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Jerschke E, Barkovsky M, Jung N, Neuberger H, Stenzel J, Eyer F, Skerra A, Geith S. In vivo Neutralization of Colchicine Toxicity by a PASylated Anticalin in a Rat Model. Toxicology 2023; 492:153526. [PMID: 37116682 DOI: 10.1016/j.tox.2023.153526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 04/30/2023]
Abstract
We have investigated the pharmacokinetics (PK) and in vivo activity of an Anticalin exhibiting picomolar affinity towards colchicine, a plant toxin with low tolerable dose in humans. PK analysis of the 20-kDa "Colchicalin" protein in male Sprague Dawley rats (n=3) revealed a very short plasma half-life (3.5min), which was prolonged 21-fold via genetic fusion with a 200-residue Pro/Ala sequence (PASylation). The scavenging activity of the PASylated Colchicalin was investigated over 3.5h via stoichiometric application following a sub-toxic i.v. dose of colchicine on anesthetized rats (n=2) leading to a rapid rise in total plasma colchicine concentration. We then established a 14-day intoxication model in rats (n=3) at a 30mg/kg p.o. colchicine dose which was characterized by severe weight loss, elevated neutrophil-to-lymphocyte ratio and shortened survival. Colchicalin administration at 4.2% of the neutralizing dose (125mg/kg/day daily for 12 consecutive days) resulted in faster relief of the symptoms in 2/3 of animals (n=6) compared to the control group without Colchicalin treatment (n=5). Nevertheless, 1/3 of the rats died suddenly after the first Colchicalin injection, probably due to a steep rise in the total colchicine plasma concentration, which suggests further improvement of the dosing scheme prior to potential application in acute human colchicine poisoning.
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Affiliation(s)
- Elena Jerschke
- Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising, Germany
| | - Mikhail Barkovsky
- Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising, Germany
| | - Nicole Jung
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Heidi Neuberger
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Arne Skerra
- Lehrstuhl für Biologische Chemie, Technische Universität München, 85354 Freising, Germany.
| | - Stefanie Geith
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.
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Schmoll S, Heier EC, Böll R, Zellner T, Romanek K, Eyer F, Rabe C, Geith S. Independent validation of the Tanta University Risk Model for intensive care requirement in acutely poisoned adults. Clin Toxicol (Phila) 2023; 61:266-269. [PMID: 37129221 DOI: 10.1080/15563650.2023.2188142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To independently validate the predictive value of the Tanta University Risk Model for intensive care requirement in unselected poisoned patients. METHOD Retrospective chart review of 293 poisoned patients. The Tanta University Risk Model was calculated as follows: Tanta University Risk Model = -1.966*Glasgow Coma Scale - 0.329*oxygen saturation - 0.212*diastolic blood pressure + 0.27*respiratory rate - 0.33*standard bicarbonate. It was then compared to a composite endpoint indicating an intensive care unit requirement (death in hospital, vasopressors, need for intubation). RESULTS Nineteen of 293 patients had a complicated clinical course as defined by meeting the primary endpoint definition. Receiver operating characteristic analysis revealed the area under the curve to be 0.79 (95% confidence interval 0.73-0.83). A positive Tanta University Risk Model was defined >-73.46. Fifteen out of 84 patients with a positive Tanta University Risk Model had a complicated course, while four of 209 patients with a negative Tanta University risk model had a complicated course (P<0.0001, Fisher's exact test). The negative predictive value of the Tanta University Risk Model was 0.98 (95% confidence interval 0.95-0.99), the sensitivity was 0.79 and that specificity was 0.75. CONCLUSION Poisoned patients with a negative Tanta University Risk Model score are unlikely to need an intensive care unit level of care.
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Affiliation(s)
- Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eva-Carina Heier
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Regina Böll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Zellner
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Zellner T, Romanek K, Rabe C, Schmoll S, Geith S, Heier EC, Stich R, Burwinkel H, Keicher M, Bani-Harouni D, Navab N, Ahmadi SA, Eyer F. ToxNet: an artificial intelligence designed for decision support for toxin prediction. Clin Toxicol (Phila) 2023; 61:56-63. [PMID: 36373611 DOI: 10.1080/15563650.2022.2144345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artificial intelligences (AIs) are emerging in the field of medical informatics in many areas. They are mostly used for diagnosis support in medical imaging but have potential uses in many other fields of medicine where large datasets are available. AIM To develop an artificial intelligence (AI) "ToxNet", a machine-learning based computer-aided diagnosis (CADx) system, which aims to predict poisons based on patient's symptoms and metadata from our Poison Control Center (PCC) data. To prove its accuracy and compare it against medical doctors (MDs). METHODS The CADx system was developed and trained using data from 781,278 calls recorded in our PCC database from 2001 to 2019. All cases were mono-intoxications. Patient symptoms and meta-information (e.g., age group, sex, etiology, toxin point of entry, weekday, etc.) were provided. In the pilot phase, the AI was trained on 10 substances, the AI's prediction was compared to naïve matching, literature matching, a multi-layer perceptron (MLP), and the graph attention network (GAT). The trained AI's accuracy was then compared to 10 medical doctors in an individual and in an identical dataset. The dataset was then expanded to 28 substances and the predictions and comparisons repeated. RESULTS In the pilot, the prediction performance in a set of 8995 patients with 10 substances was 0.66 ± 0.01 (F1 micro score). Our CADx system was significantly superior to naïve matching, literature matching, MLP, and GAT (p < 0.005). It outperformed our physicians experienced in clinical toxicology in the individual and identical dataset. In the extended dataset, our CADx system was able to predict the correct toxin in a set of 36,033 patients with 28 substances with an overall performance of 0.27 ± 0.01 (F1 micro score), also significantly superior to naïve matching, literature matching, MLP, and GAT. It also outperformed our MDs. CONCLUSION Our AI trained on a large PCC database works well for poison prediction in these experiments. With further research, it might become a valuable aid for physicians in predicting unknown substances and might be the first step into AI use in PCCs.
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Affiliation(s)
- Tobias Zellner
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Eva-Carina Heier
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Raphael Stich
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Hendrik Burwinkel
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - Matthias Keicher
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - David Bani-Harouni
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, TUM Department of Informatics, Technical University of Munich, Garching, Germany
| | | | - Florian Eyer
- Division of Clinical Toxicology, Department of Internal Medicine II, Poison Control Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Lumpe M, Schurr J, Rabe C, Ott A, Zellner T, Rentrop M, Eyer F, Geith S. Socio-demographic and psychiatric profile of patients hospitalized due to self-poisoning with suicidal intention. Ann Gen Psychiatry 2022; 21:16. [PMID: 35681219 PMCID: PMC9185897 DOI: 10.1186/s12991-022-00393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To identify the psychiatric profile of patients hospitalized due to self-intoxication associated with suicide-related behavior (SRB). METHODS In this retrospective single-center study, records of consecutive patients treated for suicidal poisoning in our Clinical Toxicology unit between 1st January 2012 and 31st December 2016, who received at least one psychiatric exploration during their inpatient stay, were analyzed with regard to epidemiological data, ingested substances, psychiatric and somatic comorbidities, suicidal circumstances and follow-up therapy. RESULTS Out of 1289 hospitalized patients, 1090 patients with complete data were analyzed. Mean age was 40.5 ± 17.2 years, 66.7% were female. 32.0% of patients had previously engaged in SRB, in 76.3% intention was suicidal. 64.7% of patients had a pre-existing psychiatric disorder (PD). Patients with a pre-existing PD more often displayed prior SRB than those without PD (40.7% vs 15.3%; p < 0.001; Fisher's exact test), used long-term/on demand medication (70.2% vs 38.9%; p < 0.001), distanced themselves from the current suicide attempt (65.9% vs 50.8%; p < 0.001) and had no detectable trigger (38.7% vs 18.1%; p < 0.001). Partnership conflict was the most commonly named trigger, and it was documented more often in patients without than in those with PD (41.6% vs 25.6%). After psychiatric reevaluation, most patients were diagnosed with mood disorders (29.7%) and stress disorders (17.0%); 32.8% of patients had a combination of two or more PDs. CONCLUSION Hospitalization due to self-poisoning is associated with pre-existing PD, prior SRB and access to psychiatric medication. Detection of these risk factors could allow timely introduction of effective preventive measures tailored to particularly vulnerable subgroups and appropriate relief. However, lack of a detectable trigger in many cases may hamper the identification of those at risk.
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Affiliation(s)
- Maja Lumpe
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Christian Rabe
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Tobias Zellner
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Rentrop
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,kbo-Inn-Salzach Clinic, Wasserburg am Inn, Germany
| | - Florian Eyer
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany.
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Geith S, Ganzert M, Schmoll S, Acquarone D, Deters M, Sauer O, Stürer A, Tutdibi E, Wagner R, Eyer F. Erratum: Deutschlandweites Vergiftungsspektrum im Kindes- und
Jugendalter. Klin Padiatr 2022. [DOI: 10.1055/a-1790-4559] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stefanie Geith
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum
rechts der Isar, Technische Universität München
| | - Martin Ganzert
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum
rechts der Isar, Technische Universität München
| | - Sabrina Schmoll
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum
rechts der Isar, Technische Universität München
| | - Daniela Acquarone
- Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Giftnotruf
der Charité, Berlin
| | - Michael Deters
- Gemeinsames Giftinformationszentrum der Länder Mecklenburg-Vorpommern,
Sachsen, Sachsen-Anhalt und Thüringen c/o HELIOS Klinikum Erfurt,
Erfurt
| | - Oliver Sauer
- Giftinformationszentrum der Länder Rheinland-Pfalz und Hessen –
Klinische Toxikologie, Universitätsmedizin Mainz
| | - Andreas Stürer
- Giftinformationszentrum der Länder Rheinland-Pfalz und Hessen –
Klinische Toxikologie, Universitätsmedizin Mainz
| | - Erol Tutdibi
- Informations- und Behandlungszentrum für Vergiftungen des Saarlandes,
Universitätsklinikum und Medizinische Fakultät der Universität des Saarlandes,
Homburg
| | - Rafael Wagner
- Zentrum 5 Pharmakologie und Toxikologie, Giftinformationszentrum,
Georg-August-Universität Gottingen Universitätsmedizin, Göttingen
| | - Florian Eyer
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum
rechts der Isar, Technische Universität München
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Noseda R, Schmid Y, Scholz I, Liakoni E, Liechti ME, Dargan PI, Wood DM, Dines AM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Ceschi A, Anand L, Anseeuw K, Badaras R, Bonnici J, Brvar M, Burke R, Caganova B, Eyer F, Galicia M, Geith S, Gillebeert J, Grenc D, Gorozia K, Jaffal K, Jürgens G, Konstari J, Kutubidze S, Laubner G, Liguts V, Lyphout C, Mégarbane B, Miró Ò, Moughty A, O'Connor N, Paasma R, Perez JO, Perminas M, Persett PS, Põld K, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Sopirala R, Stašinskis R, Surkus J, Toth I, Vallersnes OM, Vigorita F, Waldman W, Waring WS, Zacharov S. MDMA-related presentations to the emergency departments of the European Drug Emergencies Network plus (Euro-DEN Plus) over the four-year period 2014–2017. Clin Toxicol (Phila) 2020; 59:131-137. [DOI: 10.1080/15563650.2020.1784914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Yasmin Schmid
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Irene Scholz
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Matthias E. Liechti
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Alison M. Dines
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Bodo, Norway
| | - Knut E. Hovda
- The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Lukasz Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Poland
| | - Kurt Anseeuw
- Department of Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
| | | | | | - Miran Brvar
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rachel Burke
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland
| | - Blazena Caganova
- National Toxicological Information Centre, University Hospital, Bratislava, Slovakia
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | | | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Johan Gillebeert
- Department of Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
| | - Damjan Grenc
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ketevan Gorozia
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Lariboisiere Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Gesche Jürgens
- Zealand University Hospital Roskilde, Clinical Pharmacology Unit, Roskilde, Denmark
| | | | - Soso Kutubidze
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - Gabija Laubner
- Republic Vilnius University Hospital, Vilnius, Lithuania
| | | | | | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisiere Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Òscar Miró
- Emergency Department, Hospital Clınic, University of Barcelona, Catalonia, Spain
| | - Adrian Moughty
- Emergency Department, Mater Misericordiae University Hospital, Dublin 7, Republic of Ireland
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | | | - Juan Ortega Perez
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | - Marius Perminas
- Hospital of Lithuanian University of Health Sciences (LSMU), Kauno klinikos, Kaunus, Lithuania
| | - Per Sverre Persett
- Department of Acute Medicine, Medical Division, Oslo University Hospital, Norway
| | - Kristiina Põld
- Emergency Medicine Department, North-Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Puiguriguer
- Clinical Toxicology Unit, Emergency Department, Hospital Son Espases, Palma de Mallorca, Balearic Island, Spain
| | | | - Jan Rulisek
- Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic
| | - Radhika Sopirala
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, County Louth, Republic of Ireland
| | | | - Jonas Surkus
- Hospital of Lithuanian University of Health Sciences (LSMU), Kauno klinikos, Kaunus, Lithuania
| | | | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | | | - Wojciech Waldman
- Department of Clinical Toxicology, Medical University of Gdansk, Poland
- Pomeranian Centre of Toxicology, Gdansk, Poland
| | - W. Stephen Waring
- Acute Medical Unit, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sergej Zacharov
- Toxicological Information Centre, Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Na Bojisti 1, 120 00 Prague 2, Czech Republic
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Wolfe CE, Wood DM, Dines A, Whatley BP, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI, Anseeuw K, Badaras R, Bonnici J, Brvar M, Caganova B, Ceschi A, Eyer F, Galicia M, Geith S, Gillebeert J, Grenc D, Gorozia K, Jaffal K, Jürgens G, Kabata PM, Kennedy I, Konstari J, Kutubidze S, Laubner G, Liakoni E, Liechti ME, Lyphout C, Mégarbane B, Miró Ò, Moughty A, Müller L, O'Connor N, Paasma R, Perez JO, Perminas M, Persett PS, Põld K, Puiguriguer J, Radenkova-Saeva J, Rulisek J, Schmid Y, Scholz I, Sopirala R, Surkus J, Toth I, Vallersnes OM, Vigorita F, Waldman W, Waring WS, Zacharov S. Seizures as a complication of recreational drug use: Analysis of the Euro-DEN Plus data-set. Neurotoxicology 2019; 73:183-187. [DOI: 10.1016/j.neuro.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
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Geith S, Stecher L, Rabe C, Sack S, Eyer F. Sustained low efficiency dialysis should not be interrupted for performing transpulmonary thermodilution measurements. Ann Intensive Care 2018; 8:113. [PMID: 30470931 PMCID: PMC6251800 DOI: 10.1186/s13613-018-0455-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 11/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Treatment of multiple organ failure frequently requires enhanced hemodynamic monitoring. When renal replacement is indicated, it remains unclear whether transpulmonary thermodilution (TPTD) measurements are influenced by renal replacement therapy (RRT) and whether RRT should be paused for TPTD measurements. Our aim was therefore to investigate the effect of pausing RRT on TPTD results in two dialysis catheter locations. Materials and methods In total, 62 TPTD measurements in 24 patients (APACHE: 32 ± 7 [mean ± standard deviation (SD)]) were performed using the PiCCO™ system (Pulsion, Germany). Patients were treated with sustained low efficiency dialysis (SLED; Genius™ system, Fresenius, Germany) as RRT. Measurements were taken during ongoing hemodialysis (HD, HDO), during paused HD (HDP) and immediately after termination of HD and blood restitution (HDT). Dialysis catheters were placed either in the superior vena cava (SVC, 19 times) or in the inferior vena cava (IVC, 5 times). Statistical analysis was performed to assess the effects of the measurement setting, SLED (blood flow rate) and the catheter location, on cardiac index (CI), global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) as measured by TPTD. Multilevel models were used for the analysis due to the triplicate measurements and due to 12 out of 19 SVC and 2 out of 5 IVC patients having more than one TPTD measured. Results CI and GEDVI were significantly higher at time point HDP compared to both HDO and HDT. In contrast, values for EVLWI were lower at HDP when compared to HDO and HDT. These findings were independent of the site of dialysis catheter insertion and blood flow rate. Conclusions PiCCO™ measurements assessed at paused SLED significantly deviate from ongoing and terminated SLED. Therefore, the dialysis system should not be paused for measurements. TPTD measurements in patients with PiCCO monitoring seem sufficiently reliable during ongoing SLED as well as after its termination. An effect of dialysis catheter location (SVC vs IVC) and blood flow rate on PiCCO™ measurements could not be shown.
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Affiliation(s)
- Stefanie Geith
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Munich, Germany.
| | - Lynne Stecher
- Institute of Medical Informatics, Statistics, and Epidemiology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Sack
- Department of Cardiology, Pneumology and Intensive Care, Emergency Center for Internal Affairs, Academic General Hospital Munich - Hospital Schwabing, Munich, Germany
| | - Florian Eyer
- Division of Clinical Toxicology and Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Geith S, Walochnik J, Prantl F, Sack S, Eyer F. Lethal outcome of granulomatous acanthamoebic encephalitis in a man who was human immunodeficiency virus-positive: a case report. J Med Case Rep 2018; 12:201. [PMID: 29996943 PMCID: PMC6042392 DOI: 10.1186/s13256-018-1734-8] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/03/2018] [Indexed: 11/15/2022] Open
Abstract
Background Acanthamoeba species can cause disseminating infections in immunocompromised individuals. Case presentation Here, we report a case of granulomatous acanthamoebic encephalitis with a lethal outcome in a 54-year-old German man who was human immunodeficiency virus-positive. The diagnosis was based on symptoms of progressive neurological deficits, including sensorimotor paralysis of his right leg and deteriorating alertness. Due to the rapid course and rather late diagnosis of the infection, effective treatment could not be applied and he died 12 days after hospital admission. Conclusions To the best of our knowledge, this is the second case of granulomatous acanthamoebic encephalitis reported within Germany. Our case highlights the importance of early diagnosis of granulomatous acanthamoebic encephalitis to prevent fatal outcome.
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Affiliation(s)
- Stefanie Geith
- Division of Clinical Toxicology & Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Julia Walochnik
- Medical University of Vienna, Center for Pathophysiology, Infectiology and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Franz Prantl
- Institute of Pathology, Academic Clinic Munich-Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Stefan Sack
- Department of Cardiology, Pneumology and Internal Intensive Medicine, Academic Clinic Munich-Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Florian Eyer
- Division of Clinical Toxicology & Poison Control Centre Munich, Department of Internal Medicine II, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Geith S, Ganzert M, Schmoll S, Acquarone D, Deters M, Sauer O, Stürer A, Tutdibi E, Wagner R, Eyer F. Deutschlandweites Vergiftungsspektrum im Kindes- und Jugendalter. Klin Padiatr 2018; 230:205-214. [DOI: 10.1055/a-0594-9480] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Zusammenfassung
Hintergrund Vergiftungen verursachen bei Kindern den Großteil der Notfalleinsätze in Deutschland, die durch präventive Maßnahmen verhindert oder gemildert werden könnten. Daher ist für den Pädiater das Wissen um häufige Intoxikationen essentiell. Die vorliegende Arbeit zeigt allgemeine und epidemiologische Daten zu Vergiftungen sowie einen Überblick über die häufigsten einzelnen Noxen und -kategorien im Kindes- und Jugendalter.
Methoden Retrospektiv wurden Vergiftungsfälle bei Kindern und Jugendlichen aus 6 deutschen Giftnotrufzentralen (2012–2016 und 2002–2016) ausgewertet. Kategorielle Daten sind als Mittelwerte±Standardabweichung, häufigste Noxen nach Punkten angegeben.
Ergebnisse Die Anruferzahl insbesondere der Laien nahm ab 2002 deutlich zu. Zwei Drittel der Fälle traten bei Klein- und Vorschulkindern auf, häufiger bei Jungen (50%) als bei Mädchen (44%), bei Jugendlichen überwiegen weibliche Patienten (>60%). Im Alter<14 Jahre sind Intoxikationen auf Unfälle in Haushalt, Kindertagespflege oder Schulen zurückzuführen (>95%), bei Jugendlichen treten suizidale Intoxikationen und Abusus (13%) in den Vordergrund. 90% der Fälle verlaufen asymptomatisch oder leicht, wobei der Anteil der klinisch symptomatischen Fälle mit dem Alter zunimmt (Jugendliche 13% vs. Säuglinge 1%). Vergiftungen mit Medikamenten stellen bei Jugendlichen die häufigste Gruppe dar, bei Kindern tensidhaltige Reinigungsmittel und Kosmetika, Sanitärreinigungsmittel, Tabak, Knicklicht und Entkalker in Lösung.
Diskussion und Schlussfolgerung Stetig steigende Anruferzahlen von Fachpersonal und Laien veranschaulichen die Bedeutung der Giftnotrufzentralen. Obwohl Vergiftungen bei Kindern und Jugendlichen meist asymptomatisch oder mit leichten Symptomen verlaufen, darf die Relevanz präventiver Maßnahmen v. a. bei Kindern<7 Jahren nicht unterschätzt werden.
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Affiliation(s)
- Stefanie Geith
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum rechts der Isar, Technische Universität München
| | - Martin Ganzert
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum rechts der Isar, Technische Universität München
| | - Sabrina Schmoll
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum rechts der Isar, Technische Universität München
| | - Daniela Acquarone
- Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Giftnotruf der Charité, Berlin
| | - Michael Deters
- Gemeinsames Giftinformationszentrum der Länder Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt und Thüringen c/o HELIOS Klinikum Erfurt, Erfurt
| | - Oliver Sauer
- Giftinformationszentrum der Länder Rheinland-Pfalz und Hessen – Klinische Toxikologie, Universitätsmedizin Mainz
| | - Andreas Stürer
- Giftinformationszentrum der Länder Rheinland-Pfalz und Hessen – Klinische Toxikologie, Universitätsmedizin Mainz
| | - Erol Tutdibi
- Informations- und Behandlungszentrum für Vergiftungen des Saarlandes, Universitätsklinikum und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Rafael Wagner
- Zentrum 5 Pharmakologie und Toxikologie, Giftinformationszentrum, Georg-August-Universität Gottingen Universitätsmedizin, Göttingen
| | - Florian Eyer
- Abteilung für Klinische Toxikologie & Giftnotruf München, Klinikum rechts der Isar, Technische Universität München
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11
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Böll R, Romanek K, Schmoll S, Stich R, Ott A, Stenzel J, Geith S, Eyer F, Rabe C. Independent validation of the ICU requirement score in a cohort of acutely poisoned adults. Clin Toxicol (Phila) 2017; 56:664-666. [DOI: 10.1080/15563650.2017.1401635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Regina Böll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katrin Romanek
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Raphael Stich
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Armin Ott
- Institute of Medical Informatics, Statistics, and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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12
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Schmoll S, Romanek K, Stich R, Bekka E, Stenzel J, Geith S, Eyer F, Rabe C. An internet-based survey of 96 German-speaking users of "bath salts": frequent complications, risky sexual behavior, violence, and delinquency. Clin Toxicol (Phila) 2017; 56:219-222. [PMID: 28753045 DOI: 10.1080/15563650.2017.1353094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To define the demographics of German-speaking "bath salt" users. DESIGN Prospective web-based survey of volunteer users of "bath salts". Subject recruitment/exclusion: Participation was solicited by posts in web forums frequented by users of synthetic cathinones. An invitation to participate was also disseminated via regional drug information centers. Responses were discarded if participants refused data analysis, provided incomplete surveys, were under 18 years of age (five cases), and in case of clearly improbable answers (i.e., two cases with profanity typed in free-form input fields). Overall 96 out of 180 participants provided complete questionnaires. These were further analyzed. RESULTS AND CONCLUSIONS 74% of respondents were male. 41% were under the age of 30 and a further 38% between 30 and 39 years old. Cathinones were used on more than 10 days in the preceding year by 62% of study subjects. The nasal and intravenous routes of administration were most often used. About 80% of respondents reported binge use. There were frequent co-administrations of opioids and opiates. The most common complication was prolonged confusion (47%). 16% had been involuntarily confined. One third had thoughts of violence and 16% acted on these thoughts either against themselves or others. About 44% reported high-risk sexual activity under the influence of cathinones. About 31% had driven or ridden a bike while intoxicated. About 6% had problems with law-enforcement for selling cathinones and 16% for crimes committed under the influence of cathinones. In conclusion, cathinone users are typically young males in their twenties and thirties. Most are experienced drug users, particularly of alcohol and opiates/opioids. The impact on society is tremendous as evidenced by high rates of self-reported violence, high-risk sexual activity, crimes, and traffic violations.
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Affiliation(s)
- Sabrina Schmoll
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Katrin Romanek
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Raphael Stich
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Elias Bekka
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Jochen Stenzel
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Stefanie Geith
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Florian Eyer
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - Christian Rabe
- a Department of Clinical Toxicology, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
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13
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Romanek K, Stenzel J, Schmoll S, Schrettl V, Geith S, Eyer F, Rabe C. Synthetic cathinones in Southern Germany – characteristics of users, substance-patterns, co-ingestions, and complications. Clin Toxicol (Phila) 2017; 55:573-578. [DOI: 10.1080/15563650.2017.1301463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrin Romanek
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jochen Stenzel
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Verena Schrettl
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefanie Geith
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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14
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Ben Abdeljelil J, Saghrouni F, Nouri S, Geith S, Khammari I, Fathallah A, Sboui H, Ben Saïd M. Neonatal invasive candidiasis in Tunisian hospital: incidence, risk factors, distribution of species and antifungal susceptibility. Mycoses 2012; 55:493-500. [PMID: 22448706 DOI: 10.1111/j.1439-0507.2012.02189.x] [Citation(s) in RCA: 10] [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: 11/27/2022]
Abstract
The aim of our study was to assess epidemiological features of neonatal invasive candidiasis in Farhat Hached hospital of Sousse, Tunisia, including incidence, risk factors, mortality, species distribution and antifungal susceptibility. Laboratory data from 1995 to 2010 and medical records of 127 invasive candidiasis cases were reviewed. We tested the susceptibility of 100 Candida sp isolates by using ATB fungus(®) 3 and to fluconazole by using E-test(®) strips. A total of 252 cases of neonatal invasive candidiasis occurred over the study period. The incidence increased 1.8-fold from 1995 to 2006 and decreased fourfold from 2007 to 2010. Candida albicans was the predominant species up to 2006 and a shift in the species spectrum was observed with increase of the non-albicans species mainly C. parapsilosis. The agreement between the ATB Fungus(®) and the E-test(®) for determining fluconazole susceptibility was high. All tested isolates were susceptible to fluconazole, flucytosine, amphotéricine B and voriconazole and the itraconazole resistance rate was 5%. The mortality rate was 63%. The invasive candidiasis incidence increased from 1995 to 2006 and decreased from 2007 to 2010. The spectrum of Candida species and the lack of fluconazole-resistant strains argue for the usefulness of fluconazole as an empiric treatment.
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Affiliation(s)
- J Ben Abdeljelil
- Laboratoire de Parasitologie-Mycologie, Hôpital Farhat Hached, Sousse, Tunisia.
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15
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Sack S, Schelp MK, Poppe S, Weber M, Krüger T, Geith S, Lieber M, Schleger S, Eichinger W, Menne J. [Aortic valve stenosis: transcatheter aortic valve implantation (TAVI) – transarterial or transapical approach]. Dtsch Med Wochenschr 2011; 136:417-26; quiz 427-30. [PMID: 21344357 DOI: 10.1055/s-0031-1274524] [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: 10/18/2022]
Abstract
The calcified aortic stenosis is the dominating valve disease. Patients affected are most common elderly people in the 8 (th) or 9 (th) decade of their life who often show associated comorbidities like reduced left ventricular function, impaired renal function, pulmonary hypertension, and further diseases (Diabetes mellitus, stroke, COPD). In many cases perioperative morbidity and mortality are too high for surgical valve replacement and up to 30 % of patients are rejected. Nevertheless, prognosis of aortic stenosis is worse if the typical symptoms like dyspnea on exertion, syncope, and angina occur. The transcatheter aortic valve implantation is a new method treating this particular group of patients. The aortic valve bioprothesis consists of a balloon-expandable stent or a self-expandable frame, in which a valve of bovine or porcine pericardium is incorporated. The implantation is performed by retrograde access via the femoral or subclavian artery; the balloon-expandable prosthesis can also be implanted by transapical approach. Recently, the PARTNER trial and other studies demonstrate a high implantation success rate and better survival in comparison to standard therapy but exhibit also cerebral vascular and peripheral vascular complications. A further reduction of the available delivery systems and new types of valves which are under experimental tests and clinical evaluation contribute to this development.
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Affiliation(s)
- S Sack
- Klinik für Kardiologie, Pneumologie, Internistische Intensivmedizin und Zentrale Notaufnahme, Sektion Innere Medizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, München.
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Ott I, Andrassy M, Zieglgänsberger D, Geith S, Schömig A, Neumann FJ. Regulation of monocyte procoagulant activity in acute myocardial infarction: role of tissue factor and tissue factor pathway inhibitor-1. Blood 2001; 97:3721-6. [PMID: 11389008 DOI: 10.1182/blood.v97.12.3721] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In acute myocardial infarction (AMI), monocyte procoagulant activity is increased and may contribute to the risk for recurrence and other thrombotic events. This study sought to investigate the role tissue factor (TF) and tissue factor pathway inhibitor-1 (TFPI-1) in the regulation of monocyte procoagulant activity in AMI. Serial venous blood samples were obtained from 40 patients with AMI undergoing revascularization by stent placement. Twenty patients with elective stenting for stable angina served as control subjects. TF proteolytic activity was measured with spectrozyme factor Xa (FXa), TF and TFPI-1 surface expression on monocytes by flow cytometry, RNA expression in whole blood by reverse transcription-polymerase chain reaction, and concentrations of plasma prothrombin fragments F(1 + 2) by immunoassay. Forty-eight hours after AMI, an increase was found in TF RNA, followed by an increase in TF surface expression by 24% +/- 4% and in plasma concentration of F(1 + 2) by 103% +/- 17% (P <.05). These changes could not be attributed to the intervention because they did not occur in the control group. TFPI-1 RNA and binding to the monocyte surface remained unchanged. FXa generation by monocytes of patients with AMI increased 53.6% +/- 9% in the presence of polyclonal antibodies to TFPI-1, indicating that cell-associated TFPI-1 inhibits monocyte TF activity. The increased monocyte procoagulant activity in AMI was caused by an up-regulation of TF that was partially inhibited by surface-bound TFPI-1. Anticoagulant therapy by direct inhibition of TF activity may, thus, be particularly effective in AMI. (Blood. 2001;97:3721-3726)
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Affiliation(s)
- I Ott
- Deutsches Herzzentrum der Technischen Universität Munich, Lazarettstrasse 36, 80636 Munich, Germany.
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