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Critical Care 04/2012; 4:1-2. · 4.93 Impact Factor
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ABSTRACT: To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with dual-source computed tomography (DSCT) correlate with measurements obtained by echocardiography and to correlate the amount of calcification of the aortic valve with AVA in a group of patients after aortic valve replacement.
23 patients underwent dual-source computed tomography (DSCT) of the heart (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany), without heart rate control (heart rate 52-113 beats/minute). All patients had undergone aortic valve replacement (homografts, mean time after surgery: 7+/-3 years). The AVA of the transplanted aortic valve graft was measured planimetrically by means of DSCT and compared with echocardiography as a standard of reference, to exclude post-surgical restenosis of the valve. Maximum AVA in systole planimetrically measured with CT was compared with calculated AVA values determined with the continuity equation, using transvalvular pressure gradients. The amount of calcification of the aortic valve was quantified and correlated (Spearman's R) with the AVA. To assess intra- and inter-reader reproducibility, the DCST data was re-analyzed by two readers 4 weeks after the initial review.
All DSCT datasets were of diagnostic image quality concerning valve depiction. The mean AVA as measured by DSCT was 2.7+/-0.9 cm (2) compared to 1.8+/-0.5 cm (2) by echocardiography (p<0.05). The planimetric evaluation of the CT data as compared to results of echocardiography showed a significant correlation of the results (Pearson's correlation coefficient R=0.78, p<0.001). Intra- and inter-reader reproducibility was good with intra-class correlation coefficients of 0.86 and 0.81, respectively (p<0.001). There was a significant negative correlation between the amount of aortic valve calcification and AVA as measured by echocardiography (R= -0.42; p<0.05) and as measured by DSCT (R= -0.67; p=0.001).
First experience indicates that DSCT is able to assess aortic valve opening area with high image quality and good intra- and inter-reader reproducibility in subjects after aortic valve replacement. The negative correlation between AVA and the amount of aortic valve calcification suggests that calcification is a possible risk factor for restenosis in subjects with aortic valve replacement.
RöFo - Fortschritte auf dem Gebiet der R 06/2008; 180(6):553-60. · 2.76 Impact Factor
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ABSTRACT: The main aim of our study was to compare the results and value of angiography and multi-slice computed tomography (MSCT) after coronary artery bypass grafting using complex arterial conduit combinations.
Twenty-six patients underwent coronary surgery. In all patients, we utilized a T-graft (free arterial graft centrally implanted into the left internal thoracic artery IN SITU). Postoperative coronary angiography and MSCT were carried out prior to discharge. The results were interpreted separately by two different investigators.
One hundred and thirteen distal anastomoses using 59 grafts for T-graft combinations were performed in 26 patients. A mean of 3.5 peripheral anastomoses was established per patient. Angiography showed a bypass graft patency rate of 94.6 % (56/59). In angiography, the patency rate of anastomoses was 96.5 % (109/113). All occlusions were identified in sequential anastomoses. The bypass patency rate measured by MSCT was 100 % and the patency rate of anastomoses 100 %. Based on these results, MSCT showed a sensitivity of 98.9 %. The specificity was 50.8 %, the positive predictive value was 94.6 % and the negative predictive value had a level of 99.9 %.
MSCT is a simple, less invasive and useful method of monitoring results after coronary surgery including anastomosis and graft patency after complex arterial grafts. Its value may be restricted for sequential anastomoses and angiography should be preferentially used in these cases.
The Thoracic and Cardiovascular Surgeon 05/2007; 55(3):173-6. · 0.88 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the clinical potential of dual-source computed tomography (DSCT) in pre- and postsurgical diagnostics in the field of cardiac surgery.
A total of 20 patients underwent DSCT of the heart. This CT system with two rotating X-ray tubes (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany) achieves a temporal resolution of 83 ms and a spatial resolution of 0.4 x 0.4 x 0.4 mm. The patient cohort consisted of two subgroups. In a group of ten patients with known coronary artery disease (CAD), scheduled for bypass surgery (i.e., high pretest likelihood for having significant CAD), the results of DSCT coronary angiography (CTA) and invasive quantitative catheter angiography (QCA) were compared to assess the diagnostic accuracy of DSCT in the detection of significant coronary artery stenoses (>50%). In a second group of ten patients with previous aortic valve replacement (homografts), the valve opening area of the transplanted aortic valve graft was measured by DSCT and compared with echocardiography as a standard of reference to exclude postsurgical restenosis of the valve.
Of 150 coronary artery segments depicted by CT, 144 (96%) were classified as "assessable." A significant CAD was known in all patients, and altogether 43 significant stenoses were present according to the results of QCA. Blinded to these results, DSCTA reached a sensitivity and specificity of 95% (41/43) and 93% (103/111), yielding a positive and negative predictive value (PPV, NPV) of 79% (31/39) and 98% (103/105), respectively. In patients with aortic valve homografts, all DSCT datasets were considered as being of diagnostic image quality concerning valve depiction. The planimetric evaluation of the CT data as compared to results of echocardiography showed a significant correlation of the results (r=0.64, p=0.0467). A high-grade valve stenosis (opening area <1.0 cm(2)) could be correctly excluded by DSCT in all patients.
Dual-source CT shows great diagnostic potential in patients before or after cardiac surgery. DSCT provides a high diagnostic accuracy for detection of coronary artery stenosis before bypass surgery. DSCT also proved to be accurate in the assessment of patients who received aortic valve replacement.
Der Radiologe 04/2007; 47(4):310-8. · 0.61 Impact Factor
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ABSTRACT: FragestellungZiel der Studie war es festzustellen, in wieweit die Dual-source-Computertomographie (DSCT) verschiedene pr- und postoperative diagnostische Fragestellungen in der Kardiochirurgie zu klren vermag.MethodikZwanzig Patienten wurden einer DSCT des Herzens unterzogen. Das CT-Gert mit 2 rotierenden Rntgenrhren (Somatom Definition, Siemens Medical Solutions, Forchheim, Deutschland) erreicht eine zeitliche Auflsung von 83ms. Das Patientenkollektiv bestand aus 2 Subkollektiven: Bei 10Patienten mit bekannter koronarer Herzkrankheit (KHK) wurden vor einer geplanten Bypassoperation die Ergebnisse der DSCT-Koronarangiographie (CTA) und der quantitativen Katheterangiographie (QCA) verglichen, um die diagnostische Genauigkeit der DSCT zum Nachweis signifikanter Koronarstenosen (>50%) in einem Kollektiv mit groer Vortestwahrscheinlichkeit fr das Vorliegen einer KHK zu evaluieren. Bei 10 weiteren Patienten wurde nach Aortenklappenersatz (Homografts) im postoperativen Verlauf die Frage untersucht, ob eine Restenose ausgeschlossen und die Aortenklappenffnungsflche (AKF) im Vergleich zur Echokardiographie korrekt gemessen werden kann.ErgebnisseIm Rahmen der properativen Stenosenauswertung wurden 144 von 150 Koronararteriensegmenten (96%) in der CTA als beurteilbar eingestuft. Laut QCA lag bei allen Patienten eine signifikante KHK mit insgesamt 43 signifikant stenosierten Segmenten vor. Sensitivitt und Spezifitt der CTA lagen in der geblindeten Analyse bei 95% (41/43) und 93% (103/111), bei einem positiven und negativen Vorhersagewert (PPV, NPV) von 79% (31/39) und 98% (103/105). Bei den 10Patienten mit Aortenklappendiagnostik waren alle CT-Datenstze diagnostisch verwertbar. Der Korrelationskoeffizient der CT-planimetrisch bestimmten Klappenffnungsflche und der in der Echokardiographie nach der Kontinuittsgleichung berechneten Klappenffnungsflche betrug r=0,64 (p=0,0467). Eine moderate oder hochgradige Stenose (Aortenklappenflche <1,0cm2) lag echokardiographisch bei keinem Patienten vor und konnte CT-planimetrisch auch bei allen Patienten korrekt ausgeschlossen werden.SchlussfolgerungenDie Dual-source-CT ist zur Beantwortung verschiedener diagnostischer Fragestellungen der Herzchirurgie wertvoll. Die nichtinvasive Koronarangiographie besitzt fr die Planung einer Bypassoperation eine hohe diagnostische Genauigkeit. Nach operativem Ersatz kann die Herzklappenfunktion genau beurteilt werden.PurposeThe aim of this study was to evaluate the clinical potential of dual-source computed tomography (DSCT) in pre- and postsurgical diagnostics in the field of cardiac surgery.Material and methodsA total of 20patients underwent DSCT of the heart. This CT system with two rotating X-ray tubes (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany) achieves a temporal resolution of 83ms and a spatial resolution of 0.40.40.4mm. The patient cohort consisted of two subgroups. In a group of ten patients with known coronary artery disease (CAD), scheduled for bypass surgery (i.e., high pretest likelihood for having significant CAD), the results of DSCT coronary angiography (CTA) and invasive quantitative catheter angiography (QCA) were compared to assess the diagnostic accuracy of DSCT in the detection of significant coronary artery stenoses (>50%). In a second group of ten patients with previous aortic valve replacement (homografts), the valve opening area of the transplanted aortic valve graft was measured by DSCT and compared with echocardiography as a standard of reference to exclude postsurgical restenosis of the valve.ResultsOf 150 coronary artery segments depicted by CT, 144 (96%) were classified as assessable. A significant CAD was known in all patients, and altogether 43 significant stenoses were present according to the results of QCA. Blinded to these results, DSCTA reached a sensitivity and specificity of 95% (41/43) and 93% (103/111), yielding a positive and negative predictive value (PPV, NPV) of 79% (31/39) and 98% (103/105), respectively. In patients with aortic valve homografts, all DSCT datasets were considered as being of diagnostic image quality concerning valve depiction. The planimetric evaluation of the CT data as compared to results of echocardiography showed a significant correlation of the results (r=0.64, p=0.0467). A high-grade valve stenosis (opening area <1.0cm2) could be correctly excluded by DSCT in all patients.ConclusionsDual-source CT shows great diagnostic potential in patients before or after cardiac surgery. DSCT provides a high diagnostic accuracy for detection of coronary artery stenosis before bypass surgery. DSCT also proved to be accurate in the assessment of patients who received aortic valve replacement.
Der Radiologe 03/2007; 47(4):310-318. · 0.61 Impact Factor
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ABSTRACT: Coronary artery anomalies are not frequent, nevertheless they are associated with increased and potentially lethal cardiac events. Recognition of these anomalies is fundamental in patients undergoing diagnostic or interventional coronary angiography. Most patients presenting with coronary anomalies are asymptomatic, but the risk of myocardial ischemia and sudden death requires the treatment of those patients. Different therapeutic options have been discussed, including surgery, conservative therapy, and interventional approaches. In this report, an aberrant origin of the left main coronary artery arising from the right coronary artery associated with coronary artery atherosclerosis and its surgical correction is described.
Heart Surgery Forum 02/2007; 10(2):E173-4. · 0.63 Impact Factor
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ABSTRACT: Tacrolimus is a macrolide immunosuppressant frequently used after solid-organ transplantation. Moderate and severe neurologic side effects have been reported in patients receiving tacrolimus. Cerebral neurotoxicity is a rare but fatal calcineurin inhibitor-related complication, especially in kidney and liver transplant recipients. Often a reduction or a change in immunosuppressive regimen is the only means of clinical management. Herein we report a case of a 31-year-old man who developed cerebellar atrophia while under immunosuppressive therapy 9 years after heart transplantation. His neurologic constitution ameliorated after an immunosuppressant switch from tacrolimus to sirolimus.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 02/2007; 26(1):89-92. · 3.54 Impact Factor
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ABSTRACT: Durch eine ausgeprgte Reduktion postoperativ erhhter
Fibrinogen-Spiegel mit Hilfe der H.E.L.P.-Apherese-Therapie
erscheint es mglich, den Teufelskreis aus verndertem
rheologischen Muster und reduziertem Blutfluss, zunehmender
Aggregationstendenz der Thrombozyten und schlielich vlliger
Stase zu durchbrechen. Die Bildung von Thromben wird nachhaltig
reduziert, einer Aktivierung des Gerinnungssystems wird
entgegengewirkt und es kommt zu einer Verbesserung der
Mikrozirkulation und somit zu einer Reduktion von
Frhverschlssen nach Bypassoperationen (Frhverschlussrate in
unserer Studiengruppe 2,3% bzw. 97,7% der Bypsse waren nach der
Operation offen). Die bei den Patienten beobachteten
therapeutischen Effekte unterstreichen die pathogenetische
Bedeutung des Fibrinogens fr die Verschlechterung der
myokardialen Mikrozirkulation nach einer Bypassoperation. Aus
den erhobenen Daten lsst sich daher unter Umstnden eine
zuknftige Bedeutung fr solche therapeutischen Strategien
ableiten. Diese Ergebnisse sollten aus unserer Sicht Anlass
sein, in einer prospektiven randomisierten Studie verifiziert zu
werden.
Background:
Early graft occlusion is a known complication after CABG
(Coronary Artery Bypass Grafting). The thromboembolic closure of
the bypass occurs at a frequency of 5–15%, depending on the
implemented vessel (arterial or venous graft).Fibrinogen as a substrate of thrombus formation plays a
major role in both primary and secondary haemostasis. The
operative trauma triggers the acutephase-response and also
activates the clotting process. This leads to high fibrinogen
levels of up to 600 mg/dl postoperatively, providing an impaired
haemorrheological pattern which promotes thrombus formation. In
a prospective pilot-study we examined whether drastic
postoperative lowering of fibrinogen by
H.E.L.P.-(Heparin-mediated Extracorporeal LDL-/Fibrinogen
Precipitation) apheresis can prevent early graft vessel closure
in patients undergoing CABG.
Methods:
For the purpose of this study 12 male patients (mean age
605.8 years) who underwent multivessel CABG were recruited
between 12/2000 and 2/2002 according to a GCP approved protocol.
The postoperative fibrinogenlevels of the patients were
monitored and H.E.L.P. apheresis was applied when plasma
fibrinogen levels exceeded >350 mg/dl on day 1 and >250
mg/dl every following day up to day 8 after the operation. Pre-
and postapheresis blood samples were obtained and reduction of
plasma fibrinogen, LDL-Cholesterol and CRP were determined.
Coronary angiography was performed within the 9th-16th
postoperative day. To investigate the long term outcome a second
coronary angiography was performed half a year after the
operation.
Results:
A total of 44 bypass grafts (23 arterial; 21 vein grafts)
were implemented in 12 patients (mean 3.6/patient) and a total
of 66 H.E.L.P.-Apherses from day 1–8 were postoperatively
applied (mean 5.5/patient). Fibrinogen levels were lowered from
a maximum on day 2 of 447112.2 mg/dl (pre-apheresis) to a
minimum on day 8 of 22846.2 mg/dl (pre-apheresis) demonstrating
a reduction of 50%. Per single treatment the fibrinogen was
lowered from 35793 mg/dl (pre-apheresis) to 15746 mg/dl (post
apheresis); reduction: 55%. Coronary angiography revealed graft
patency in 43 of 44 grafts (97.7% patency). The one occluded
bypass was an Y-graft to a diagonal branch less than 1mm in
diameter. No bleeding or H.E.L.P. related complications were
observed.Up to now 7 of 12 patients underwent the second coronary
angiography according to the study protocol. Apart from the
already immediately postoperatively occluded Y-graft no new
bypass-occlusion was revealed.
Conclusions:
Early and extensive reduction of postoperatively elevated
plasma fibrinogen levels by H.E.L.P. apheresis seems to be an
efficient and safe therapeutic approach for preventing early
graft occlusion in patients undergoing multivessel CABG.
Zeitschrift für Kardiologie 11/2003; 92:iii42-iii47. · 0.97 Impact Factor
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ABSTRACT: Early graft occlusion is a known complication after CABG (Coronary Artery Bypass Grafting). The thromboembolic closure of the bypass occurs at a frequency of 5-15%, depending on the implemented vessel (arterial or venous graft). Fibrinogen as a substrate of thrombus formation plays a major role in both primary and secondary haemostasis. The operative trauma triggers the acute phase-response and also activates the clotting process. This leads to high fibrinogen levels of up to 600 mg/dl postoperatively, providing an impaired haemorrheological pattern which promotes thrombus formation. In a prospective pilot-study we examined whether drastic postoperative lowering of fibrinogen by H.E.L.P.-(Heparin-mediated Extracorporeal LDL-/Fibrinogen Precipitation) apheresis can prevent early graft vessel closure in patients undergoing CABG.
For the purpose of this study 12 male patients (mean age 60+/-5.8 years) who underwent multivessel CABG were recruited between 12/2000 and 2/2002 according to a GCP approved protocol. The postoperative fibrinogen levels of the patients were monitored and H.E.L.P. apheresis was applied when plasma fibrinogen levels exceeded >350 mg/dl on day 1 and >250 mg/dl every following day up to day 8 after the operation. Pre- and post apheresis blood samples were obtained and reduction of plasma fibrinogen, LDL-Cholesterol and CRP were determined. Coronary angiography was performed within the 9th-16th postoperative day. To investigate the long term outcome a second coronary angiography was performed half a year after the operation.
A total of 44 bypass grafts (23 arterial; 21 vein grafts) were implemented in 12 patients (mean 3.6/patient) and a total of 66 H.E.L.P.-Apherses from day 1-8 were postoperatively applied (mean 5.5/patient). Fibrinogen levels were lowered from a maximum on day 2 of 447+/-112.2 mg/dl (pre-apheresis) to a minimum on day 8 of 228+/-46.2 mg/dl (pre-apheresis) demonstrating a reduction of 50%. Per single treatment the fibrinogen was lowered from 357+/-93 mg/dl (pre-apheresis) to 157+/-46 mg/dl (post apheresis); reduction: 55%. Coronary angiography revealed graft patency in 43 of 44 grafts (97.7% patency). The one occluded bypass was an Y-graft to a diagonal branch less than 1mm in diameter. No bleeding or H.E.L.P. related complications were observed.Up to now 7 of 12 patients underwent the second coronary angiography according to the study protocol. Apart from the already immediately postoperatively occluded Y-graft no new bypass-occlusion was revealed.
Early and extensive reduction of postoperatively elevated plasma fibrinogen levels by H.E.L.P. apheresis seems to be an efficient and safe therapeutic approach for preventing early graft occlusion in patients undergoing multivessel CABG.
Zeitschrift für Kardiologie 02/2003; 92(Suppl 3):III42-7. · 0.97 Impact Factor
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ABSTRACT: The objective of this study was to identify parameters indicating a risk for developing typical haemolytic uremic syndrome (D+HUS) during the prodromal phase of diarrhea caused by enterohaemorrhagic Escherichia coli (EHEC). Forty-eight children were studied prospectively with regard to inflammatory serum factors on admission to hospital. Ten patients developed D+HUS (group I), 15 suffered from viral-gastroenteritis (group IIa) and 23 from other types of bacterial gastroenteritis (group IIb). Mean levels of IL-8 tended to be elevated in group I compared to groups IIa and IIb. Neopterin and IL-10 levels particularly were significantly decreased in HUS in comparison to both gastroenteritis groups. Low IL-10 levels indicate a substantial disregulation of the immune response in HUS, as IL-10 downregulates the pro-inflammatory response and suppresses pro-coagulant activity in experimental endotoxemia. Our results suggest low neopterin, high IL-8 and especially low IL-10 levels are indicators of a high risk for developing HUS.
Cytokine 07/2000; 12(6):822-7. · 3.02 Impact Factor
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ABSTRACT: To determine the correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein (CRP) and procalcitonin (PCT)) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients on randomly chosen days.
Prospective consecutive case series.
Surgical intensive care unit (ICU) of a university hospital.Patients: Two hundred forty-three patients experiencing ICU stays of longer than 48 h categorized for sepsis according to ACCP/SCCM Consensus Conference criteria.
CRP and PCT were both significantly correlated with TNF-alpha and IL-6. Based on the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, predictive capability was highest for PCT (0.846 for TNF-alpha>40 pg/ml and 0.837 for IL-6>500 pg/ml), moderate with CRP (0.744 and 0.748, respectively), and lowest for leukocyte count (0.562 and 0.534, respectively) and body temperature (0.570 and 0.623, respectively). Sensitivity, specificity, positive and negative predictive values and test effectiveness all followed this same pattern of being highest for PCT followed by CRP, with leukocyte count and body temperature being lowest.
PCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.
European Journal of Intensive Care Medicine 03/2000; 26 Suppl 2:S170-4. · 5.17 Impact Factor
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ABSTRACT: To determine correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein [CRP], and procalcitonin [PCT]) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients.
Prospective consecutive case series.
Surgical intensive care unit (ICU) of a university hospital.
A total of 175 patients experiencing intensive care unit stays >48 hrs categorized for sepsis according to ACCP/ SCCM Consensus Conference criteria.
CRP and PCT were both significantly correlated with TNF-alpha and IL-6. Based on the area-under-the-curve of the receiver operating characteristics curves, predicting capability was highest for PCT (0.814 for TNF-alpha >40 pg/mL and 0.794 for IL-6 >500 pg/mL), moderate with CRP (0.732 and 0.716, respectively), and lowest for leukocyte count (0.493 and 0.483, respectively) and body temperature (0.587 and 0.589, respectively). Sensitivity, specificity, positive, and negative predictive values and test effectiveness all followed this same pattern of being highest for PCT followed by CRP, with leukocyte count and body temperature being lowest.
PCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.
Critical Care Medicine 10/1999; 27(9):1814-8. · 6.33 Impact Factor
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ABSTRACT: The search for sensitive and specific markers of systemic infection has shown that procalcitonin levels are increased in sepsis, and, consequently, this plasma protein has come into the focus of clinical research. Human procalcitonin is encoded by the Calc-l gene, which gives rise to two alternatively spliced transcripts. Despite systemic investigation of the Calc-l gene and mechanisms of the tissue-specific regulation and alternative splicing, little is known about the biology of procalcitonin and the cells which express this protein during inflammation. Here we focus on the molecular and biochemical properties of the molecule and summarize the known biological functions of procalcitonin. We report on the structure of the Calc-l gene, the amino acid conservation of procalcitonin in different species, and the consensus sequences of the protein with regard to sites relevant for posttranslational modification, spatial distribution, and homologies to other cytokines. We discuss aspects of intracellular location of procalcitonin and demonstrate that it has the characteristics of a secreted protein.
Clinical Chemistry and Laboratory Medicine 09/1999; 37(8):789-97. · 2.15 Impact Factor
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Molecular Medicine Today 08/1999; 5(7):286-7.
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ABSTRACT: Procalcitonin (PCT), the precursor of calcitonin, was recently put forward as a diagnostic marker of systemic bacterial infection and sepsis. The major PCT production site in sepsis still remains unclear. Because of a certain association between increased levels of PCT and leukocyte-derived cytokines during sepsis, we assessed the possible expression of PCT in human peripheral blood mononuclear cells (PBMCs) and the modulation of PCT by lipopolysaccharides (LPS) and various sepsis-related cytokines by reverse transcriptase-polymerase chain reaction (RT-PCR) by using a novel primer set and flow cytometric analysis with intracellular staining with antibodies to the PCT components calcitonin and katacalcin. RT-PCR and flow cytometric analysis demonstrated that PBMCs express PCT both on mRNA and on protein levels. LPS and various proinflammatory cytokines (interleukin-1beta (IL-1beta), IL-6, tumor necrosis factor-alpha (TNF-alpha), IL-2) had pronounced stimulatory effects on the expression of PCT mRNA. Under identical experimental conditions the anti-inflammatory cytokine IL-10 had no effect on the expression of mRNA for PCT. Flow cytometric analysis demonstrated increased intracellular amounts of PCT components after LPS stimulation. Thus we demonstrate for the first time that PCT is expressed in PBMCs. This expression is modulated by bacterial LPS and sepsis-related cytokines. Therefore PBMCs may be among the sources of elevated PCT levels in patients with sepsis.
Journal of Laboratory and Clinical Medicine 08/1999; 134(1):49-55. · 2.62 Impact Factor
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ABSTRACT: Prokalzitonin ist ein Propeptid von Kalzitonin. Bei Gesunden ist Prokalzitonin mit kommerziellen Tests im Blut nicht nachweisbar,
seine Konzentration steigt aber bei schweren generalisierten bakteriellen, parasitären und pilzbedingten Infektionen stark
an. Bei lokal begrenzten Infektionen, bei viralen Infekten oder bei nichtinfektiösen inflammatorischen Erkrankungen steigt
die Prokalzitoninkonzentration nicht oder nur gering an. Der Prokalzitoninspiegel steigt mit zunehmendem Schweregrad einer
generalisierten Infektion an. Daher eignet sich Prokalzitonin als diagnostischer Parameter zur Differentialdiagnose und Verlaufskontrolle
schwerer inflammatorischer Zustände. Bei Gesunden wird Prokalzitonin in den C-Zellen der Schilddrüse produziert, bei Patienten
mit schweren Infektionen werden andere Syntheseorte für die hohen Prokalzitoninwerte verantwortlich gemacht. Die enge Assoziation
mit anderen Mediatoren der Inflammation und eine erste tierexperimentelle Studie lassen vermuten, daß Prokalzitonin als Mediator
im Rahmen einer inflammatorischen Antwort auf eine Infektion bedeutsam ist. Weitere Studien sind notwendig, um den Bildungsort
und die pathophysiologische Rolle dieses Parameters bei schweren Infektionen besser zu verstehen.
Procalcitonin is a propeptide of calcitonin. It is usually not detectable in healthy volunteers but appears in high concentrations
in the serum of patients with severe bacterial, parasitic or fungal infection. In contrast, procalcitonin levels do not or
only moderately increase during viral infections or during non-infectious systemic inflammatory states. Because of these properties,
procalcitonin has been proposed to serve as a marker of severe infections and sepsis. Increased procalcitonin levels have
recently been shown to indicate the severity of systemic infection with increasing specificity. Normally, procalcitonin is
produced in the C-cells of the thyroid gland. The origin of the high levels of procalcitonin in septic conditions is not fully
understood. Although procalcitonin has drawn attention as a marker of severe systemic infections, a recent study suggests
it may also be a mediator of sepsis. More studies are needed to uncover the nature and pathophysiological role of this molecule.
Intensivmedizin + Notfallmedizin 07/1999; 36(6):493-499.
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ABSTRACT: Wir berichten über erste klinische Erfahrungen mit PCT bei Kindern mit hämolytisch-urämischem Syndrom (HUS) unter besonderer
Berücksichtigung von Umgebungsuntersuchungen im Rahmen zweier HUS-Erkrankungen in einer kleinen Gemeinde bei München im Winter
1997.
Monatsschrift Kinderheilkunde 05/1999; 147(4):373-376. · 0.27 Impact Factor
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Critical Care 04/1999; 3:1-2. · 4.93 Impact Factor
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Critical Care 04/1999; 3:1-1. · 4.93 Impact Factor
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Critical Care 04/1999; 3:1-1. · 4.93 Impact Factor
