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Viniol S, Thomas RP, Gombert S, König AM, Betz S, Mahnken AH. Comparison of different resuscitation methods with regard to injury patterns in cardiac arrest survivors based on computer tomography. Eur J Radiol 2020; 131:109244. [PMID: 32905956 DOI: 10.1016/j.ejrad.2020.109244] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To ensure that patients survive cardiac arrest, cardiopulmonary resuscitation (CPR) is needed. However, the procedure itself can lead to severe injuries. This study aims to examine both possibilities of resuscitation - mechanical or manual - with regard to their risk of injury. To this end, we compare the injuries patterns in both groups of patients after successful resuscitation based on computer tomography (CT). METHODS This single-centre retrospective study included 32 patients (female: 21.87 %, male: 78.12 %, Mean age: 60.22 ± 13.93 years) with cardiac arrest followed by successful mechanical CPR, who underwent an early whole-body CT. A control group of 32 patients (female: 21.87 %, male: 78.12 %, mean age: 60.75 ± 13.34 years) that had been resuscitated successfully with manual CPR was matched according to gender and age for a better statistical comparison. Patients with cardiac arrest due to trauma were excluded from the study population. RESULTS Mechanically resuscitated patients showed significantly more CPR-related injuries than those who were resuscitated manually (100 % vs. 84.37 %; p = 0.02). In particular, dislocated rib fractures (40.47 vs. 23.80 mean rank, p < 0.01), sternal fractures (74.19 % vs. 25 %; p < 0,01), bleeding complications (29.03 % vs. 3.12 %; p = 0.01), pneumothorax (38.71 % vs. 9.37 %; p = 0.01), mediastinal haematomas (58.01 % vs. 25 %, p = 0.01) and liver lacerations (29.03 % vs. 0 %, p = 0.04) were observed significantly more in patients after mechanical CPR compared to those with manual resuscitation. CONCLUSIONS The guideline-based use of mechanical CPR results in a significant increase of internal and musculoskeletal injuries compared to manual CPR.
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Affiliation(s)
- S Viniol
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany.
| | - R P Thomas
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - S Gombert
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - A M König
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - S Betz
- Department of Emergency Medicine, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - A H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
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Viniol S, Thomas RP, König AM, Betz S, Mahnken AH. Early whole-body CT for treatment guidance in patients with return of spontaneous circulation after cardiac arrest. Emerg Radiol 2019; 27:23-29. [PMID: 31468207 DOI: 10.1007/s10140-019-01723-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 06/11/2019] [Accepted: 08/22/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Non-traumatic cardiac arrest (CA) and return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) are often associated with multiple pathologies. Expecting a high prevalence of important findings, a whole-body CT (WBCT) could be of relevance for therapy. The aim of this study is to investigate the feasibility and diagnostic yield of an early WBCT in this setting. METHODS This single-center retrospective study included 100 consecutive patients (27 female; 73 male; mean age 68.5± 12.57 years) with non-traumatic, in- and out-of-hospital CA and ROSC following CPR, who underwent a contrast-enhanced WBCT within 6 h after ROSC over 12 months. CT findings were determined corresponding to anatomical region. RESULTS Early WBCT was successfully carried out in 100% of the patients with CA and ROSC after CPR. Acute pathologies were found not only in the chest but also in the head (15%) and the abdomen (6%). Early global brain edema (n = 12), acute stroke (n = 3), pulmonary embolism (n = 10), pneumothorax (26%), acute abdominal pathologies (n = 6), iatrogenic bleeding (4%), and CPR-related injuries (93%) were detected by CT right from the beginning of the post-cardiac arrest care. CONCLUSIONS An early WBCT is feasible and provides added diagnostic value for patients with ROSC after non-traumatic CA.
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Affiliation(s)
- S Viniol
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany.
| | - R P Thomas
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - A M König
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - S Betz
- Department of Emergency Medicine, Marburg University Hospital, Philipps-University, Marburg, Germany
| | - A H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Philipps-University, Marburg, Germany
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Del Rey A, Verdenhalven M, Lörwald AC, Meyer C, Hernangómez M, Randolf A, Roggero E, König AM, Heverhagen JT, Guaza C, Besedovsky HO. Brain-borne IL-1 adjusts glucoregulation and provides fuel support to astrocytes and neurons in an autocrine/paracrine manner. Mol Psychiatry 2016; 21:1309-20. [PMID: 26643538 DOI: 10.1038/mp.2015.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/26/2015] [Accepted: 09/29/2015] [Indexed: 12/13/2022]
Abstract
It is still controversial which mediators regulate energy provision to activated neural cells, as insulin does in peripheral tissues. Interleukin-1β (IL-1β) may mediate this effect as it can affect glucoregulation, it is overexpressed in the 'healthy' brain during increased neuronal activity, and it supports high-energy demanding processes such as long-term potentiation, memory and learning. Furthermore, the absence of sustained neuroendocrine and behavioral counterregulation suggests that brain glucose-sensing neurons do not perceive IL-1β-induced hypoglycemia. Here, we show that IL-1β adjusts glucoregulation by inducing its own production in the brain, and that IL-1β-induced hypoglycemia is myeloid differentiation primary response 88 protein (MyD88)-dependent and only partially counteracted by Kir6.2-mediated sensing signaling. Furthermore, we found that, opposite to insulin, IL-1β stimulates brain metabolism. This effect is absent in MyD88-deficient mice, which have neurobehavioral alterations associated to disorders in glucose homeostasis, as during several psychiatric diseases. IL-1β effects on brain metabolism are most likely maintained by IL-1β auto-induction and may reflect a compensatory increase in fuel supply to neural cells. We explore this possibility by directly blocking IL-1 receptors in neural cells. The results showed that, in an activity-dependent and paracrine/autocrine manner, endogenous IL-1 produced by neurons and astrocytes facilitates glucose uptake by these cells. This effect is exacerbated following glutamatergic stimulation and can be passively transferred between cell types. We conclude that the capacity of IL-1β to provide fuel to neural cells underlies its physiological effects on glucoregulation, synaptic plasticity, learning and memory. However, deregulation of IL-1β production could contribute to the alterations in brain glucose metabolism that are detected in several neurologic and psychiatric diseases.
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Affiliation(s)
- A Del Rey
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
| | - M Verdenhalven
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
| | - A C Lörwald
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
| | - C Meyer
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
| | - M Hernangómez
- Neuroimmunology Group, Functional and Systems Neurobiology Department, Instituto Cajal, CSIC, Madrid, Spain
| | - A Randolf
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
| | - E Roggero
- Instituto de Inmunologia, Facultad de Medicina, Universidad Nacional de Rosario and Universidad Abierta Interamericana, Rosario, Argentina
| | - A M König
- Centre of Imaging Research (ZebiF), University Institute of Diagnostic and Interventional Radiology, Marburg, Germany
| | - J T Heverhagen
- University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - C Guaza
- Neuroimmunology Group, Functional and Systems Neurobiology Department, Instituto Cajal, CSIC, Madrid, Spain
| | - H O Besedovsky
- Division of Immunophysiology, Department Neurophysiology, Institute of Physiology and Pathophysiology, Marburg, Germany
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Uzunoglu FG, Kolbe J, Wikman H, Güngör C, Bohn BA, Nentwich MF, Reeh M, König AM, Bockhorn M, Kutup A, Mann O, Izbicki JR, Vashist YK. VEGFR-2, CXCR-2 and PAR-1 germline polymorphisms as predictors of survival in pancreatic carcinoma. Ann Oncol 2013; 24:1282-90. [PMID: 23293110 DOI: 10.1093/annonc/mds634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Hypoxic environment of pancreatic cancer (PC) implicates high vascular in-growth, which may be influenced by angiogenesis-related germline polymorphisms. Our purpose was to evaluate polymorphisms of vascular endothelial growth factor receptor 2 (VEGFR-2), CXC chemokine receptor 2 (CXCR-2), proteinase-activated receptor 1 (PAR-1) and endostatin (ES) as prognostic markers for disease-free (DFS) and overall survival (OS) in PC. PATIENTS AND METHODS Genotyping of 173 patients, surgically treated for PC between 2004 and 2011, was carried out by TaqMan(®) genotyping assays or polymerase chain reaction. Chi-square test, Kaplan-Meier estimator and Cox regression hazard model were used to assess the prognostic value of selected polymorphisms. RESULTS VEGFR-2 -906 T/T and PAR-1 -506 Del/Del genotypes predicted longer DFS (P = 0.003, P = 0.014) and OS (VEGFR-2 -906, P = 0.011). CXCR-2 +1208 T/T genotype was a negative predictor for DFS (P < 0.0001). Combined analysis for DFS and OS indicated that patients with the fewest number of favorable genotypes simultaneously present (VEGFR-2 -906 T/T, CXCR-2 +1208 C/T or C/C and PAR-1 -506 Del/Del) were at the highest risk for recurrence or death (P < 0.0001). CONCLUSION VEGFR-2 -906 C>T, CXCR-2 +1208 C>T and PAR-1 -506 Ins/Del polymorphisms are potential predictors for survival in PC.
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Affiliation(s)
- F G Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany.
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König AM, Hofmann BT, Groth S, Izbicki JR. [Emergency interventions for perforation and bleeding in esophageal cancer patients]. Chirurg 2012; 83:719, 722-5. [PMID: 22878577 DOI: 10.1007/s00104-011-2266-6] [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: 11/24/2022]
Abstract
Bleeding and perforation in esophageal cancer patients are rare but associated with a high morbidity and mortality. Because of disappointing results after primary surgical exploration and resection endoscopic intervention was introduced as the primary treatment option with an improved outcome. Aortoesophageal and esophagobronchial fistulas may occur spontaneously or secondary to stenting of the esophagus. They are uncommon but fatal if untreated. The first option is prompt placement of a stent graft as a bridging solution followed by surgical treatment.
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Affiliation(s)
- A M König
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Deutschland.
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Bücking W, Du B, Turshatov A, König AM, Reviakine I, Bode B, Johannsmann D. Quartz crystal microbalance based on torsional piezoelectric resonators. Rev Sci Instrum 2007; 78:074903. [PMID: 17672786 DOI: 10.1063/1.2756740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A quartz crystal microbalance (QCM) is described, which is based on a torsional resonator, rather than a conventional thickness-shear resonator. Typical applications are measurements of film thickness in the coating industry and monitoring of biofouling. The torsional QCM is about a factor of 100 less sensitive than the conventional QCM. On the other hand, it can probe film thicknesses in the range of hundreds of microns, which is impossible with the conventional QCM due to viscoelastic artifacts. Data acquisition and data analysis proceed in analogy to the conventional QCM. An indicator of the material's softness can be extracted from the bandwidth of the resonance. Within the small-load approximation, the frequency shift is independent of whether the sample is applied to the face or to the side of the cylinder. Details of the geometry matter if the viscoelastic properties of the sample are of interest.
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Affiliation(s)
- W Bücking
- Institute of Physical Chemistry, Clausthal University of Technology, Arnold-Sommerfeld-Strasse 4, D-38678 Clausthal-Zellerfeld, Germany
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