1
|
Nadjiri J, Koppara T, Kafka A, Weis F, Rasper M, Gassert FG, von Schacky CE, Pfeiffer D, Laugwitz KL, Makowski MR, Ibrahim T. Coronary plaque characterization assessed by delayed enhancement dual-layer spectral CT angiography and optical coherence tomography. Int J Cardiovasc Imaging 2022; 38:2491-2500. [DOI: 10.1007/s10554-022-02638-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
|
2
|
Zimmermann GS, Palm J, Lahmann AL, Peltz F, Okrojek R, Weis F, Müller A, Ziegler T, Steger A, Haller B, Hoppmann P, Laugwitz KL, Hautmann H. Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis. J Clin Med 2021; 10:jcm10143055. [PMID: 34300221 PMCID: PMC8306153 DOI: 10.3390/jcm10143055] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients suffering from out-of-hospital cardiac arrest (OHCA) frequently receive a bronchoscopy after being admitted to the ICU. We investigated the optimal timing and the outcome in these patients. METHODS All patients who suffered from OHCA and were treated in our ICU from January 2013 to December 2018 were retrospectively analyzed. The data were collected from the patients' medical files, and included duration of mechanical ventilation, antibiotics, microbiological test results and neurological outcome. The outcome was the effect of early bronchoscopy (≤48 h after administration) on the rate of intubated patients on day five and day seven. RESULTS From January 2013 to December 2018, 190 patients were admitted with OHCA. Bronchoscopy was performed in 111 patients out of the 164 patients who survived the first day. Late bronchoscopy >48 h was associated with higher rates of intubation on day five (OR 4.94; 95% CI 1.2-36.72, 86.7% vs. 55.0%, p = 0.036) and day seven (OR 4.96; 95% CI 1.38-24.69; 80.0% vs. 43.3%, p = 0.019). CONCLUSION This study shows that patients who suffered from OHCA might have a better outcome if they receive a bronchoscopy early after hospital admission. Our data suggests an association of early bronchoscopy with a shorter intubation period.
Collapse
Affiliation(s)
- Gregor S. Zimmermann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
- Correspondence:
| | - Jana Palm
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Anna Lena Lahmann
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
| | - Friedhelm Peltz
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Rainer Okrojek
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Florian Weis
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Arne Müller
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Tilman Ziegler
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Alexander Steger
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, 81675 Munich, Germany;
| | - Petra Hoppmann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Hubert Hautmann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
- Department of Internal Medicine, Klinik Ottobeuren, 87724 Ottobeuren, Germany
| |
Collapse
|
3
|
Vitadello T, Kunze KP, Nekolla SG, Langwieser N, Bradaric C, Weis F, Cassese S, Fusaro M, Hapfelmeier A, Lewalter T, Schwaiger M, Kastrati A, Laugwitz KL, Rischpler C, Ibrahim T. Hybrid PET/MR imaging for the prediction of left ventricular recovery after percutaneous revascularisation of coronary chronic total occlusions. Eur J Nucl Med Mol Imaging 2020; 47:3074-3083. [PMID: 32472438 PMCID: PMC7680332 DOI: 10.1007/s00259-020-04877-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/19/2020] [Indexed: 01/12/2023]
Abstract
Purpose To evaluate myocardial viability assessment with hybrid 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MR) in predicting left ventricular (LV) wall motion recovery after percutaneous revascularisation of coronary chronic total occlusion (CTO). Methods and results Forty-nine patients with CTO and corresponding wall motion abnormality (WMA) underwent [18F]FDG-PET/MR imaging for viability assessment prior to percutaneous revascularisation. After 3–6 months, 23 patients underwent follow-up MR to evaluate wall motion recovery. In total, 124 segments were assigned to the CTO territories, while 80 segments displayed impaired wall motion. Of these, 68% (54) were concordantly viable in PET and MR; conversely, only 2 segments (2%) were assessed non-viable by both modalities. However, 30% showed a discordant viability pattern, either PET non-viable/MR viable (3 segments, 4%) or PET viable/MR non-viable (21 segments, 26%), and the latter revealed a significant wall motion improvement at follow-up (p = 0.033). Combined imaging by [18F]FDG-PET/MR showed a fair accuracy in predicting myocardial recovery after CTO revascularisation (PET/MR area under ROC curve (AUC) = 0.72, p = 0.002), which was superior to LGE-MR (AUC = 0.66) and [18F]FDG-PET (AUC = 0.58) alone. Conclusion Hybrid PET/MR imaging prior to CTO revascularisation predicts more accurately the recovery of dysfunctional myocardium than PET or MR alone. Its complementary information may identify regions of viable myocardium with increased potential for functional recovery.
Collapse
Affiliation(s)
- Teresa Vitadello
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Karl P Kunze
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan G Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nicolas Langwieser
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Bradaric
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Weis
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thorsten Lewalter
- Osypka Herzzentrum, Internistisches Klinikum München Süd, Munich, Germany
| | - Markus Schwaiger
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christoph Rischpler
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| |
Collapse
|
4
|
Nadjiri J, Zaschka AL, Straeter AS, Sauter A, Englmaier M, Weis F, Laugwitz KL, Rummeny EJ, Pfeiffer D, Rasper M. Evaluation of a shortened cardiac MRI protocol for left ventricular examinations: diagnostic performance of T1-mapping and myocardial function analysis. BMC Med Imaging 2019; 19:57. [PMID: 31340756 PMCID: PMC6657063 DOI: 10.1186/s12880-019-0358-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/18/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background In this study we sought to retrospectively evaluate whether a very brief cardiac magnetic resonance imaging (CMR) protocol sufficiently distinguishes patients with relevant myocardial changes with need for further examination from healthy subjects. Methods Patients with clinical indication for CMR (n = 160) were included in the study. Patients were categorized into two groups depending on presence of left ventricular (LV) dysfunction. ROC-analysis was done for results of T1-, T2- mapping and extracellular volume evaluation in patients without LV dysfunction. Binary endpoint was correctly depicted pathology of the conventional qualitative CMR techniques and report. Results In the patient cohort without LV dysfunction (49%), AUC for T1 mapping was 82% (p < 0.001), 60% for T2 mapping (p = 0.1) and 79% for ECV (p < 0.001). T1 mapping was significantly superior to T2 mapping to rule out left ventricular pathology (p = 0.012). Sensitivity for the combined use of T1 mapping and sBTFE cine imaging was 98%; the negative predictive value was 90%. In 49 patients (30%) full protocol CMR did not provide any additional information; T1 mapping correctly detected 57% of the subjects from this group who would not benefit from additional CMR. Conclusion A shortened CMR protocol comprising T1 mapping and LV-function analysis seems suitable to rule out myocardial alterations. Every third patient of the study population did not benefit from full contrast enhanced CMR. The shortened protocol correctly identified every fifth patient who would not benefit but no relevant pathologic findings with the obligation for treatment were missed.
Collapse
Affiliation(s)
- Jonathan Nadjiri
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Anna-Lena Zaschka
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alexandra S Straeter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Sauter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian Englmaier
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Weis
- Department of Cardiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Cardiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rasper
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
5
|
Beiras-Fernandez A, Kornberger A, Oberhoffer M, Kur F, Weis M, Vahl CF, Weis F. Levosimendan as rescue therapy in low output syndrome after cardiac surgery: effects and predictors of outcome. J Int Med Res 2019; 47:3502-3512. [PMID: 30909776 PMCID: PMC6726822 DOI: 10.1177/0300060519835087] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives Calcium sensitizers have been shown to improve outcomes in patients with low cardiac output syndrome (LCOS) after cardiac surgery. We assessed the effects of levosimendan on LCOS in cardiac surgical patients to identify outcome predictors. Methods A total of 106 patients in whom LCOS persisted despite conventional therapy additionally received 0.1 µg/kg/min of levosimendan for 24 hours according to a defined treatment algorithm. Baseline and treatment data as well as hemodynamic and outcome parameters were compared between survivors and nonsurvivors, and a multivariate correlation and regression tree analysis was implemented. Results The ejection fraction significantly increased from 27% ± 4% to 38% ± 8% within 24 hours and to 45% ± 10% within 48 hours of starting levosimendan. These changes were accompanied by a significant increase in cardiac output from 5.2 ± 0.6 to 6.2 ± 0.7 L/min within 24 hours and significant dose reductions in vasopressors and inotropes. In contrast to nonsurvivors, survivors’ need for inotropic support decreased after the addition of levosimendan to the therapy. Conclusion In our patients, all of whom were treated according to the same algorithm, the response to levosimendan in terms of the post-levosimendan need for inotropes and vasopressors predicted survival.
Collapse
Affiliation(s)
- Andres Beiras-Fernandez
- 1 Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Angela Kornberger
- 1 Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Martin Oberhoffer
- 1 Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Felix Kur
- 2 Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany
| | - Marion Weis
- 3 Department of Anaesthesiology, University Hospital Grosshadern, Munich, Germany
| | | | - Florian Weis
- 3 Department of Anaesthesiology, University Hospital Grosshadern, Munich, Germany
| |
Collapse
|
6
|
Brettner F, Chappell D, Nebelsiek T, Hauer D, Schelling G, Becker BF, Rehm M, Weis F. Preinterventional hydrocortisone sustains the endothelial glycocalyx in cardiac surgery. Clin Hemorheol Microcirc 2019; 71:59-70. [DOI: 10.3233/ch-180384] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Florian Brettner
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
- Walter-Brendel Centre of Experimental Medicine, Ludwig-Maximilians-University Munich, Martinsried, Germany
| | - Daniel Chappell
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Tim Nebelsiek
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Daniela Hauer
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Gustav Schelling
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Bernhard F. Becker
- Walter-Brendel Centre of Experimental Medicine, Ludwig-Maximilians-University Munich, Martinsried, Germany
| | - Markus Rehm
- Department of Anaesthesiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Florian Weis
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Germany
| |
Collapse
|
7
|
Nadjiri J, Kaissis G, Meurer F, Weis F, Laugwitz KL, Straeter AS, Muenzel D, Noël PB, Rummeny EJ, Rasper M. Accuracy of Calcium Scoring calculated from contrast-enhanced Coronary Computed Tomography Angiography using a dual-layer spectral CT: A comparison of Calcium Scoring from real and virtual non-contrast data. PLoS One 2018; 13:e0208588. [PMID: 30521612 PMCID: PMC6283621 DOI: 10.1371/journal.pone.0208588] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 11/20/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose Modern non-invasive evaluation of Coronary Artery Disease (CAD) requires non-contrast low dose Computed Tomography (CT) imaging for determination of Calcium Scoring (CACS) and contrast-enhanced imaging for evaluation of vascular stenosis. Several methods for calculation of CACS from contrast-enhanced images have been proposed before. The main principle for that is generation of virtual non-contrast images by iodine subtraction from a contrast-enhanced spectral CT dataset. However, those techniques have some limitations: Dual-Source CT imaging can lead to increased radiation exposure, and switching of the tube voltage (rapid kVp switching) can be associated with slower rotation speed of the gantry and is thus prone to motion artefacts that are especially critical in cardiac imaging. Both techniques cannot simultaneously acquire spectral data. A novel technique to overcome these difficulties is spectral imaging with a dual-layer detector. After absorption of the lower energetic photons in the first layer, the second layer detects a hardened spectrum of the emitted radiation resulting in registration of two different energy spectra at the same time. The objective of the present investigation was to evaluate the accuracy of virtual non-contrast CACS computed from spectral data in comparison to standard non-contrast imaging. Methods We consecutively investigated 20 patients referred to Coronary Computed Tomography Angiography (CCTA) with suspicion of CAD using a Dual-Layer spectral CT system (IQon; Philips Healthcare, The Netherlands). CACS was calculated from both, real- and virtual non-contrast images by certified software for medical use. Correlation analyses for real- and virtual non-contrast images and agreement evaluation with Bland-Altman-Plots were performed. Results Mean patient age was 57.7 ± 14 years (n = 20). 13 patients (65%) were male. Inter-quartile-range of clinical CACS was 0–448, the mean was 334. Correlation of CACS from real- and virtual non-contrast images was very high (0.94); p < 0.0001. The slope was 2.3 indicating that values from virtual non-contrast images are approximately half of the results obtained from real non-contrast data. Visual analysis of Bland-Altman-Plot shows good accordance of both methods when results from virtual non-contrast data are multiplied by the slope of the logistic regression model (2.3). The acquired power of this results is 0.99. Conclusion Determination of Calcium Score from contrast enhanced CCTA using spectral imaging with a dual-layer detector is feasible and shows good agreement with the conventional technique when a proportionality factor is applied. The observed difference between both methods is due to an underestimation of plaque volume, and—to an even greater extend -an underestimation of plaque density with the virtual non-contrast approach. Our data suggest that radiation exposure can be reduced through omitting additional native scans for patients referred to CCTA when using a dual-layer spectral system without the usual limitations of dual energy analysis.
Collapse
Affiliation(s)
- Jonathan Nadjiri
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felix Meurer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Weis
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexandra S. Straeter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Rasper
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
8
|
Nebelsiek T, Weis F, Angele M, Brettner F. Perioperative intra-aortic balloon counterpulsation in a patient with myocardium at risk undergoing urgent noncardiac surgery. Ann Card Anaesth 2016; 18:242-5. [PMID: 25849701 PMCID: PMC4881634 DOI: 10.4103/0971-9784.154491] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We are presenting the case of a 76-year-old female scheduled for major abdominal surgery. Her past medical history was remarkable for a three-vessel coronary artery disease, with a severely impaired left ventricular function. She had already undergone complex coronary artery bypass surgery. Currently, she presented with the rare constellation of a hemodynamic relevant and interventionally intractable stenosis of the left subclavian artery proximal to a crucial coronary bypass from left internal mammary artery to the left anterior descending. To protect this patient from perioperative myocardial infarction, an intra-aortic balloon pump was successfully used.
Collapse
Affiliation(s)
- Tim Nebelsiek
- Department of Anaesthesiology, University Hospital of Munich, Marchioninistrasse 15, D-81377 Munich, Germany
| | | | | | | |
Collapse
|
9
|
Kammerer T, Beiras-Fernandez A, Rehm M, Stangl M, Guba M, Kupatt-Jeremias C, Weis F. Use of drug-eluting balloon coronary intervention prior to living donor kidney transplantation. BMC Cardiovasc Disord 2014; 14:112. [PMID: 25179749 PMCID: PMC4162970 DOI: 10.1186/1471-2261-14-112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/19/2014] [Indexed: 11/11/2022] Open
Abstract
Background Kidney transplantation is the gold standard of therapy in patients with terminal renal insufficiency. Living donor transplantation is a well-established option in this field. Enlarging the donor’s pool implicates the acceptance of an increased rate of comorbidities. Among them, coronary artery disease is a growing problem. An increasing number of patients, undergoing living donation, receive antiplatelet therapies due to coronary disease. Case presentation Here we report about the perioperative treatment with a drug-eluting balloon in a patient with major cardiac risk factors who underwent kidney transplantation. Conclusion At the current time no recommendation can be given for the routine use of drug-eluting balloons.
Collapse
Affiliation(s)
| | - Andres Beiras-Fernandez
- Department of Thoracic and Cardiovascular Surgery, University Hospital, JW Goethe-University, Theodor-Stern-Kai 7, 61590 Frankfurt, Germany.
| | | | | | | | | | | |
Collapse
|
10
|
Nebelsiek T, Beiras-Fernandez A, Kilger E, Möhnle P, Weis F. Routine use of corticosteroids to prevent inflammation response in cardiac surgery. ACTA ACUST UNITED AC 2013; 7:170-4. [PMID: 23035828 DOI: 10.2174/157489012803832829] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 09/24/2012] [Accepted: 09/28/2012] [Indexed: 11/22/2022]
Abstract
Cardiac surgery, especially if it involves cardiopulmonary bypass, is associated with a severe systemic inflammatory response. It is characterized by complement activation and initiation of coagulation, fibrinolysis and kallikrein cascades. Consecutive activation of immunoregulatory cells results in an extensive release of pro- and anti-inflammatory cytokines. This inflammatory storm is related to organ dysfunction or failure and correlates with postoperative morbidity. In order to attenuate this deleterious inflammatory response in the perioperative period alternative surgical techniques, novel extracorporeal circulation devices and immunomodulatory pharmacological strategies are in focus of contemporary research. Since decades corticosteroids have been used and studied in patients undergoing cardiac surgery. Although it could be shown that glucocorticoids seem to change the pro-inflammatory cytokine profile in a favourable manner, it still remains controversial if this effect translates into a better clinical outcome. Several clinical trials have proclaimed an association between this inflammatory response and the incidence of major complications i.e, myocardial infarction and pulmonary complications, but until now they have failed to show conclusive results. This article describes the different types and recommended dose schemes of corticosteroids in the perioperative period of cardiac surgery along with the discussion of few patents. It will comment on potential side effects and review the effect on the postoperative outcome.
Collapse
Affiliation(s)
- Tim Nebelsiek
- Department for Anaesthesiology, Ludwig-Maximilians-University Munich, Germany
| | | | | | | | | |
Collapse
|
11
|
Kanzler I, Weis F, Beiras-Fernandez A. Current use of daptomycin in cardiac surgery and postoperative intensive care. Expert Rev Anti Infect Ther 2013; 11:309-20. [PMID: 23458770 DOI: 10.1586/eri.13.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections due to multidrug-resistant pathogens have an increasing impact on patients undergoing cardiac surgery. Preoperative infections, such as endocarditis, and postoperative infections, including wound and device infection, influence patient outcomes. Special interest needs to be taken in patients admitted to cardiac surgical intensive care units, as these patients are at high risk for infections, particularly nosocomial pneumonia, catheter-related and wound infections. The increasing numbers of infections due to Gram-positive multidrug-resistant pathogens underline the necessity for newer antibiotics with bactericidal effects and a more favorable profile of side effects. Daptomycin, a lipopeptide antimicrobial agent with bactericide activity against Gram-positive organisms, has been successfully used in the treatment of complicated infections due to Gram-positive multidrug-resistant pathogens, especially regarding endocarditis, wound infections, device and catheter-related infections in intensive care units. In this review, the authors will summarize therapeutic potential of daptomycin in cardiac surgery and postoperative intensive care.
Collapse
Affiliation(s)
- Isabella Kanzler
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt, Germany
| | | | | |
Collapse
|
12
|
Hauer D, Weis F, Campolongo P, Schopp M, Beiras-Fernandez A, Strewe C, Giehl M, Toth R, Kilger E, Schelling G. Glucocorticoid-endocannabinoid interaction in cardiac surgical patients: relationship to early cognitive dysfunction and late depression. Rev Neurosci 2013; 23:681-90. [PMID: 23006898 DOI: 10.1515/revneuro-2012-0058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 08/01/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endocannabinoids (ECs) are rapidly acting immune-modulatory lipid-signaling molecules that are important for adaptation to stressful and aversive situations.They are known to interact with glucocorticoids and other stress-responsive systems. Maladaptation to acute or chronic stress represents a major risk factor for the development of psychiatric disorders. In the present study, we administered stress doses of hydrocortisone ina prospective, randomized, placebo-controlled double blind study in patients undergoing cardiac surgery (CS) to examine the relationship between the use of glucocorticoids, plasma EC levels, and the occurrence of early postoperative cognitive dysfunction (delirium) and of later development of depression. METHODS We determined plasma levels of the ECs anandamide and 2-arachidonoylglycerol (2-AG) in CS patients of the hydrocortisone (n=56) and the placebo group(n=55) preoperatively, at postoperative day (POD) 1, at intensive care unit discharge, and at 6 months after CS(n=68). Postoperative delirium was diagnosed according to Diagnostic and Statistical Manual of the American Psychiatric Association IVth Edition (DSM-IV) criteria, and depression was determined by validated questionnaires and a standardized psychological interview (Structured Clinical Interview for DSM-IV). RESULTS Stress doses of hydrocortisone did not affect plasma EC levels and the occurrence of delirium or depression. However, patients who developed deliriumon POD 1 had significantly lower preoperative 2-AG levels of the neuroprotective EC 2-AG (median values, 3.8 vs. 11.3ng/ml; p=0.03). Preoperative 2-AG concentrations were predictive of postoperative delirium (sensitivity=0.70;specificity=0.69; cutoff value=4.9 ng/ml; receiver operating characteristic curve area=0.70; 95 o/o confidence interval=0.54-0.85). Patients with depression at 6 months after CS (n=16) had significantly lower anandamide and 2-AG levels during the perioperative period. CONCLUSIONS A low perioperative EC response may indicate an increased risk for early cognitive dysfunction and long-term depression in patients after CS. Glucocorticoids do not seem to influence this relationship.
Collapse
Affiliation(s)
- Daniela Hauer
- Department of Anaesthesiology, Ludwig Maximilians University, Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Beiras-Fernandez A, Ledderose C, Weis F, Beiras A, Kreth S. miRNA Modulation of Adiponectin Receptor 2 in Myocardium of Patients with End-Stage Heart Failure. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.1010] [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: 11/29/2022] Open
|
14
|
Hinske LCG, Weis F, Heyn J, Hinske P, Beiras-Fernandez A. The role of micafungin and anidulafungin in the treatment of systemic fungal infections: applications and patents for two novel echinocandins. ACTA ACUST UNITED AC 2013; 7:1-7. [PMID: 22044354 DOI: 10.2174/157489112799829747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 09/08/2011] [Accepted: 09/08/2011] [Indexed: 11/22/2022]
Abstract
Fungal infections are becoming an increasing menace in the hospital care setting. Among them, non-albicans Candida species have gained significant attention. Especially in the ICU setting, therapeutic options are limited in many cases by the side-effects of conventional antifungal therapy. Echinocandins are a relatively new class of antifungal agents that promise good effectiveness against Candida and Aspergillus species. Due to their underlying mechanisms of action, they yield good tolerability and few limitations of usage. In the current manuscript we describe the patents of two recently approved echinocandins, micafungin (US approved 2005) and anidulafungin (2006) and provide an overview of the mechanisms, clinical effectiveness and safety of antifungal therapy with these agents.
Collapse
|
15
|
Beiras-Fernandez A, Weis F, Ledderose C, Kaczmarek I, Beiras A, Kreth S. Modulation of adiponectin receptor 2 through MiRNA150 in the myocardium of patients with end-stage heart failure. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332599] [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: 10/27/2022]
|
16
|
Beiras-Fernandez A, Weis F, Kilger E, Adnan L, Nassau K, Kur F, Möhnle P. ICG clearance is a relevant outcome prediction tool in cardiac surgery. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332311] [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: 10/27/2022]
|
17
|
Beiras-Fernandez A, Kammerer T, Heinz F, Kur F, Kiessling AH, Weis M, Hagl C, Weis F. Influence of gender on postoperative outcome after intra-aortic balloon counter-pulsation and cardiac surgery. Thorac Cardiovasc Surg 2013; 61:47-51. [PMID: 23307277 DOI: 10.1055/s-0032-1331405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Female gender is an established risk factor for worse outcomes after cardiac surgery, and women are more likely to experience postoperative complications. Our aim was to analyze the influence of gender on outcome and postoperative complications after the use of intra-aortic balloon counter-pulsation (IABP) in cardiac surgery patients. METHODS Fifty-seven consecutive female patients (mean age: 73 ± 9 years) requiring an IABP at our department from January 2007 to January 2010 were retrospectively analyzed and compared with 182 male patients receiving IABP support within the same period. The collected data included patient demographics, preoperative state, operative details, postoperative pharmacological treatment, IABP-associated complications, and inhospital mortality. Preoperative mortality risk was calculated by logistic EuroSCORE. RESULTS There were no differences regarding the type of operation, preoperative renal or hepatic failure, though the prevalence of peripheral artery occlusive disease was higher in men. Furthermore, female patients receiving an IABP were significantly older (73 ± 9 vs. 67 ± 10 years), had a higher ejection fraction (EF) (45% ± 24% vs. 36% ± 14%), and had a higher EuroSCORE (25% ± 20% vs. 19% ± 17%; p < 0.05). Postoperative catecholamine support was significantly higher in the female patients. Women had a prolonged length of stay (LOS) at the ICU (10.64 ± 9.7 vs. 7.6 ± 7.6 days), higher incidence of renal replacement therapy, and a higher mortality (19 [19.4%] vs. 35 [33.9%]; p < 0.05) after the use of IABP. CONCLUSION Women have a worse outcome after the use of IABP, including LOS at the ICU, postoperative renal failure, and inhospital mortality, despite higher EF, when compared with men.
Collapse
|
18
|
Beiras-Fernandez A, Weis F, Rothkopf J, Kaczmarek I, Ledderose C, Dick A, Keller T, Beiras A, Kreth S. Local expression of myocardial galectin-3 does not correlate with its serum levels in patients undergoing heart transplantation. Ann Transplant 2013; 18:643-50. [DOI: 10.12659/aot.889396] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Florian Weis
- Department of Anaesthesiology, Ludwig-Maximilian-University, Munich, Germany
| | - Julia Rothkopf
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - Ingo Kaczmarek
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - Carola Ledderose
- Department of Anaesthesiology, Ludwig-Maximilian-University, Munich, Germany
| | - Andrea Dick
- Division of Transfusion Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - Till Keller
- Department of Cardiology, JW Goethe University, Frankfurt, Germany
| | - Andres Beiras
- Department of Morphological Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Simone Kreth
- Department of Anaesthesiology, Ludwig-Maximilian-University, Munich, Germany
| |
Collapse
|
19
|
Hornuss C, Zagler A, Dolch ME, Wiepcke D, Praun S, Boulesteix AL, Weis F, Apfel CC, Schelling G. Breath isoprene concentrations in persons undergoing general anesthesia and in healthy volunteers. J Breath Res 2012; 6:046004. [PMID: 23151715 DOI: 10.1088/1752-7155/6/4/046004] [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: 01/24/2023]
Abstract
Human breath contains an abundance of volatile organic compounds (VOCs). Analysis of breath VOC may be used for diagnosis of various diseases or for on-line monitoring in anesthesia and intensive care. However, VOC concentrations largely depend on the breath sampling method and have a large inter-individual variability. For the development of breath tests, the influence of breath sampling methods and study subject characteristics on VOC concentrations has to be known. Therefore, we investigated the VOC isoprene in 62 study subjects during anesthesia and 16 spontaneously breathing healthy volunteers to determine (a) the influence of artificial and spontaneous ventilation and (b) the influence of study subject characteristics on breath isoprene concentrations. We used ion molecule reaction mass spectrometry for high-resolution breath-by-breath analysis of isoprene. We found that persons during anesthesia had significantly increased inspiratory and end-expiratory isoprene breath concentrations. Measured isoprene concentrations (median [first quartile-third quartile]) were in the anesthesia group: 54 [40-79] ppb (inspiratory) and 224 [171-309] ppb (end-expiratory), volunteer group: 14 [11-17] ppb (inspiratory) and 174 [124-202] ppb (end-expiratory). Higher end-tidal CO(2) concentrations in ventilated subjects were associated with higher expiratory isoprene levels. Furthermore, inspiratory and end-expiratory isoprene concentrations were correlated during anesthesia (r = 0.603, p < 0.001). Multivariate analysis showed that men had significantly higher end-expiratory isoprene concentrations than women. Rebreathing of isoprene from the anesthesia machine possibly accounts for the observed increase in isoprene in the anesthesia group.
Collapse
Affiliation(s)
- Cyrill Hornuss
- Department of Anaesthesiology, Klinikum der Universität München, Munich, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Luchting B, Weis F, Heyn J, Beiras-Fernandez A. [Daptomycin for the treatment of gram-positive infections after cardiac surgery]. Med Klin Intensivmed Notfmed 2012; 108:59-62. [PMID: 23149592 DOI: 10.1007/s00063-012-0163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 04/24/2011] [Accepted: 07/11/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND METHOD Surgical infection remains a main cause of death after heart surgery, despite advances in pharmacological therapy. Daptomycin is a cyclic lipopeptide antibiotic, useful in gram-positive organisms resistant to standard treatment, including vancomycin. The aim of this study was to describe the use of daptomycin regarding efficacy, efficiency and safety in patients with gram-positive infections after heart surgery using a retrospective analysis on 49 adult patients. CONCLUSION Daptomycin shows excellent in vitro and in vivo activity against gram-positive organisms, such as Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, especially MRSA. Daptomycin is also effective against increasing vancomycin-resistant or vancomycin-intermediate S. aureus.
Collapse
Affiliation(s)
- B Luchting
- Klinik für Anaesthesiologie, Klinikum der Universität München-Campus Großhadern, Munich, Germany
| | | | | | | |
Collapse
|
21
|
Scheiermann P, Meimarakis G, Bamberg F, Weis F. Ruptured splenic artery aneurysm masquerading as a gastric hemorrhage. J Vasc Surg 2012; 56:509. [PMID: 22840901 DOI: 10.1016/j.jvs.2011.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/18/2011] [Accepted: 10/05/2011] [Indexed: 12/13/2022]
Affiliation(s)
- Patrick Scheiermann
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany
| | | | | | | |
Collapse
|
22
|
Weis F, Heyn J, Hinske CL, Vogt F, Weis M, Kur F, Hagl C, Beiras-Fernandez A. Daptomycin as supportive treatment option in patients developing mediastinitis after open cardiac surgery. J Cardiothorac Surg 2012; 7:81. [PMID: 22943887 PMCID: PMC3485632 DOI: 10.1186/1749-8090-7-81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/08/2012] [Accepted: 08/23/2012] [Indexed: 12/03/2022] Open
Abstract
Background Mediastinitis is a severe complication after cardiac surgery. While improvement of prophylaxis and of medical and surgical therapy has reduced its incidence, the treatment of mediastinitis continues to be a challenging problem. Within this study, we report the successful use of daptomycin as supportive therapy in patients developing mediastinitis after open cardiac surgery. Methods The records of 21 consecutive patients who developed mediastinitis after cardiac surgery were retrospectively reviewed. After diagnosis, all patients received surgical debridement and antibiotic therapy with daptomycin. All patients were followed up to death or discharge. Results Clinical improvement after combined surgical and antibiotic therapy with daptomycin was found in 90.5% of the patients. The median time until clinical improvement occurred was 5 [4/6] days. Daptomycin was well-tolerated and no major adverse events during therapy were observed observed. Conclusions This study provides new and helpful information regarding the beneficial use of daptomycin as supportive treatment option in patients developing mediastinitis after cardiac surgery.
Collapse
Affiliation(s)
- Florian Weis
- Department of Anaesthesiology, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Cushing's syndrome is associated with excessive cortisol secretion by the adrenal gland or ectopic tumours and may result in diabetes, hypertension, and life-threatening infections with high mortality rates especially in the case of surgical resection. Although surgical resection is the treatment of choice, patients may benefit from preceding medical therapy. This may especially be useful as an adjunctive approach in emergency settings, if patients cannot undergo surgery, if surgery or radiotherapy fails, or if the tumour recurs. Medical therapy can be categorized in three different groups-inhibition of steroidogenesis, suppression of adrenocorticotropic hormone, and antagonism of the glucocorticoid receptor. However, the majority of common drugs are not available for parenteral administration, which may evoke a management problem in emergency settings or in patients unable to tolerate oral medication. The carboxylated imidazole etomidate is a well known parenteral induction agent for general anaesthesia. Besides its hypnotic properties, etomidate also has α-adrenergic characteristics and inhibits the enzyme 11-deoxycortisol ß-hydroxylase, which catalyzes the final step of the conversion of cholesterol to cortisol. Adverse outcomes have been reported when used for sedation in septic or trauma patients probably by its interference with steroid homeostasis. However, its capability of inhibition of the 11-deoxycortisol ß-hydroxylase leads to suppression of cortisol secretion which has been demonstrated to be a useful tool in severe and complicated hypercortisolemia. Within this article, we review the data concerning different pharmacological approaches with particular consideration of etomidate in order to suppress steroidogenesis in patients with Cushing's syndrome.
Collapse
Affiliation(s)
- Jens Heyn
- Department of Anesthesiology-Grosshadern, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
| | | | | | | | | |
Collapse
|
24
|
Toller W, Algotsson L, Guarracino F, Hörmann C, Knotzer J, Lehmann A, Rajek A, Salmenperä M, Schirmer U, Tritapepe L, Weis F, Landoni G. Perioperative use of levosimendan: best practice in operative settings. J Cardiothorac Vasc Anesth 2012; 27:361-6. [PMID: 22658687 DOI: 10.1053/j.jvca.2012.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 04/03/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Wolfgang Toller
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Michel S, Weis F, Sodian R, Beiras-Fernandez A, Bigdeli AK, Kaczmarek I, Bruegger D. Use of methylene blue in the treatment of refractory vasodilatory shock after cardiac assist device implantation: report of four consecutive cases. J Clin Med Res 2012; 4:212-5. [PMID: 22719809 PMCID: PMC3376881 DOI: 10.4021/jocmr804w] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 11/15/2022] Open
Abstract
Vasodilatory shock frequently occurs after cardiac surgery, particularly after cardiac assist device implantation. This complication is often associated with high mortality, especially if refractory to conventional vasoconstrictor treatment. Methylene blue, a guanylate cyclase inhibitor, has been successfully used in the management of vasodilatory shock associated with cardiopulmonary bypass. We present four successive cases after implantation of cardiac assist devices suffering from norepinephrine and vasopressin refractory severe vasodilatory shock. In all patients, administration of a single dose of methylene blue (2 mg/kg body weight) resulted in an immediate and persistent decrease in vasoconstrictor dosages and serum lactate concentrations. Despite of this benefit, all patients deceased during hospital stay, however, this was not related to the methylene blue treatment. Methylene blue seems to be a promising therapeutical option in patients with otherwise resistant vasodilatory shock after cardiac assist device implantation. However, controlled clinical trials are necessary to substantiate safety and efficacy.
Collapse
Affiliation(s)
- Sebastian Michel
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | | | | | | |
Collapse
|
26
|
Beiras-Fernandez A, Rothkopf J, Reinwand S, Kaczmarek I, Kreth S, Weis F. 190 Local Expression of Myocardial Galectin-3 Does Not Correlate with Its Serum Levels in Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.189] [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: 11/16/2022] Open
|
27
|
Rothkopf J, Weis F, Kaczmarek I, Kreth S, Beiras-Fernandez A. 191 Modulation of the Myocardial Expression of Neuregulin-1 and Its Receptor ErbB4 in Patients with Chronic Heart Failure. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.190] [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: 10/28/2022] Open
|
28
|
Möhnle P, Kilger E, Adnan L, Beiras-Fernandez A, Vicol C, Weis F. Indocyanine green clearance after cardiac surgery: the impact of cardiopulmonary bypass. Perfusion 2012; 27:292-9. [DOI: 10.1177/0267659112439596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Plasma clearance of indocyanine green has recently been established as a tool to monitor hepatic function and perfusion non-invasively. Reduced indocyanine green clearance has been associated with adverse outcome in cardiac surgery patients, and cardiopulmonary bypass has been hypothesized to be one important triggering factor. We performed a prospective observational study comparing the influence of off-pump and on-pump coronary surgery on perioperative indocyanine green clearance. Twenty-five consecutive adult patients without known pre-existing hepatic diseases scheduled for off-pump coronary artery bypass grafting were evaluated for hepatic dysfunction pre- and postoperatively with serial measurements of indocyanine green plasma clearance, specific laboratory values and liver function scores. Twenty-five matched patients who underwent coronary artery bypass grafting surgery with cardiopulmonary bypass in the same period served as controls. Parameters of postoperative hepatic function, including measurements of indocyanine green plasma clearance and specific laboratory values and scores, did not differ significantly between patients undergoing off-pump coronary artery bypass grafting and patients undergoing coronary artery bypass grafting with extracorporeal circulation. In patients without pre-existing hepatic diseases, a significant influence of cardiopulmonary bypass on perioperative indocyanine green plasma clearance as well as on liver specific laboratory parameters and scores cannot be proven.
Collapse
Affiliation(s)
- P Möhnle
- Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - E Kilger
- Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - L Adnan
- Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - A Beiras-Fernandez
- Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - C Vicol
- Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - F Weis
- Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| |
Collapse
|
29
|
Rothkopf J, Reinwand S, Kreth S, Weis F, Dick A, Kaczmarek I, Beiras-Fernandez A. Expression of myocardial Galectin-3 does not correlate with its serum levels in patients with chronic heart failure. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297557] [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: 10/14/2022]
|
30
|
Beiras-Fernandez A, Wogawa F, Weis M, Kur F, Weis F. Anidulafungin is a safe treatment option for the empiric treatment of invasive fungal infections of high-risk cardiac surgery patients at the intensive care unit. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297810] [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: 10/14/2022]
|
31
|
Beiras-Fernandez A, Wogawa F, Weis M, Sodian R, Kur F, Weis F. Low-dose caspofungin is a safe and effective treatment option for invasive fungal infections after cardiac surgery. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297809] [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: 10/14/2022]
|
32
|
Beiras-Fernandez A, Kilger E, Adnan L, Vicol C, Weis F, Moehnle P. Hepatic dysfunction and Indocyanine green clearance (LiMON) after coronary surgery: Impact of cardiopulmonary bypass. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297807] [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: 10/14/2022]
|
33
|
Bamberg CE, von Ziegler F, Weis F, Beiras-Fernandez A, Schmoeckel M, Meiser B, Kaczmarek I. Donor transmitted left atrial myxoma 13 years after heart transplantation. Ann Transplant 2012; 16:118-21. [PMID: 22210431 DOI: 10.12659/aot.882228] [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: 11/09/2022] Open
Abstract
BACKGROUND Left atrial cardiac myxomas are among the most common cardiac masses. However, occurrence of left atrial myxomas in post-transplant patients is very rare and often misdiagnosed as left atrial thrombus formation. CASE REPORT We report the case of a 67-year old female, who was referred due to suspected left atrial thrombus but was found to have a pediculated mass at the suture line of the left atrium on cardiac MRI. After resection, the diagnosis myxoma was confirmed histologically and the donor origin of the myxoma was proven by tissue typing. CONCLUSIONS Despite a rare entity, atrial myxomas may occur in post cardiac transplant patients and may therefore support the role of advanced imaging techniques in patients with suspected left atrial masses.
Collapse
Affiliation(s)
- Claire E Bamberg
- Department of Anesthesiology, Ludwig Maximilians University, Marchioninistrasse 15, Munich, Germany
| | | | | | | | | | | | | |
Collapse
|
34
|
Neubauer N, Weis F, Binder A, Seipenbusch M, Kasper G. A highly sensitive technique for detecting catalytically active nanoparticles against a background of general workplace aerosols. ACTA ACUST UNITED AC 2011. [DOI: 10.1088/1742-6596/304/1/012011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
35
|
Beiras-Fernandez A, Kur F, Kaczmarek I, Frisch P, Weis M, Reichart B, Weis F. Levosimendan for Primary Graft Failure After Heart Transplantation: A 3-Year Follow-up. Transplant Proc 2011; 43:2260-2. [DOI: 10.1016/j.transproceed.2011.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
36
|
Scheiermann P, Beiras-Fernandez A, Mutlak H, Weis F. The protective effects of levosimendan on ischemia/reperfusion injury and apoptosis. ACTA ACUST UNITED AC 2011; 6:20-6. [PMID: 21208156 DOI: 10.2174/157489011794578482] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/29/2010] [Indexed: 11/22/2022]
Abstract
Levosimendan is a calcium sensitizer with positive inotropic and vasodilating properties. It increases the sensitivity of troponin C for calcium, opens adenosine triphosphate-dependent potassium K(+) channels and inhibits phosphodiesterase III. Levosimendan is approved for use in cardiac failure but large clinical trials have raised doubts whether levosimendan is superior to β-adrenergic agonists regarding long-term survival of patients. Despite this controversy, there is growing evidence of beneficial effects of levosimendan in ischemia/reperfusion (I/R) injury due to its effect on K(+) channels. As a consequence, patents on K(+) channel agonists have been granted recently for reducing injury in organs or tissue in transplants and trauma therapy. Moreover, experimental studies and clinical trials have shown that levosimendan effectively inhibits cardiomyocyte apoptosis. The underlying molecular mechanism is currently unclear. However, it is tempting to assume that levosimendan inhibits cardiomyocyte apoptosis due to its beneficial effect on I/R injury. However, the link between these two phenomena has not been well established. This review summarizes experimental studies and clinical trials on the effects of levosimendan in I/R injury and apoptosis also discussing recent patents.
Collapse
Affiliation(s)
- Patrick Scheiermann
- Department of Anesthesiology, Hospital of the Ludwig-Maximilians-University - Campus Grosshadern, Munich, Germany
| | | | | | | |
Collapse
|
37
|
Scheiermann P, Rösch I, Nerlich AG, Huf R, Kunz SN, Janner F, Weis F, Peschel O. Unusual presentation of Streptococcus pneumoniae-induced septic shock 36 years after splenectomy. Infection 2011; 39:283-5. [PMID: 21424436 DOI: 10.1007/s15010-011-0097-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/28/2011] [Indexed: 11/30/2022]
|
38
|
Kilger E, Heyn J, Beiras-Fernandez A, Luchting B, Weis F. Stress doses of hydrocortisone reduce systemic inflammatory response in patients undergoing cardiac surgery without cardiopulmonary bypass. Minerva Anestesiol 2011; 77:268-274. [PMID: 21441882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Systemic inflammatory response occurs after cardiac surgery (CS) and leads to a worse outcome in many cases. Stress doses of hydrocortisone have been successfully used to reduce SIRS and to improve outcome of patients after CS with cardiopulmonary bypass grafting (on-pump CABG), but the effect of hydrocortisone on patients undergoing CS without cardiopulmonary bypass grafting (off-pump CABG) is unclear. Therefore, we evaluated the effect of stress doses of hydrocortisone in this group of patients. METHODS A total of 305 patients undergoing off-pump CABG were enrolled in a prospective randomized trial according to the study protocol. The patients either received stress doses of hydrocortisone or placebo. We measured various laboratory and clinical variables characterizing the patients' outcomes. RESULTS The two study groups did not differ with regard to demographic data. Patients receiving hydrocortisone had an increased Higgins score and a decreased ejection fraction. Furthermore, patients from the hydrocortisone group had significantly lower levels of IL-6 (275 [162/677] pg/mL vs. 450 [320/660] pg/mL, P=0.001) and a shorter stay in the ICU (1 [1/3] day vs. 2 [2/3] days, P=0.04). Both groups did not differ in regard to catecholamine support, duration of mechanical ventilation, incidence of postoperative atrial fibrillation, blood loss, and mortality rate. CONCLUSION We conclude that intravenous stress doses of hydrocortisone lead to a reduction of systemic inflammation and to a potential improvement in the early outcome of patients undergoing off-pump CABG.
Collapse
Affiliation(s)
- E Kilger
- Department of Anesthesiology, Grosshadern, University Hospital Munich, Munich, Germany
| | | | | | | | | |
Collapse
|
39
|
Beiras-Fernandez A, Weis F, Heinz F, Sodian R, Bigdeli A, Kur F, Weis M, Reichart B. Impact of preoperative intra-aortic balloon counter-pulsation on postoperative outcome in cardiac surgery patients: a single centre experience. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269313] [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]
|
40
|
Beiras-Fernandez A, Weis F, Kreth S, Kaczmarek I, Ledderose C, Sodian R, Beiras A, Reichart B. Modulation of Adiponectin, a cardiovascular hormone, in the myocardium of patients with chronic heart failure. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269292] [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]
|
41
|
Beiras-Fernandez A, Kilger E, Lahib A, Möhnle P, Nassau K, Vicol C, Reichart B, Weis F. Preoperative indocyanine green clearance (LiMON®) is predictive for prolonged intensive care unit stay after cardiac surgery in patients with reduced ejection fraction. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269138] [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]
|
42
|
Beiras-Fernandez A, Weis F, Heinz F, Eifert S, Sodian R, Michel S, Kur F, Weis M, Reichart B. Intra-aortic balloon counter-pulsation and postoperative outcome in cardiac surgery: does gender matter? Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269310] [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]
|
43
|
Michel S, Bruegger D, Sodian R, Beiras-Fernandez A, Kur F, Bigdeli A, Weis M, Überfuhr P, Weis F, Reichart B. Use of methylene blue in the treatment of refractory hypotension after assist device implantation: report of five consecutive cases. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269285] [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]
|
44
|
Heyn J, Beiras-Fernandez A, Luchting B, Briegel J, Weis F. Inflammatory reactions and hydrocortisone in the setting of cardiac surgery: an overview. Cardiovasc Hematol Agents Med Chem 2011; 9:56-61. [PMID: 21067514 DOI: 10.2174/187152511794182800] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 11/02/2010] [Indexed: 05/30/2023]
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with activation of the complement system, platelets, neutrophils, monocytes, and macrophages which may lead to systemic inflammatory response syndrome in several cases. Despite modification of surgical techniques, biocompatibility of the bypass circuit and intensive care procedures after operation, CPB is still associated with post-operative morbidity including reduced cardiac function, capillary leak or multi-organ dysfunction. Corticosteroids are known for their anti-inflammatory effects and therefore, they are beneficial in selected trauma or septic patients. Prophylaxis with corticosteroids in cardiac surgery has been used since decades. The studies for methylprednisolone and hydrocortisone, the most commonly used corticosteroids, show conflicting results. For hydrocortisone, which is the mainstream of corticosteroid treatment in septic patients, the number of studies is low, but will increase in the next years. This article reviews the data concerning its use in patients undergoing cardiac surgery, its contraindications, adverse effects, risks, and benefits.
Collapse
Affiliation(s)
- Jens Heyn
- Department of Anaesthesiology-Grosshadern, University Hospital Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | | | | | | | | |
Collapse
|
45
|
Beiras-Fernandez A, Kreth S, Weis F, Ledderose C, Pöttinger T, Dieguez C, Beiras A, Reichart B. Altered myocardial expression of ghrelin and its receptor (GHSR-1a) in patients with severe heart failure. Peptides 2010; 31:2222-8. [PMID: 20804798 DOI: 10.1016/j.peptides.2010.08.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/20/2010] [Accepted: 08/20/2010] [Indexed: 12/20/2022]
Abstract
Ghrelin is a peptide hormone mainly produced by the stomach, which strongly stimulates the release of growth hormone (GH) via the GH secretagogue receptor 1a (GHSR-1a) located in the hypothalamus. It has been reported to exert performance-enhancing effects on myocardial function, and as both ghrelin and GHSR-1a are expressed in myocardial tissues, the ghrelin system may have a direct GH-independent impact on cardiac function. We intended to investigate the expression of ghrelin and its receptor GHSR-1a in different myocardial areas of patients with chronic heart failure (CHF) as compared to heart-healthy subjects to better define the role of the ghrelin signaling system in the networks regulating cardiac function and its potential as a target for diagnosis and/or treatment of CHF. Myocardium biopsies of 12 patients undergoing heart transplantation and suffering from CHF were obtained. Expression of both ghrelin and GHSR-1a was assessed by means of immunohistochemistry and real-time PCR. Expression of ghrelin was significantly decreased in CHF hearts both in atrium and ventricles in comparison to the control hearts (p<0.05). The expression of the GHS-1a receptor was significantly increased in the CHF biopsies as compared to controls (p<0.05). No significant differences were found between the anatomical areas studied. Expression of myocardial ghrelin and GHSR-1a is directly associated with myocardial function: CHF hearts exhibit an impaired ghrelin production which might reflect maladaptive processes and an - probably compensatory - increase in GHSR-1a expression. These findings may open up new perspectives regarding the potential of ghrelin signaling as a target for pharmacological modulation.
Collapse
Affiliation(s)
- Andres Beiras-Fernandez
- Department of Cardiac Surgery, Ludwig-Maximilian-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Beiras-Fernandez A, Vogt F, Sodian R, Weis F. Daptomycin: a novel lipopeptide antibiotic against Gram-positive pathogens. Infect Drug Resist 2010; 3:95-101. [PMID: 21694898 PMCID: PMC3108743 DOI: 10.2147/idr.s6961] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 08/27/2010] [Indexed: 11/23/2022] Open
Abstract
The aim of this review is to summarize the historical background of drug resistance of Gram-positive pathogens as well as to describe in detail the novel lipopeptide antibiotic daptomycin. Pharmacological and pharmacokinetic aspects are reviewed and the current clinical use of daptomycin is presented. Daptomycin seems to be a reliable drug in the treatment of complicated skin and skin structure infections, infective right-sided endocarditis, and bacteremia caused by Gram-positive agents. Its unique mechanism of action and its low resistance profile, together with its rapid bactericidal action make it a favorable alternative to vancomycin in multi-drug resistant cocci. The role of daptomycin in the treatment of prosthetic material infections, osteomyelitis, and urogenital infections needs to be evaluated in randomized clinical trials.
Collapse
Affiliation(s)
- Andres Beiras-Fernandez
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilian-University, Munich, Germany
| | | | | | | |
Collapse
|
47
|
Weis F, Beiras-Fernandez A, Hauer D, Hornuss C, Sodian R, Kreth S, Briegel J, Schelling G. Effect of anaesthesia and cardiopulmonary bypass on blood endocannabinoid concentrations during cardiac surgery. Br J Anaesth 2010; 105:139-44. [PMID: 20525978 DOI: 10.1093/bja/aeq117] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The endocannabinoid system (ECS) is an endogenous signalling system which includes the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) and specific G-protein-coupled endocannabinoid receptors (CB1 and CB2). Recent studies have described important roles of the peripheral ECS in human atherosclerosis, cardiometabolic disorders, heart failure, and systemic inflammation. We sought to study changes in plasma endocannabinoid concentrations during cardiac surgery (CS) under general anaesthesia with isoflurane/sufentanil, and during cardiopulmonary bypass (CPB). METHODS We studied 30 patients undergoing CS with CPB. All patients received midazolam and sufentanil for induction and isoflurane and sufentanil for maintenance of general anaesthesia. Blood samples were drawn before and after induction of general anaesthesia, after the beginning of surgery, during and after weaning from CPB, and after admission to intensive care unit (ICU) after surgery. Endocannabinoid measurements were performed by HPLC-tandem mass spectrometry. RESULTS Induction of general anaesthesia led to a significant decline in plasma AEA concentrations [from mean (sd) 0.39 (0.03) to 0.27 (0.03) ng ml(-1), P<0.01]. CPB induced a pronounced increase in 2-AG concentrations [from 112.5 (163.5) to 321.0 (120.4) ng ml(-1), P<0.01], whereas AEA concentrations remained persistently low until admission to the ICU. 2-AG concentrations returned to preoperative values after surgery. CONCLUSIONS General anaesthesia with isoflurane significantly reduces plasma AEA concentrations. This could be a consequence of stress reduction after loss of consciousness. The significant increase in 2-AG after initiation of CPB may be part of an inflammatory response. These findings suggest that anaesthesia and surgery have differential effects on the ECS which could have substantial clinical consequences.
Collapse
Affiliation(s)
- F Weis
- Klinikum Grosshadern, Department of Anesthesiology, Ludwig-Maximilians University, Munich, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Kilger E, Möhnle P, Nassau K, Beiras-Fernandez A, Lamm P, Frey L, Briegel J, Zwissler B, Weis F. Noninvasive Mechanical Ventilation in Patients with Acute Respiratory Failure after Cardiac Surgery. Heart Surg Forum 2010; 13:E91-5. [DOI: 10.1532/hsf98.20091116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Krauseneck T, Padberg F, Roozendaal B, Grathwohl M, Weis F, Hauer D, Kaufmann I, Schmoeckel M, Schelling G. A beta-adrenergic antagonist reduces traumatic memories and PTSD symptoms in female but not in male patients after cardiac surgery. Psychol Med 2010; 40:861-869. [PMID: 19691871 DOI: 10.1017/s0033291709990614] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epinephrine enhances emotional memory whereas beta-adrenoceptor antagonists (beta-blockers, BBs) impair it. However, the effects of BB administration on memory are sex dependent. Therefore, we predicted differential effects of epinephrine and the BB metoprolol given to male and female patients after cardiac surgery (CS) on traumatic memories and post-traumatic stress disorder (PTSD) symptoms. METHOD We performed a prospective observational study and determined the number of standardized traumatic memories (NTRM) and PTSD symptom intensity in cardiac surgical patients at 1 day before surgery, and at 1 week and 6 months after the procedure. PTSD symptoms and NTRM were quantified using validated questionnaires. Metoprolol could be administered any time post-operatively. RESULTS Baseline NTRM was not significantly different between male (n=95) and female patients (n=33). One week after CS, the NTRM in male patients was significantly higher. Metoprolol had no significant effect in either sex. At 6 months, females with metoprolol (n=18) showed a significantly lower NTRM and significantly lower PTSD symptom scores than females without BBs (n=15, p=0.02). By contrast, the totally administered dosage of epinephrine correlated with NTRM in males (r=0.33, p<0.01) but not in females (r=0.21, p=0.29). CONCLUSIONS beta-Adrenergic stimulation with epinephrine enhances memory for adverse experiences in males but not in females whereas beta-blockade selectively reduces memory for post-operative adverse events and PTSD symptoms in females.
Collapse
Affiliation(s)
- T Krauseneck
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Beiras-Fernandez A, Weis F, Pöttinger T, Kreth S, Kaczmarek I, Sodian R, Beiras A, Reichart B. Modulation of Ghrelin, a cardiovascular hormone, and Ghrelin-receptor in the myocardium of patients with chronic heart failure. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247067] [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]
|