung N, Wiesmüller G, Meissner A, Zweigner J, Langebartels G, Kolibay F, Suárez V, Burst V, Valentin P, Schedler D, Cornely OA, Hallek M, Fätkenheuer G, Rybniker J, Lehmann C. Rapid response infrastructure for pandemic preparedness in a tertiary care hospital: lessons learned from the COVID-19 outbreak in Cologne, Germany, February to March 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32489176 PMCID: PMC7268272 DOI: 10.2807/1560-7917.es.2020.25.21.2000531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The coronavirus disease (COVID-19) pandemic has caused tremendous pressure on hospital infrastructures such as emergency rooms (ER) and outpatient departments. To avoid malfunctioning of critical services because of large numbers of potentially infected patients seeking consultation, we established a COVID-19 rapid response infrastructure (CRRI), which instantly restored ER functionality. The CRRI was also used for testing of hospital personnel, provided epidemiological data and was a highly effective response to increasing numbers of suspected COVID-19 cases.
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Affiliation(s)
- Max Augustin
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Philipp Schommers
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,These authors contributed equally to this article.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Isabelle Suárez
- These authors contributed equally to this article.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Philipp Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Christian Maurer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany
| | - Vanessa Priesner
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Kirsten Schmidt-Hellerau
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Jakob J Malin
- University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Melanie Stecher
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Norma Jung
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | | | - Arne Meissner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | | | - Felix Kolibay
- Department for Clinical Affairs, University of Cologne, Germany
| | - Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philippe Valentin
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dirk Schedler
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Jan Rybniker
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Clara Lehmann
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
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van Duijn PJ, Verbrugghe W, Jorens PG, Spöhr F, Schedler D, Deja M, Rothbart A, Annane D, Lawrence C, Nguyen Van JC, Misset B, Jereb M, Seme K, Šifrer F, Tomiç V, Estevez F, Carneiro J, Harbarth S, Eijkemans MJC, Bonten M. The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial. Lancet Infect Dis 2018; 18:401-409. [PMID: 29396000 DOI: 10.1016/s1473-3099(18)30056-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/02/2017] [Accepted: 11/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether antibiotic rotation strategies reduce prevalence of antibiotic-resistant, Gram-negative bacteria in intensive care units (ICUs) has not been accurately established. We aimed to assess whether cycling of antibiotics compared with a mixing strategy (changing antibiotic to an alternative class for each consecutive patient) would reduce the prevalence of antibiotic-resistant, Gram-negative bacteria in European intensive care units (ICUs). METHODS In a cluster-randomised crossover study, we randomly assigned ICUs to use one of three antibiotic groups (third-generation or fourth-generation cephalosporins, piperacillin-tazobactam, and carbapenems) as preferred empirical treatment during 6-week periods (cycling) or to change preference after every consecutively treated patient (mixing). Computer-based randomisation of intervention and rotated antibiotic sequence was done centrally. Cycling or mixing was applied for 9 months; then, following a washout period, the alternative strategy was implemented. We defined antibiotic-resistant, Gram-negative bacteria as Enterobacteriaceae with extended-spectrum β-lactamase production or piperacillin-tazobactam resistance, and Acinetobacter spp and Pseudomonas aeruginosa with piperacillin-tazobactam or carbapenem resistance. Data were collected for all admissions during the study. The primary endpoint was average, unit-wide, monthly point prevalence of antibiotic-resistant, Gram-negative bacteria in respiratory and perineal swabs with adjustment for potential confounders. This trial is registered with ClinicalTrials.gov, number NCT01293071. FINDINGS Eight ICUs (from Belgium, France, Germany, Portugal, and Slovenia) were randomly assigned and patients enrolled from June 27, 2011, to Feb 16, 2014. 4069 patients were admitted during the cycling periods in total and 4707 were admitted during the mixing periods. Of these, 745 patients during cycling and 853 patients during mixing were present during the monthly point-prevalence surveys, and were included in the main analysis. Mean prevalence of the composite primary endpoint was 23% (168/745) during cycling and 22% (184/853) during mixing (p=0·64), yielding an adjusted incidence rate ratio during mixing of 1·039 (95% CI 0·837-1·291; p=0·73). There was no difference in all-cause in-ICU mortality between intervention periods. INTERPRETATION Antibiotic cycling does not reduce the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU. FUNDING European Union Seventh Framework Programme.
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Affiliation(s)
- Pleun Joppe van Duijn
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands.
| | - Walter Verbrugghe
- Department of Critical Care Medicine, Antwerp University Hospital, Antwerp, Belgium
| | | | - Fabian Spöhr
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Cologne, Germany
| | - Dirk Schedler
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Cologne, Germany
| | - Maria Deja
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Rothbart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin, Berlin, Germany
| | - Djillali Annane
- General Intensive Care Unit, Raymond-Poincaré Hospital, Garches, France
| | | | | | - Benoit Misset
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Matjaz Jereb
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Franc Šifrer
- Department of Intensive Care Medicine, Klinika Golnik, Golnik, Slovenia
| | - Viktorija Tomiç
- Department of Medical Microbiology, Klinika Golnik, Golnik, Slovenia
| | - Francisco Estevez
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Jandira Carneiro
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Marc Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
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Lambertz R, Drinhaus H, Schedler D, Bludau M, Schröder W, Annecke T. [Perioperative management of transthoracic oesophagectomies : Fundamentals of interdisciplinary care and new approaches to accelerated recovery after surgery]. Anaesthesist 2017; 65:458-66. [PMID: 27245922 DOI: 10.1007/s00101-016-0179-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient. For an optimal outcome, the careful interdisciplinary selection of patients, preoperative risk evaluation and conditioning are essential. The caseload of the centres correlates inversely with the complication rate. The leading surgical complication is anastomotic leakage, which is diagnosed endoscopically and usually treated with the aid of endoscopic procedures. Pulmonary infections are the most frequent non-surgical complication. Thoracic epidural anaesthesia and perfusion-orientated fluid management can reduce the rate of pulmonary complications. Patients are ventilated protecting the lungs and are extubated as early as possible. Oesophagectomies should only be performed in high-volume centres with the close cooperation of surgeons and anaesthesia/intensive care specialists. Programmes of enhanced recovery after surgery (ERAS) hold further potential for the patient's quicker postoperative recovery. In this review article the fundamental aspects of the interdisciplinary perioperative management of transthoracic oesophagectomy are described.
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Affiliation(s)
- R Lambertz
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Uniklinik Köln, Köln, Deutschland
| | - H Drinhaus
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpenerstr. 62, 50937, Köln, Deutschland
| | - D Schedler
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpenerstr. 62, 50937, Köln, Deutschland
| | - M Bludau
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Uniklinik Köln, Köln, Deutschland
| | - W Schröder
- Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Uniklinik Köln, Köln, Deutschland
| | - T Annecke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Kerpenerstr. 62, 50937, Köln, Deutschland.
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Födinger M, Schedler D, Fritsche-Polanz R, Hörl WH, Sunder-Plassmann G. Molecular analysis of the carboxy terminus of the beta and gamma subunits of the epithelial sodium channel in patients with end-stage renal disease. Nephron Clin Pract 2000; 81:381-6. [PMID: 10095172 DOI: 10.1159/000045320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mutations in the carboxy termini of the beta subunit (hbetaENaC) and the gamma subunit (hgammaENaC) of the human epithelial sodium channel have been identified in patients with Liddle syndrome. Moreover polymorphisms have been described in these genes, the clinical relevance of which for progression to end-stage renal disease (ESRD) is unknown. We, therefore, have screened ESRD patients for putative variants of these genes. METHODS We investigated 256 chronic hemodialysis patients, including 123 patients with a history of hypertension as a cause of ESRD. Screening for mutations in the carboxy termini of hbetaENaC and hgammaENaC was accomplished by polymerase chain reaction amplification followed by single-strand conformation polymorphism analysis. RESULTS In 231 patients single-strand conformation polymorphism analysis of the polymerase chain reaction fragments of the hbetaENaC and hgammaENaC genes showed a similar migration pattern as compared with negative control subjects. In 25 patients a band shift was observed. However, sequence analysis in all these patients revealed wild-type sequence. CONCLUSIONS The present study demonstrates the absence of genetic variants in the carboxy terminus of the hbetaENaC and hgammaENaC genes in Austrian patients with ESRD maintained on chronic hemodialysis treatment. Thus, mutations in these genes are unlikely to be associated with ESRD.
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Affiliation(s)
- M Födinger
- Department of Laboratory Medicine, Division of Molecular Biology, University of Vienna, Austria.
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8
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Födinger M, Hirschl MM, Schedler D, Herkner H, Bur A, Laggner AN, Hörl WH, Sunder-Plassmann G. Mutations in the carboxy terminus of the beta and gamma subunits of the epithelial sodium channel are not present in patients with hypertensive crisis. Eur J Clin Invest 1998; 28:707-11. [PMID: 9767369 DOI: 10.1046/j.1365-2362.1998.00369.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathophysiology of hypertensive crises is poorly understood. To date, no information is available about genetic determinants underlying the individual risk for development of hypertensive urgencies or emergencies. Recently, mutations in the beta subunit (h beta ENaC) and the gamma subunit (h gamma ENaC) of the human epithelial sodium channel (hENaC) have been shown to result in excessive elevation of blood pressure in patients with Liddle's syndrome. METHODS Using polymerase chain reaction and direct sequencing of amplification products we have screened 90 consecutive out-patients with hypertensive urgency or hypertensive emergency for the presence of mutations in the carboxy terminus of these genes. Furthermore, serum potassium concentrations were determined in all 90 patients, and serum aldosterone levels and plasma renin activity were measured in a subset of 34 patients. RESULTS Among 71 patients with hypertensive urgency (78.9%) and 19 patients with hypertensive emergency (21.1%) not one individual showed a mutation in genomic DNA extending from codon 532 to codon 637 of h beta ENaC and from codon 525 to codon 651 of h gamma ENaC. Twelve of 90 patients showed mild hypokalaemia (13.3%), 16 of 34 patients had a plasma renin activity below the lower normal range (47.1%) and one of 34 patients had a low serum aldosterone concentration (2.9%). CONCLUSIONS The present study clearly demonstrates the absence of mutations in the carboxy terminus of the h beta ENaC and h gamma ENaC gene of hENaC in an Austrian cohort of 90 patients suffering from hypertensive crisis.
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Affiliation(s)
- M Födinger
- Department of Laboratory Medicine, University of Vienna, Austria.
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