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Riessen R, Haap M, Hellwege RS. [Intensive care monitoring]. Dtsch Med Wochenschr 2021; 147:34-41. [PMID: 34963172 DOI: 10.1055/a-1226-9164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Monitoring the function of essential organ systems is a hallmark of critical care. In combination with the medical history, physical examination and selective diagnostic tests. Monitoring facilitates the bed-side diagnosis of many diseases in critical care and guides therapeutic management while providing optimal patient safety. The availability of monitoring compensates in the very often complex and multimorbid patients and the very dynamic course of their diseases the lack of universally applicable treatment protocols, that are based on the results of randomized critical care trials. In the future clinical decision support systems based on artificial intelligence might support intensivists in the analysis of monitoring data in terms of individual prognosis assessment and choice of therapy.
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2
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Schork A, Moll K, Haap M, Riessen R, Wagner R. Course of lactate, pH and base excess for prediction of mortality in medical intensive care patients. PLoS One 2021; 16:e0261564. [PMID: 34929006 PMCID: PMC8687550 DOI: 10.1371/journal.pone.0261564] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction As base excess had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and methods For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum or minimum in the first 24 hours and in 24–48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 (N = 4067 at admission, N = 1715 with ICU treatment > 48 h) and investigated for prediction of in-hospital-mortality. Results Mortality was 22% and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). Conclusion Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24–48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.
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Affiliation(s)
- Anja Schork
- Division of Endocrinology, Diabetology, and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
- * E-mail:
| | - Kathrin Moll
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Robert Wagner
- Division of Endocrinology, Diabetology, and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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Gonzalez-Granda A, Schollenberger A, Thorsteinsson R, Haap M, Bischoff SC. Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study. Clin Nutr ESPEN 2021; 45:486-491. [PMID: 34620359 DOI: 10.1016/j.clnesp.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. OBJECTIVE To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. METHODS Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44 ± 16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST + group; SAPS II 65 ± 19) and 31 not (after NST - group; SAPS II, 54 ± 16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. RESULTS NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27 ± 8 to 18 ± 6, p < 0.001; NUTRIC, from 7 ± 2 to 4 ± 2, p < 0.001) compared to no NST intervention (APACHE II from 24 ± 7 to 21 ± 7, p < 0.05; NUTRIC from 6 ± 2 to 5 ± 2, p < 0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. CONCLUSION In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. TRIAL REGISTRATION ClinicalTrials.gov (NCT02200874).
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Affiliation(s)
- Anita Gonzalez-Granda
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany.
| | - Asja Schollenberger
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany; Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
| | - Regina Thorsteinsson
- Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
| | - Michael Haap
- Medical Intensive Care Unit, Dept. of Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany; Centre of Nutritional Medicine, University Hospital of Tübingen and University of Hohenheim, Otfried-Mueller-Str. 14, 72076, Tübingen, Germany.
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4
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Gonzalez-Granda A, Seethaler B, Haap M, Riessen R, Bischoff SC. Effect of an intensified individual nutrition therapy on serum metabolites in critically ill patients - A targeted metabolomics analysis of the ONCA study. Clin Nutr ESPEN 2021; 43:267-275. [PMID: 34024526 DOI: 10.1016/j.clnesp.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The effect of medical nutrition on serum metabolomics has been poorly explored. The aim of the study was to investigate the relation between energy supply and metabolic profiles in critically ill patients. MATERIALS AND METHODS Twenty mechanically ventilated patients on enteral nutrition (EN) or enteral/parenteral nutrition (EN/PN) were randomized into two groups. One group received an individual energy supply based on indirect calorimetry (IC group, n = 9), the other group received a standard energy supply based on a formula, the standard care group (SC group, n = 11). Targeted metabolomics was performed in early-, late- and post-acute metabolic phase. RESULTS Individual versus standard care energy supply resulted in a metabolite class separation between the IC and the SC group (P < 0.001). In the SC group concentrations of four glucogenic amino acids and three biogenic amines increased between the early- and late-acute metabolic phase (P < 0.05). The metabolomics pattern differed between the routes of nutrition administration (P < 0.01). CONCLUSIONS The amount of energy supply by EN or PN, besides other factors, seems to modulate serum metabolites. Nutrition therapy based on individualized energy supply is associated with a reduction of metabolites reflecting catabolism. Therefore, metabolomics could be a new tool to determine metabolic phases in critically ill patients.
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Affiliation(s)
- Anita Gonzalez-Granda
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany.
| | - Benjamin Seethaler
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany.
| | - Michael Haap
- Medical Intensive Care Unit. Dept. of Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany.
| | - Reimer Riessen
- Medical Intensive Care Unit. Dept. of Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany.
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany.
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Abstract
Decisions about the initiation, continuation and termination of life-supporting treatments are a permanent challenge in intensive care units (ICUs). Decisions should be based on patient preferences and the medical indication. The medical indication is mainly the result of an assessment of the patient's prognosis and the applicable therapeutic options. Factors influencing the short term prognosis are mostly the severity of the acute leading disease, the number and severity of other organ failures and the response to initial treatment. Long term prognosis is dominated by the severity and number of comorbidities, age and the resulting frailty. Because in many patients all these informations are not available at the time of admission, in these cases a time-limited trial is often justified to gather all this information before a decision is made. These principles of decision making can also applied to situations in which ICU-capacities are limited (e. g. COVID-19 pandemic).
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Affiliation(s)
- Reimer Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Michael Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Moritz Mahling
- Sektion Nieren- und Hochdruckkrankheiten, Medizinische Klinik IV, Diabetologie, Endokrinologie und Nephrologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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6
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Affiliation(s)
- Karolin Baumgartner
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Germany
| | - Michael Haap
- Notfallmedizin und Internistische Intensivmedizin, Universitätsklinikum Tübingen, Germany
| | - Hans Bösmüller
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Marius Horger
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Germany
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7
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Häntschel M, Niebling J, Häring A, Häring MF, Groß T, Horger M, Riessen R, Haap M, Lewis RA, Böckeler M, Hetzel J. Life-threatening pneumonitis after first-line treatment with osimertinib for primary T790M mutated non-small cell lung cancer. Thorac Cancer 2020; 11:2044-2047. [PMID: 32374485 PMCID: PMC7327687 DOI: 10.1111/1759-7714.13476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 03/19/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022] Open
Abstract
Epithelial growth factor receptor (EGFR) directed tyrosine kinase inhibitor (TKI) treatment is the standard approach in patients with advanced, EGFR‐mutated non‐small cell lung cancer (NSCLC). Although benefit/risk ratio is favorable for these TKI and side effects are manageable in the vast majority of patients, severe and even life‐threatening side effects have been reported. TKI‐induced interstitial lung disease (ILD) has been reported for single cases in modest severity, predominantly in EGFR‐TKI pretreated patients. Here, we report a case of successful stabilization of a life‐threatening ILD in a de novo T790M mutated NSCLC during first‐line treatment with osimertinib. As osimertinib will be used more often in many EGFR‐positive NSCLC patients in the future, this potentially life‐threatening side effect should receive special attention, especially in first‐line treatment.
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Affiliation(s)
- Maik Häntschel
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Johannes Niebling
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Almut Häring
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Max-Felix Häring
- Department of Internal Medicine II, Oncology, Hematology, Clinical Immunology and Rheumatology, Eberhard Karls University, Tübingen, Germany
| | - Thorben Groß
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Marius Horger
- Department of Radiology, University Hospital and Comprehensive Cancer Center Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, Eberhard Karls University, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, Eberhard Karls University, Tübingen, Germany
| | | | - Michael Böckeler
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
| | - Jürgen Hetzel
- Department of Internal Medicine VIII, Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany
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8
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Heitmann JS, Märklin M, Truckenmüller FM, Hinterleitner C, Dörfel D, Haap M, Kopp HG, Wirths S, Müller MR. A novel flow cytometry-based assay to measure compromised B cell receptor signaling as a prognostic factor in chronic lymphocytic leukemia. J Leukoc Biol 2020; 108:1851-1857. [PMID: 32303123 DOI: 10.1002/jlb.5ta0320-411rr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/06/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. In the past years, new therapeutic approaches (e.g., ibrutinib or venetoclax) have been established and greatly improved treatment of CLL. However, complete control or cure of the disease have not been reached so far. Thus, reliable prognostic markers are an imperative for treatment decisions. Recent studies have revealed an essential role for B cell receptor (BCR) signaling in the pathogenesis, prognosis, and therapy of CLL. A heterogeneous response to receptor stimulation with anti-IgM treatment culminating in different calcium flux capabilities has been demonstrated by several authors. However, the methods employed have not reached clinical application. Here, we report on a flow cytometry-based assay to evaluate calcium flux capabilities in CLL and demonstrate that compromised BCR signaling with diminished calcium flux is associated with a significantly better clinical outcome and progression free survival. In summary, our data strongly support the role of compromised BCR signaling as an important prognostic marker in CLL and establish a novel diagnostic tool for its assessment in clinical settings.
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Affiliation(s)
- Jonas S Heitmann
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany.,Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University of Tübingen, Tübingen, Germany
| | - Melanie Märklin
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University of Tübingen, Tübingen, Germany
| | - Felicia M Truckenmüller
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Clemens Hinterleitner
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Daniela Dörfel
- Department of Hematology, Oncology and Immunology, KRH Klinikum Siloah, Hannover, Germany
| | - Michael Haap
- Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
| | - Hans-Georg Kopp
- Klinik Schillerhöhe, Robert Bosch Centrum für Tumorerkrankungen, Stuttgart, Germany
| | - Stefan Wirths
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Martin R Müller
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany.,Department of Hematology, Oncology and Immunology, KRH Klinikum Siloah, Hannover, Germany
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9
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Benignus C, Burger L, Haap M, Horger M, Riessen R. [Large mediastinal mass with protrusion into the right atrium]. Med Klin Intensivmed Notfmed 2019; 115:156-158. [PMID: 31811309 DOI: 10.1007/s00063-019-00644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- C Benignus
- Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - L Burger
- Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - M Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, 72076, Tübingen, Deutschland
| | - M Horger
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - R Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, 72076, Tübingen, Deutschland.
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10
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Baumgartner K, Kübler J, Haap M, Hetzel J, Horger M. [Allergic bronchopulmonary aspergillosis (ABPA)]. ROFO-FORTSCHR RONTG 2019; 192:617-619. [PMID: 31779028 DOI: 10.1055/a-1047-1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Karolin Baumgartner
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jens Kübler
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Haap
- Notfallmedizin und Internistische Intensivmedizin, Universitätsklinikum Tübingen, Germany
| | - Jürgen Hetzel
- Internal Medicine II, Department of Oncology, Haematology, Clinical Immunology, Rheumatology and Pneumology, University of Tübingen, Germany
| | - Marius Horger
- Diagnostische Radiologie (Chairman Prof. Dr. C. D. Claussen), Eberhard-Karls-Universität, Tübingen, Germany
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11
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Bunz H, Tschritter O, Haap M, Riessen R, Heyne N, Artunc F. Elimination of Contrast Agent Gadobutrol with Sustained Low Efficiency Daily Dialysis Compared to Intermittent Hemodialysis. Kidney Blood Press Res 2019; 44:1363-1371. [PMID: 31751997 DOI: 10.1159/000502960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with renal failure, gadolinium-based contrast agents (GBCA) can be removed by intermittent hemodialysis (iHD) to prevent possible toxic effects. There is no data on the efficacy of GBCA removal via sustained low efficiency daily dialysis (SLEDD) which is mainly used in intensive care unit (ICU) patients. METHODS We compared the elimination of the GBCA gadobutrol in 6 ICU patients treated with SLEDD (6-12 h, 90 L dialysate) with 7 normal ward inpatients treated with iHD (4 h, dialysate flow 500 mL/min). Both groups received 3 dialysis sessions on 3 consecutive days starting after the application of gadobutrol. Blood samples were drawn before and after each session and total dialysate, as well as urine was collected. Gadolinium (Gd) concentrations were measured using mass spectrometry and eliminated Gd was calculated from dialysate and urine. RESULTS The initial mean plasma Gd concentration was 385 ± 183 µM for the iHD and 270 ± 97 µM for the SLEDD group, respectively (p > 0.05). The Gd-reduction rate after the first dialysis session was 83 ± 9 and 67 ± 9% for the iHD and the SLEDD groups, respectively (p = 0.0083). The Gd-reduction rate after the second and third dialysis was 94-98 and 89-96% for the iHD and the SLEDD groups (p > 0.05). The total eliminated Gd was 89 ± 14 and 91 ± 4% of the dose in the iHD and the SLEDD groups, respectively (p > 0.05). Gd dialyzer clearance was 95 ± 22 mL/min and 79 ± 19 mL/min for iHD and SLEDD, respectively (p > 0.05). CONCLUSIONS Gd-elimination with SLEDD is equally effective as iHD and can be safely used to remove GBCA in ICU patients.
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Affiliation(s)
- Hanno Bunz
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany, .,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany, .,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany,
| | - Otto Tschritter
- Department of Emergency Medicine, St. Mary´s Hospital, Stuttgart, Germany
| | - Michael Haap
- Department of Internal Medicine, Internal Intensive Care Unit, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Internal Intensive Care Unit, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany
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12
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Baumgartner K, Haap M, Nägele T, Beck R, Horger M. [Influenza virus-induced encephalitis/encephalopathy]. ROFO-FORTSCHR RONTG 2019; 191:1055-1058. [PMID: 31698467 DOI: 10.1055/a-0948-5546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Karolin Baumgartner
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Universitätsklinikum Tübingen, Germany
| | - Thomas Nägele
- Department of Diagnostic and Interventional Neuroradiology, University-Hospital Tübingen, Germany
| | - Robert Beck
- Institute of Medical Virology and Epidemiology of Viral Diseases, University-Hospital Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
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13
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Abstract
Several confounders must be considered in the evaluation of urinary catecholamine excretion. However, literature is contradictory about potential confounders. The aim of the present study was to assess correlations between catecholamine excretion and anthropometric or clinical parameters with special attention to urine volume. A total of 967 24-h urinary catecholamine measurements were performed in 593 patients for diagnostic purposes. The indication for urine examination was suspicion of secondary hypertension, phaeochromocytoma, or paraganglioma. From the patients examined, 57% were females and 43% were males. The patients' age ranged between 15 and 87 years with a median [Q1; Q3] of 51 [39; 62] years. Seventy-eight percent of the patients suffered from hypertension. Seventy percent of patients took one or more antihypertensive drugs. The most commonly used drugs were ACE inhibitors (43%), while α-blockers (15%) were the least used drugs. Urinary excretion was between 500 and 11 950 ml/24 h with a median of 2200 [1600; 2685] ml/24 h. The median body mass index (BMI) was 26.7 [24.0; 30.4] kg/m2. The excretion of all catecholamines was greater in men than in women (all p<0.0001). Epinephrine (p=0.0026), dopamine (p<0.0001), and metanephrine (p=0.0106) excretion decreased with age. BMI was associated with urinary excretion of dopamine (p<0.0001), norepinephrine (p=0.0026), normetanephrine (p<0.0001), and homovanillylmandelic acid (HVMA; p=0.0251). Urine volume correlated with urinary dopamine (p=0.0127), metanephrine (p<0.0001), normetanephrine (p=0.0070), and HVMA (p<0.0028) excretion. In addition to the established associations between urinary catecholamine excretion and age, gender, and BMI in the present study, urinary catecholamine excretion correlated also with urine volume.
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Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Friedemann Blaschka
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Rainer Lehmann
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Annika Hoyer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karsten Müssig
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology und Diabetology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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14
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Müller DJ, Wirths S, Fuchs AR, Märklin M, Heitmann JS, Sturm M, Haap M, Kirschniak A, Sasaki Y, Kanz L, Kopp HG, Müller MR. Loss of NFAT2 expression results in the acceleration of clonal evolution in chronic lymphocytic leukemia. J Leukoc Biol 2018; 105:531-538. [PMID: 30556925 DOI: 10.1002/jlb.2ab0218-076rr] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) can be defined as a clonal expansion of B cells with stereotypic BCRs. Somatic hypermutation of the BCR heavy chains (IGVH) defines a subgroup of patients with a better prognosis. In up to 10% of CLL cases, a transformation to an aggressive B cell lymphoma (Richter's syndrome) with a dismal prognosis can be observed over time. NFAT proteins are transcription factors originally identified in T cells, which also play an important role in B cells. The TCL1 transgenic mouse is a well-accepted model of CLL. Upon B cell-specific deletion of NFAT2, TCL1 transgenic mice develop a disease resembling human Richter's syndrome. Whereas TCL1 B cells exhibit tonic anergic BCR signaling characteristic of human CLL, loss of NFAT2 expression leads to readily activated BCRs indicating different BCR usage with altered downstream signaling. Here, we analyzed BCR usage in wild-type and TCL1 transgenic mice with and without NFAT2 deletion employing conventional molecular biology techniques and next-generation sequencing (NGS). We demonstrate that the loss of NFAT2 in CLL precipitates the selection of unmutated BCRs and the preferential usage of certain VDJ recombinations, which subsequently results in the accelerated development of oligoclonal disease.
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Affiliation(s)
- David J Müller
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Stefan Wirths
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Alexander R Fuchs
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Melanie Märklin
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Jonas S Heitmann
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Endocrinology, Diabetology, Clinical Pathology and Metabolism, University of Tübingen, Tübingen, Germany
| | | | - Yoshiteru Sasaki
- Department of Hematology and Oncology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Lothar Kanz
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Hans-Georg Kopp
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
| | - Martin R Müller
- Department of Oncology, Hematology and Immunology, University of Tübingen, Tübingen, Germany
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15
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Fuchs AR, Märklin M, Heitmann JS, Futterknecht S, Haap M, Wirths S, Kopp HG, Hinterleitner C, Dörfel D, Müller MR. A Chromatin Immunoprecipitation Assay to Identify Novel NFAT2 Target Genes in Chronic Lymphocytic Leukemia. J Vis Exp 2018. [PMID: 30582586 DOI: 10.3791/58270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by the expansion of malignant B cell clones and represents the most common leukemia in western countries. The majority of CLL patients show an indolent course of the disease as well as an anergic phenotype of their leukemia cells, referring to a B cell receptor unresponsive to external stimulation. We have recently shown that the transcription factor NFAT2 is a crucial regulator of anergy in CLL. A major challenge in the analysis of the role of a transcription factor in different diseases is the identification of its specific target genes. This is of great significance for the elucidation of pathogenetic mechanisms and potential therapeutic interventions. Chromatin immunoprecipitation (ChIP) is a classic technique to demonstrate protein-DNA interactions and can, therefore, be used to identify direct target genes of transcription factors in mammalian cells. Here, ChIP was used to identify LCK as a direct target gene of NFAT2 in human CLL cells. DNA and associated proteins are crosslinked using formaldehyde and subsequently sheared by sonication into DNA fragments of approximately 200-500 base pairs (bp). Cross-linked DNA fragments associated with NFAT2 are then selectively immunoprecipitated from cell debris using an αNFAT2 antibody. After purification, associated DNA fragments are detected via quantitative real-time PCR (qRT-PCR). DNA sequences with evident enrichment represent regions of the genome which are targeted by NFAT2 in vivo. Appropriate shearing of the DNA and the selection of the required antibody are particularly crucial for the successful application of this method. This protocol is ideal for the demonstration of direct interactions of NFAT2 with target genes. Its major limitation is the difficulty to employ ChIP in large-scale assays analyzing the target genes of multiple transcription factors in intact organisms.
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Affiliation(s)
- Alexander R Fuchs
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | - Melanie Märklin
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | - Jonas S Heitmann
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | | | - Michael Haap
- Dept. of Endocrinology, Diabetology, Clinical Pathology and Metabolism, University of Tübingen
| | - Stefan Wirths
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | - Hans-Georg Kopp
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | | | - Daniela Dörfel
- Dept. of Hematology, Oncology and Immunology, University of Tübingen
| | - Martin R Müller
- Dept. of Hematology, Oncology and Immunology, University of Tübingen;
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16
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Riessen R, Haap M. [Quality Management in Intensive Care Units]. Dtsch Med Wochenschr 2018; 143:1541-1546. [PMID: 30336507 DOI: 10.1055/s-0042-109256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The care of critically ill patients in an intensive care unit is effected by an interprofessional and interdisciplinary team. Quality and success of intensive care is mainly based on the performance of this team. Suitable quality management measures, based on valid indicators, insure an optimal workflow for the benefit of patient safety.
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17
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Häussler U, Riessen R, Haap M. Spielen Vitamine bei der Pathogenese und Therapie der Sepsis eine Rolle? Dtsch Med Wochenschr 2018; 143:1450-1454. [DOI: 10.1055/a-0661-1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Was ist neu?
Vitamin B1 (= Thiamin) Beim septischen Schock weisen erste Studien mit relativ kleinen Fallzahlen auf positive Effekte einer frühzeitigen Vitamin-B1-/Thiamin-Substitution in Bezug auf Laktatclearance, Nierenfunktion und Letalität, insbesondere bei Patienten mit Thiaminmangel hin. Da ein Thiaminmangel bei Intensivpatienten häufig ist, sollte eine Thiamin-Substitution in ausreichender Dosierung bei allen Sepsispatienten mit Laktatazidose erwogen werden.
Vitamin C Vitamin C besitzt multiple biologische Funktionen, die sich im Rahmen einer Sepsis günstig auswirken könnten. Die Applikation von hochdosiertem Vitamin C in Kombination mit Thiamin und Hydrokortison war in einer viel diskutierten, 2017 veröffentlichten klinischen Studie mit einer drastischen Senkung der Sepsisletalität assoziiert. In mehreren prospektiven randomisierten Studien wird die Wirksamkeit dieses Therapiekonzepts derzeit unabhängig voneinander überprüft.
Vitamin D Auch der Einsatz von Vitamin D3 bei der Sepsis ist aus pathophysiologischer Sicht insbesondere bei Mangelzuständen ein vielversprechender Ansatz, allerdings ist der Wert einer therapeutischen Substitution derzeit noch nicht gesichert.
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Affiliation(s)
- Ulrich Häussler
- Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
- Department Innere Medizin, Abteilung für Gastroenterologie, Hepatologie und Infektionskrankheiten, Universität Tübingen
| | - Reimer Riessen
- Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
| | - Michael Haap
- Department Innere Medizin, Internistische Intensivstation, Universität Tübingen
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18
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Gonzalez-Granda A, Schollenberger A, Haap M, Riessen R, Bischoff SC. Optimization of Nutrition Therapy with the Use of Calorimetry to Determine and Control Energy Needs in Mechanically Ventilated Critically Ill Patients: The ONCA Study, a Randomized, Prospective Pilot Study. JPEN J Parenter Enteral Nutr 2018; 43:481-489. [PMID: 30251255 DOI: 10.1002/jpen.1450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adequate nutrition therapy in critically ill patients poses a challenge because of the variable energy and substrate needs. The objective was to investigate whether nutrition therapy involving indirect calorimetry (IC), instead of equations for assessment of energy needs, could improve the nutrition status of critically ill patients. METHODS Forty mechanically ventilated patients were randomized into a group in which energy needs were controlled by calorimetry (IC group) and a group treated with a formula-based approach reflecting standard care (SC group). The primary outcome was change in the phase angle (PhA), a bioelectrical impedance parameter related to nutrition status and prognosis. RESULTS The mean IC-based energy requirement was lower than the formula-based estimate (21.1 ± 6.4 versus [vs] 25 kcal/kg/d, P < .01). The IC group reached 98% ± 8% of the energy goal, whereas the SC group reached only 79% ± 29% (P < 0.05), although mean intake was similar in both groups. The protein intake goal was better met in the IC group (91% ± 24%) than the SC group (73% ± 33%). The PhA of the IC group did not change during treatment, whereas that of the SC group tended to decrease by 0.36° ± 0.86° (P = .077). A shorter length of stay in intensive care was observed in the IC than in the SC group (13 ± 8 vs 24 ± 20 days, P < .05). CONCLUSION Intensified individual nutrition therapy involving IC appears to be useful for improving nutrition status in critically ill patients.
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Affiliation(s)
| | - Asja Schollenberger
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Michael Haap
- Medical Intensive Care Unit, Department of Medicine, University of Tübingen, Tübingen, Germany
| | - Reimer Riessen
- Medical Intensive Care Unit, Department of Medicine, University of Tübingen, Tübingen, Germany
| | - Stephan C Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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19
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Hinterleitner C, Steurer M, Dörfel D, Heitmann J, Kreisselmeier KP, Müller K, Kopp HG, Wirths S, Haap M, de Fend LQM, Horger M, Rodriguez-Galindo C, Kanz L, Müller MR. Long-term remission of refractory Rosai-Dorfman disease after salvage therapy with clofarabine in an adult patient. Ann Hematol 2018; 98:227-230. [PMID: 29980874 DOI: 10.1007/s00277-018-3421-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Clemens Hinterleitner
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Martina Steurer
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Daniela Dörfel
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Jonas Heitmann
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Klaus-Peter Kreisselmeier
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Karin Müller
- Department of Cardiology, University of Tübingen, Tübingen, Germany
| | - Hans-Georg Kopp
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Stefan Wirths
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Michael Haap
- Department of Endocrinology, Diabetology, Clinical Pathology and Metabolism, University of Tübingen, Tübingen, Germany
| | | | - Marius Horger
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St. Jude's Children Research Hospital, Memphis, TN, USA
| | - Lothar Kanz
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Martin R Müller
- Department of Oncology, Hematology and Immunology, University of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany. .,Department of Oncology, Hematology and Immunology, Klinikum Siloah, Hannover, Germany.
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20
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Haap M, Wiefels J, Horger M, Hoyer A, Müssig K. Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides. Blood Rev 2018; 32:225-234. [PMID: 29223447 DOI: 10.1016/j.blre.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 01/09/2023]
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder with its distinct unicentric (uCD) and multicentric (mCD) entities. The present work aimed at characterizing CD in more detail. From the 775 articles found by a PubMed search, 1133 cases were extracted. Two own cases were included. UCD was identified in 719 (42% males) and mCD in 416 (63% males) cases. Age in uCD was 34±17 and in mCD 48±18years. The hyaline-vascular type predominated in uCD and the plasma cell type in mCD. Clinical symptoms were more common in mCD. The head and neck region was most frequently affected in uCD and the axillary region in mCD. Prevalence of human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8) positivity was higher in mCD. In CT scans, high contrast enhancement and calcifications were more frequent in uCD (all p<0.0001). The two forms of CD not only differ markedly in their clinical, laboratory and imaging findings, but also in treatment response and prognosis.
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Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany; Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Julia Wiefels
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Annika Hoyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Center of Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Karsten Müssig
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Divison of Endocrinology und Diabetology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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21
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Liu X, Hoene M, Yin P, Fritsche L, Plomgaard P, Hansen JS, Nakas CT, Niess AM, Hudemann J, Haap M, Mendy M, Weigert C, Wang X, Fritsche A, Peter A, Häring HU, Xu G, Lehmann R. Quality Control of Serum and Plasma by Quantification of (4E,14Z)-Sphingadienine-C18-1-Phosphate Uncovers Common Preanalytical Errors During Handling of Whole Blood. Clin Chem 2018; 64:810-819. [PMID: 29567661 DOI: 10.1373/clinchem.2017.277905] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nonadherence to standard operating procedures (SOPs) during handling and processing of whole blood is one of the most frequent causes affecting the quality of serum and plasma. Yet, the quality of blood samples is of the utmost importance for reliable, conclusive research findings, valid diagnostics, and appropriate therapeutic decisions. METHODS UHPLC-MS-driven nontargeted metabolomics was applied to identify biomarkers that reflected time to processing of blood samples, and a targeted UHPLC-MS analysis was used to quantify and validate these biomarkers. RESULTS We found that (4E,14Z)-sphingadienine-C18-1-phosphate (S1P-d18:2) was suitable for the reliable assessment of the pronounced changes in the quality of serum and plasma caused by errors in the phase between collection and centrifugation of whole blood samples. We rigorously validated S1P-d18:2, which included the use of practicality tests on >1400 randomly selected serum and plasma samples that were originally collected during single- and multicenter trials and then stored in 11 biobanks in 3 countries. Neither life-threatening disease states nor strenuous metabolic challenges (i.e., high-intensity exercise) affected the concentration of S1P-d18:2. Cutoff values for sample assessment were defined (plasma, ≤0.085 μg/mL; serum, ≤0.154 μg/mL). CONCLUSIONS Unbiased valid monitoring to check for adherence to SOP-dictated time for processing to plasma or serum and/or time to storage of whole blood at 4 °C is now feasible. This novel quality assessment step could enable scientists to uncover common preanalytical errors, allowing for identification of serum and plasma samples that should be excluded from certain investigations. It should also allow control of samples before long-term storage in biobanks.
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Affiliation(s)
- Xinyu Liu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Miriam Hoene
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany
| | - Peiyuan Yin
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Louise Fritsche
- Core Facility German Center for Diabetes Research (DZD) Clinical Chemistry Laboratory, Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.,Center of Inflammation and Metabolism and Center for Physical Activity Research, Department of Infectious Diseases and Copenhagen Muscle Research Center (CMRC), Rigshospitalet, Copenhagen, Denmark
| | - Jakob S Hansen
- Center of Inflammation and Metabolism and Center for Physical Activity Research, Department of Infectious Diseases and Copenhagen Muscle Research Center (CMRC), Rigshospitalet, Copenhagen, Denmark
| | - Christos T Nakas
- University Institute of Clinical Chemistry, Center of Laboratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Laboratory of Biometry, University of Thessaly, Volos, Greece
| | - Andreas M Niess
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Jens Hudemann
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
| | - Maimuna Mendy
- Laboratory Services and Biobank Group, International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), Lyon, France
| | - Cora Weigert
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Xiaolin Wang
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Andreas Fritsche
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany.,Core Facility German Center for Diabetes Research (DZD) Clinical Chemistry Laboratory, Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Andreas Peter
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany.,Core Facility German Center for Diabetes Research (DZD) Clinical Chemistry Laboratory, Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Hans-Ulrich Häring
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany.,Core Facility German Center for Diabetes Research (DZD) Clinical Chemistry Laboratory, Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Guowang Xu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China;
| | - Rainer Lehmann
- Division of Clinical Chemistry and Pathobiochemistry (Central Laboratory), University Hospital Tübingen, Tübingen, Germany; .,Core Facility German Center for Diabetes Research (DZD) Clinical Chemistry Laboratory, Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Tübingen, Germany
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22
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Kauer J, Maksimovic O, Haap M, Horger M. [Imaging in Rhabdomyolysis with Ectopic (dystrophic) Calcification]. ROFO-FORTSCHR RONTG 2017; 189:1121-1125. [PMID: 29156458 DOI: 10.1055/s-0043-119812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Kloth C, Horger M, Bösmüller H, Haap M, Ioanoviciu S. Benigne und maligne Knochenläsionen des Kiefers. Laryngorhinootologie 2017; 96:544-548. [DOI: 10.1055/s-0043-112164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Horger M, Riessen R, Haap M, Klumpp B, Kolb M. Ursachen und Bedeutung intramuraler und intravaskulärer Luft. ROFO-FORTSCHR RONTG 2017; 189:398-404. [DOI: 10.1055/s-0042-123411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Affiliation(s)
- Reimer Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen
| | | | - Michael Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen
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26
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Haap M, Roth HJ, Huber T, Dittmann H, Wahl R. Urinary iodine: comparison of a simple method for its determination in microplates with measurement by inductively-coupled plasma mass spectrometry. Sci Rep 2017; 7:39835. [PMID: 28045077 PMCID: PMC5206638 DOI: 10.1038/srep39835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/25/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of our study was to develop and validate an inexpensive, rapid, easy to use quantitative method to determine urinary iodine without major procurement costs for equipment. The rationale behind introducing this method is the increasing demand for urinary iodine assessments. Our study included 103 patients (76 female, 27 male), age (arithmetic mean) 52 ± 17.3 years. Urinary iodine was determined in microplates by a modification of the Sandell-Kolthoff reaction. The results were compared with inductively-coupled plasma mass spectrometry (ICP-MS) for iodine, considered as reference method. Geometric mean of urinary iodine determined by the Sandell-Kolthoff reaction method was 62.69 μg/l (95% confidence interval 53.16–73.92) whereas by the ICP-MS method it was 65.53 μg/l (95% confidence interval 54.77–78.41). Passing-Bablok regression equations for both methods gave y = 3.374 + 0.873x (y: Sandell-Kolthoff method, x: ICP-MS). Spearman´s correlation coefficient was 0.981, indicating a very high degree of agreement between the two methods. Bland-Altman plots showed no significant systematic difference between the two methods. The modified Sandell-Kolthoff method using microtiter plate technique presented here is a simple, inexpensive semi-automated method to determine urinary iodine with very little toxic waste. Comparison with the ICP-MS-technique yielded a good agreement between the two methods.
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Affiliation(s)
- Michael Haap
- Internal Medicine IV (Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry), Eberhard-Karls-University, Tübingen, Germany
| | - Heinz Jürgen Roth
- Labor Dr. Limbach &Kollegen, GbR, Medizinisches Versorgungszentrum, Im Breitspiel 15, 69126 Heidelberg, Germany
| | - Thomas Huber
- Labor Dr. Limbach &Kollegen, GbR, Medizinisches Versorgungszentrum, Im Breitspiel 15, 69126 Heidelberg, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine, Eberhard-Karls-University, Tübingen, Germany
| | - Richard Wahl
- Internal Medicine IV (Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry), Eberhard-Karls-University, Tübingen, Germany
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Werner CR, Wagner V, Sipos B, Büttner-Herold M, Amann K, Haap M, Malek NP, Bitzer M, Artunc F. [Acute kidney injury in liver failure]. Dtsch Med Wochenschr 2016; 141:1559. [PMID: 27750343 DOI: 10.1055/s-0042-108747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
History and admission findings: We report on a 76-year-old man presenting with painless jaundice who developed dialysis-dependent acute kidney injury. Investigations: Biliary tract was examined with endoscopy, in addition kidney biopsy was performed. Diagnosis, treatment and course: A stenosing process could be seen in the biliary tract, leading to stent implantation. However, jaundice did not resolve. Kidney biopsy revealed bile casts indicating cholemic nephropathy. After switch of concomitant medication, hyperbilirubinemia resolved and kidney function was completely restored. Conclusion: Cholestatic liver disease can cause acute kidney injury by formation of bile casts in the tubuli defining cholemic nephropathy. Resolution of cholestasis can restore kidney function.
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Seizer P, Rockenstiehl M, Fateh-Moghadam S, Haen S, Artunc F, Müller MR, Ebrahimi A, Riessen R, Gawaz M, Fend F, Haap M. [An unexpected cause of dyspnea and degradation of performance]. Dtsch Med Wochenschr 2016; 141:1386. [PMID: 27642739 DOI: 10.1055/s-0042-109741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 55-year old man suffers from progressive, distinctive dyspnoea and physical weakness since 5 days. Due to ST-segment changes in the ECG and a positive troponin-test, the primary care physician initiates an hospitalization. INVESTIGATIONS After admission, the laboratory tests confirm the elevated troponin-values, and show additionally elevated pro-brain-natriuric-peptide-values. The coronary angiography presents a highly reduced left ventricular function, an aortic insufficiency III° and a coronary heart disease. DIAGNOSIS, TREATMENT AND COURSE After clinical deterioration and fever up to 42°C with consecutive tachycardia, the patient is taken over to the intensive care unit. Blood cultures are taken and an empirical antibiotic treatment is started. The patient dies within a few hours in catecholamine refractory circulatory failure. In the autopsy we find signs of an acute recurrent bacterial aortic valve endocarditis with a paravalvular abscess in the myocardium and a septic abscess in the left kidney. The patient died on acute left ventricular failure. DISCUSSION The manifestation of an endocarditis can be presented very variable and can thus be a challenge in clinical practice. For one thing, the disease presents as an acute, rapidly progressive infection, on the other hand it acts as subacute or chronic disease with just little fever and nonspecific symptoms. To initiate an adequate therapy without loss of time, endocarditis should be included in the differential diagnosis where the risk profile is evident. There are risk factors (poor dental status, intravenous drug use, artificial valve or cardiological devices) for endocarditis. These risk factors with additional symptoms should always be given to a further diagnostics to detect an endocarditis. In addition to a multiple cultivation and laboratory analysis additional diagnostics such as ECG, echocardiography (transthoracic, transthoracic) and chest X-ray should be performed. Further stratification of patients is then performed using the modified Duke criteria. The anti-infective therapy is carried out using the new ESC Guidelines (2015). If a surgical procedure is indicated, this should be done in close consultation with the colleagues of Thoracic and Cardiovascular Surgery.
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Kolb M, Bösmüller H, Haap M, Horger M. [Pulmonary neuroendocrine tumors]. ROFO-FORTSCHR RONTG 2016; 188:819-23. [PMID: 27579679 DOI: 10.1055/s-0042-110924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aebert E, Büttner-Herold M, Pfister F, Mühlbacher T, Berg C, Müller M, Haap M, Artunc F. [Patient from Gambia with sonographic white kidneys]. Dtsch Med Wochenschr 2016; 141:1243. [PMID: 27557072 DOI: 10.1055/s-0041-108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 39-year-old male refugee from Gambia is admitted to the emergency room with fever, body aches and productive cough. INVESTIGATIONS Laboratory, ultrasound and CT investigations show a sepsis due to Staphylcoccus aureus, a renal failure with the appearance of "snow-white" kidneys on ultrasound and a previously unknown acute HIV-infection. DIAGNOSIS, TREATMENT AND COURSE Broad antibiotic treatment and an antiretroviral therapy (adapted to the impaired renal function) as well as hemodialysis are commenced. Despite of successful sepsis treatment and viral load reduction, the kidney function does not recover. Histologically, a HIV-nephropathy is confirmed. CONCLUSIONS The appearance of "snow-white" kidneys on ultrasound can be a characteristic sign of a HIV-associated nephropathy.
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Baumann L, Haen S, Berg C, Artunc F, Riessen R, Spengler W, Fend F, Haap M. [An unexpected cause of pulmonary hypertension]. Dtsch Med Wochenschr 2016; 141:1102. [PMID: 27464283 DOI: 10.1055/s-0041-109874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND ADMISSION FINDINGS We report on a 48-year-old man presenting with progressive hepatopathy and encephalopathy for two weeks based on a chronic hepatitis C. He takes ledipasvir and sofosbuvir (Harvoni) and ribavirin for almost 24 weeks. After admission to hospital his state deteriorated rapidly. He is directly transferred to the medical intensive care unit, where he died on day 3. INVESTIGATIONS During the physical examination, a pronounced jaundice and significant peripheral edema were found. Laboratory tests showed anemia, an increased C-reactive proteine and bilirubin, a limited coagulation and renal insufficiency with elevated creatinine. Quantitative HCV-PCR was negative. Echocardiographically a severe tricuspid- and mitral-valve regurgitation was found in a massively increased pulmonary artery pressure and pulmonary heart disease. The gastroscopy revealed a Forrest IIb situation with corresponding clip supply. DIAGNOSIS, TREATMENT AND COURSE In the autopsy we find signs of portal hypertension in presence of progressive liver cirrhosis. In addition, portopulmonary hypertension is diagnosed. The patient died on right ventricular failure resulting from a massively increased pulmonary pressure Conclusion: Advanced liver disease and an increased pulmonary pressure are often associated. Therefore, an early as possible diagnosis and classification are essential for adequate therapy in these patients.
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Bocksch W, Grossmann B, Geisler T, Steeg M, Droppa M, Jorbenadze R, Haap M, Gawaz M, Fateh-Moghadam S. Clinical outcome and paravalvular leakage of the new balloon-expandable Edwards Sapien 3 valve in comparison to its predecessor model (Edwards Sapien XT) in patients undergoing transfemoral aortic valve replacement. Catheter Cardiovasc Interv 2016; 88:466-75. [DOI: 10.1002/ccd.26562] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 03/28/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Wolfgang Bocksch
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Benita Grossmann
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Tobias Geisler
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Martin Steeg
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Michal Droppa
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Rezo Jorbenadze
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Michael Haap
- Department of Medicine IV; Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Meinrad Gawaz
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
| | - Suzanne Fateh-Moghadam
- Department of Medicine III (Cardiovascular Disease); Eberhard-Karls-Universitaet Tuebingen; Germany
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Haap M. Infektiologie: Tragen Fluorchinolone zu Aortenaneurysmen bei? Dtsch Med Wochenschr 2016; 141:311. [DOI: 10.1055/s-0041-110222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kloth C, Horger M, Bösmüller H, Haap M, Ioanoviciu SD. [Benign and malignant disorders of the jaw]. ROFO-FORTSCHR RONTG 2015; 188:1-6. [PMID: 26695844 DOI: 10.1055/s-0041-105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Riessen R, Behmenburg M, Blumenstock G, Guenon D, Enkel S, Schäfer R, Haap M. A Simple "Blood-Saving Bundle" Reduces Diagnostic Blood Loss and the Transfusion Rate in Mechanically Ventilated Patients. PLoS One 2015; 10:e0138879. [PMID: 26421920 PMCID: PMC4589283 DOI: 10.1371/journal.pone.0138879] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 09/04/2015] [Indexed: 01/28/2023] Open
Abstract
Introduction Aim of this study was to reduce blood loss caused by diagnostic blood sampling and to minimize the development of anemia in a high-risk group of mechanically ventilated medical intensive care patients. We therefore implemented a “blood-saving bundle” (BSB) combining a closed-loop arterial blood sampling system, smaller sampling tubes, reduced frequency of blood drawings, and reduced sample numbers. Methods The study included all patients from our medical ICU who were ventilated for more than 72 hours. Exclusion criteria were: acute or chronic anemia on admission, bleeding episode(s) during the ICU stay, or end-of-life therapy. The BSB was introduced in 2009 with training and educational support. Patients treated in 2008, before the introduction of the BSB, served as a control group (n = 41, 617 observation days), and were compared with patients treated in 2010 after the introduction of the BSB (BSB group, n = 50, 559 observation days). Primary endpoints were blood loss per day, and development of anemia. Secondary endpoints were numbers of blood transfusions, number of days on mechanical ventilation, and length of the ICU stay. Results Mean blood loss per ICU day was decreased from 43.3 ml (95% CI: 41.2 to 45.3 ml) in the controls to 15.0 ml (14.3 to 15.7 ml) in the BSB group (P < 0.001). The introduction of a closed-loop arterial blood sampling system was the major contributor to this effect. Mean hemoglobin concentrations showed no significant differences in both groups during the ICU stay. Hemoglobin values <9 g/dl, however, were recorded in 21.2% of observation days in the controls versus 15.4% in the BSB group (P = 0.01). Units of transfused red blood cells per 100 observation days decreased from 7 to 2.3 (P < 0.001). The mean number of ventilation days was 7.1 days (6.1 to 8.3 days) in the controls and 7.5 days (6.6 to 8.5 days) in the BSB group (P = NS). In total, patients in the BSB group stayed in ICU for a mean of 9.9 days (8.6 to 11.3 days), compared to a mean ICU stay of 13.0 days (10.9 to 15.4 days) in the control group (P = 0.014). Due to the longitudinal study design, however, we cannot exclude uncontrolled confounders affecting the transfusion frequency and mean ICU stay. Conclusion Our BSB could be easily implemented and was able to reduce diagnostic blood loss.
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Affiliation(s)
- Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
- * E-mail:
| | - Melanie Behmenburg
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Doris Guenon
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Sigrid Enkel
- Clinical Transfusion Medicine, University of Tübingen, Tübingen, Germany
| | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen GmbH, Johann-Wolfgang-Goethe-University Hospital, Frankfurt/Main, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany
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Kloth C, Horger M, Haap M, Ioanoviciu S, Bösmüller H. Imaging guided differentiation of parotid tumors – Bildgebende Differenzierung von Parotistumoren. ROFO-FORTSCHR RONTG 2015; 187:735-40. [DOI: 10.1055/s-0035-1552191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Haap M, Neumayer B, Kopp HG, Peter S, Haen S, Riessen R, Artunc F, Fend F, Kanz L, Müller MR. [Pulmonary infection in neutropenia]. Dtsch Med Wochenschr 2015; 140:426-7. [PMID: 25774734 DOI: 10.1055/s-0041-100947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED MEDICAL HISTORY AND CLINICAL COURSE: A 42-year-old patient with hairy cell leukemia had been treated for 3 years by a hematologist in private practice. Initially the patient received 1 course of cladribine upon which the disease went into complete remission. 6 weeks ago a relapse was diagnosed and combination therapy with cladibrin and rituximab was initiated. Now the patient presented to the emergency room with shortness of breath and pain when breathing. INVESTIGATIONS, TREATMENT AND COURSE In the chest x-ray, patchy infiltrates and pleural effusions were found on both sides. The subsequently performed computed tomography showed bilateral compactions with an Halo suspicious for fungal infiltrates. Upon admission to the hospital, an empirical antibiotic therapy with clarithromycin and piperacillin/tazobactam was initiated, which was later escalated to meropenem and linezolid. Additionally, an antifungal therapy with voriconazole was started and later switched to liposomal amphotericin B. At his admission, a positive aspergillus antigen could be detected in the microbiological laboratory. Under antimycotic treatment the aspergillus antigen was repeatedly negative. The patient presented with pronounced cytopenias and after a switch of therapy to vemurafenib and filgrastim, the hematopoiesis could only be stimulated insufficiently. The patient was transferred to the intensive care unit three days after admission with severe respiratory failure. He died on day 8 after admission. AUTOPSY AND DIAGNOSIS: Diagnosis was consistent with relapse of hairy cell leukemia with positive BRAF mutation and a bone marrow infiltration > 80 %. Autopsy revealed a significant hepato-splenomegaly, a lack of erythro-, granulo- and thrombopoiesis. Clots interspersed with fungal hyphae were found in both lungs and an infarction of the spleen with evidence of fungal hyphae was detected. The cultural findings post mortem on yeast or mold were negative. CONCLUSION Patients with refractory hairy cell leukemia and prolonged neutropenia are at increased risk for systemic fungal infections. Therefore, prohylactic antimycotic therapy should be considered early in this group of patients. The therapeutic approach of vemurafenib in treatment-refractory hairy cell leukemia is promising and offers an additional treatment option. In the present case, the patient could unfortunately not be stabilized due to the septic complications.
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Affiliation(s)
- M Haap
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - B Neumayer
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - H-G Kopp
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - S Peter
- Abteilung für Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmonologie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - S Haen
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - R Riessen
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - F Artunc
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - F Fend
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - L Kanz
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - M R Müller
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
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Wurster T, Riessen R, Haap M. Akutes Aortensyndrom. Dtsch Med Wochenschr 2015. [DOI: 10.1055/s-0041-100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Thomas Wurster
- Medizinische Klinik III (Kardiologie), Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
| | - Reimer Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
| | - Michael Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
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Wurster T, Riessen R, Haap M. [Acute aortic syndrome]. Dtsch Med Wochenschr 2015; 140:104-9. [PMID: 25612282 DOI: 10.1055/s-0040-100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU), in which the latter may progress to AD. Suddenly emerging severe pain localized in the chest, back or the abdomen is rather characteristic for acute AD, but painless courses of the disease are also possible. Rapid diagnosis and treatment are crucial for prognosis and survival. Aortic contrast-enhanced computed tomography is the method of choice due to its broad availability, distinguished accuracy and rapid feasibility. In instable patients, transoesophagel echocardiography by an experienced examiner is also applicable. Patients suffering from Type A AD need urgent surgery in most cases, patients.
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Affiliation(s)
- Thomas Wurster
- Medizinische Klinik III (Kardiologie), Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
| | - Reimer Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
| | - Michael Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, Eberhard-Karls Universität Tübingen
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Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R. Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol 2014; 14:66. [PMID: 25110463 PMCID: PMC4126617 DOI: 10.1186/1471-2253-14-66] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 07/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask. Methods Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6–8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment. Results PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV. Conclusions In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients. Trial registration German clinical trials register: DRKS00005132.
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Affiliation(s)
- Norbert Schwabbauer
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Björn Berg
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
| | - Jürgen Hetzel
- Department of Internal Medicine, Division of Pulmonary Medicine, University of Tübingen, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany
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Baumann D, Haap M, Tsaousidis C, Krämer B, Schreieck J, Jaschonek K, Rettig I, Peter A, Wallwiener D, Artunc F. [Vaginal bleeding as symptom of a medical emergency--pitfalls of therapy with new oral anticoagulants - case 5/2014]. Dtsch Med Wochenschr 2014; 139:1539. [PMID: 25072863 DOI: 10.1055/s-0034-1370191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 90-year-old female patient treated with dabigatran for atrial fibrillation presented emergently with a spontaneous vaginal bleeding due to endometrium carcinoma. INVESTIGATIONS Laboratory analysis revealed azotemia consistent with acute-on-chronic renal failure. Coagulation was deranged (prolongation of activated partial thromboplastin time (aPTT) by 3.5-fold, international normalized ratio (INR) 7.8) due to a massive accumulation of dabigatran (measured plasma concentration 2230 ng/ml). DIAGNOSIS, TREATMENT AND COURSE Vaginal bleedings were treated with external tamponade. Hemodialysis treatment was commenced due to uremia and dabigatran accumulation. Over night, the patient was dialysed with a SLED (sustained low efficiency dialysis) regimen. After volume resuscitation renal function promptly ensued indicating prerenal azotemia as a cause of renal failure. After two more hemodialysis sessions dabigatran concentrations were no longer detecable and this was paralleled by normalization of coagulation tests. CONCLUSIONS Dabigatran can accumulate massively during acute renal failure and evoke a life-threatening bleeding diathesis. Dabigatran can be removed with low efficient dialysis (such as SLED).
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Affiliation(s)
| | - Michael Haap
- Medizinische Klinik, Universitätsklinikum Tübingen
| | | | | | | | | | - Ingo Rettig
- Medizinische Klinik, Universitätsklinikum Tübingen
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Federmann B, Lauer UM, Haen S, Kilias A, Artunc F, Riessen R, Fend F, Haap M. [An unexpected cause of progressive hepatopathy - Case 2/2014]. Dtsch Med Wochenschr 2014; 139:378. [PMID: 24519115 DOI: 10.1055/s-0033-1360047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- B Federmann
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - U M Lauer
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - S Haen
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - A Kilias
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - F Artunc
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - R Riessen
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - F Fend
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - M Haap
- Medizinische Klinik, Universitätsklinikum Tübingen
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Artunc F, Brechtel K, Kattner B, Celebi N, Bunz H, Jorbenadze R, Lutz S, Weyrich P, Haap M. Nierenversagen und wiederholte Episoden eines blitzartig auftretenden Lungenödems bei einer 70-jährigen Patientin - Fall 5/2013. Dtsch Med Wochenschr 2013; 138:1410. [DOI: 10.1055/s-0033-1343266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F. Artunc
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - K. Brechtel
- Radiologische Klinik, Universitätsklinikum Tübingen
| | - B. Kattner
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - N. Celebi
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - H. Bunz
- Medizinische Klinik, Universitätsklinikum Tübingen
| | | | - S. Lutz
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - P. Weyrich
- Medizinische Klinik, Universitätsklinikum Tübingen
| | - M. Haap
- Medizinische Klinik, Universitätsklinikum Tübingen
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Riessen R, Bantlin C, Wiesing U, Haap M. Therapiezieländerungen auf einer internistischen Intensivstation. Med Klin Intensivmed Notfmed 2013; 108:412-8. [DOI: 10.1007/s00063-013-0233-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/23/2013] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
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Wurster T, Stellos K, Haap M, Seizer P, Geisler T, Otton J, Indermuehle A, Ishida M, Schuster A, Nagel E, Gawaz M, Bigalke B. Platelet expression of stromal-cell-derived factor-1 (SDF-1): An indicator for ACS? Int J Cardiol 2013; 164:111-5. [DOI: 10.1016/j.ijcard.2011.06.082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/17/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
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Heyne N, Guthoff M, Krieger J, Haap M, Häring HU. High cut-off renal replacement therapy for removal of myoglobin in severe rhabdomyolysis and acute kidney injury: a case series. Nephron Clin Pract 2013; 121:c159-64. [PMID: 23327834 DOI: 10.1159/000343564] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Rhabdomyolysis is associated with the release of myoglobin into the circulation, promoting acute kidney injury (AKI). In severe rhabdomyolysis, dialysis-dependent AKI doubles mortality. Standard blood purification techniques have limited efficacy in removing myoglobin. We describe high cut-off (HCO) renal replacement therapy (RRT) as a novel approach for extracorporeal elimination of myoglobin in rhabdomyolysis-associated AKI. METHODS With an in vivo molecular cut-off at 45 kDa, HCO filters are effective in removing myoglobin (17.8 kDa). Clearances across standard and HCO filters using continuous or intermittent RRT are reviewed in a case series of 11 patients with severe rhabdomyolysis and dialysis-dependent AKI. RESULTS Median myoglobin clearance across standard high-flux filters was 3.3 (interquartile range 2.3-3.9) ml/min for sustained low-efficiency daily dialysis (SLEDD) batch hemodialysis (HD) and 3.7 (2.9-6.7) ml/min for conventional HD. Respective clearances using HCO filters (membrane surface area: 1.1 m(2)) were 21.7 (20.3-26.1) ml/min (SLEDD) and 44.2 (41.3-47.0) ml/min (HD). Corrected for filter size, up to 20-fold higher clearances were obtained using HCO filters, resulting in profound and sustained reduction of plasma myoglobin concentration. CONCLUSIONS As a novel approach, HCO RRT allows for rapid and effective removal of myoglobin from the circulation. In light of the pathogenic role in AKI, reducing exposure of the kidney to myoglobin may improve renal recovery and patient outcome. Our data pave the way for prospective trials, addressing this issue.
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Affiliation(s)
- Nils Heyne
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
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Abstract
A hypercalcemic crisis is a life-threatening disease with multiorgan failure due to severe hypercalcemia. If left untreated, a hypercalcemic crisis is associated with a very high mortality and requires immediate diagnostic and therapeutic interventions. Especially a rapid rise to high calcium levels impairs the function of several organ systems and leads to central nervous, renal, cardiovascular and gastrointestinal symptoms. A hypercalcemic crisis is caused in more than 90 % by malignancy or primary hyperparathyreoidism and only in very rare cases by other diseases such as granulomatous diseases or other endocrinological diseases. Causal therapeutic options include an adequate treatment of malignancy and a surgical resection of the adenomatous tissue in primary hyperparathyreoidism. In addition, an adequate supportive therapy to lower calcium levels should be initiated as soon as possible. Rehydration with normal saline is the mainstay of therapy. Additional pharmacological therapies include biphosphonates, loop diuretics, calcitonin, steroids and calcimimetics. Besides classic hemodialysis continous renal replacement therapy with citrate anticoagulation is new therapeutical approach that can be used for the acute reduction of elevated serum calcium levels.
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Affiliation(s)
- M Haap
- Medizinische Universitätsklinik Tübingen, Internistische Intensivstation, Eberhard-Karls-Universität Tübingen.
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Riessen R, Pech R, Tränkle P, Blumenstock G, Haap M. Comparison of the RAMSAY score and the Richmond Agitation Sedation Score for the measurement of sedation depth. Crit Care 2012. [PMCID: PMC3363744 DOI: 10.1186/cc10933] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Riessen R, Tränkle P, Pech R, Blumenstock G, Haap M. Implementation of a national guideline for analgesia and sedation: how often can a RASS of 0 to -2 be achieved? Crit Care 2012. [PMCID: PMC3363743 DOI: 10.1186/cc10932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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