K Weismüller

Universitätsklinikum Gießen und Marburg , Marburg, Hesse, Germany

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Publications (17)40.73 Total impact

  • K Weismüller, S Hofer, M A Weigand
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    ABSTRACT: The gastrointestinal tract is a complex organ system. Dysfunctions of this organ system may evoke a variety of consequences for the entire organism and influence the inflammatory response in particular. In perioperative medicine, nutrition, prokinetics, peridural anesthesia, catecholamines and volume therapy can be applied in order to improve the gastrointestinal functional or at least to avoid further aggravation. Early enteral nutrition is especially important in the reduction of postsurgical ileus and infectious complications. Also, prokinetics and thoracic peridural anesthesia favorably affect postsurgical ileus. Norepinephrine, if necessary in combination with dobutamine, seems to have fewer negative effects on splanchnic perfusion than epinephrine. The data on volume therapy remain controversial but fluid balance has to be calculated very carefully also considering enteral loss of fluids. Thus, in order to treat and avoid gastrointestinal problems after surgery and to prevent negative effects for the complete organism, multimodal concepts with regard to detail are required.
    Der Anaesthesist 07/2012; 61(8):722-7. · 0.85 Impact Factor
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    ABSTRACT: Intensive care medicine plays an important role in the medical care of patients as well as the economic success of hospitals. Knowledge and implementation of recent relevant scientific evidence are prerequisites for high quality care in intensive care medicine. The aim of this review is to present an overview of the most important publications in intensive care medicine published in 2010 and the first half of the year 2011 and to comment on their attributable clinical relevance for intensive care practitioners. In 2010 and up to June 2011 many studies with high patient numbers have been published. The main topics were the treatment of respiratory failure, sepsis and investigations to improve analgosedation.
    Der Anaesthesist 11/2011; 60(11):1041-56. · 0.85 Impact Factor
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    ABSTRACT: For the first time the immunonutritional role of pyruvate on neutrophils (PMN), free α-keto and amino acid profiles, important reactive oxygen species (ROS) produced [superoxide anion (O(2) (-)), hydrogen peroxide (H(2)O(2))] as well as released myeloperoxidase (MPO) acitivity has been investigated. Exogenous pyruvate significantly increased PMN pyruvate, α-ketoglutarate, asparagine, glutamine, aspartate, glutamate, arginine, citrulline, alanine, glycine and serine in a dose as well as duration of exposure dependent manner. Moreover, increases in O(2) (-) formation, H(2)O(2)-generation and MPO acitivity in parallel with intracellular pyruvate changes have also been detected. Regarding the interesting findings presented here we believe, that pyruvate fulfils considerably the criteria for a potent immunonutritional molecule in the regulation of the PMN dynamic α-keto and amino acid pools. Moreover it also plays an important role in parallel modulation of the granulocyte-dependent innate immune regulation. Although further research is necessary to clarify pyruvate's sole therapeutical role in critically ill patients' immunonutrition, the first scientific successes seem to be very promising.
    Amino Acids 04/2011; 40(4):1077-90. · 3.91 Impact Factor
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    ABSTRACT: In this retrospective observational study, we investigated the impact of prior splenectomy on the outcome of patients with complicated peritonitis. Of the 284 subjects with severe sepsis or septic shock due to intra-abdominal infection, 27 (9.5%) had undergone splenectomy before the development of that infection and 257 (90.5%) had not undergone splenectomy. The intra-abdominal source of infection was surgically confirmed (index operation). The group of patients having undergone splenectomy and that of patients not having undergone the procedure were well balanced in age, gender concomitant disease, as well as medication (prior chemotherapy). Twenty-eight-day estimated mortality did not differ between groups (33.3 versus 25.7%; P = 0.39). Ninety-day estimated mortality did not differ either (57.2 versus 49.7%; P = 0.92). Overall survival was equal between the two groups. More patients having undergone splenectomy required dialysis for renal failure (74.0 versus 44.7%; P < 0.01). A Cox regression analysis left age, sepsis-related organ failure assessment (SOFA) score immediately following index-surgery, and need for administration of norepinephrine exceeding 0.1 μg/kg body weight/min as potential predictors of fatal outcome. Our results did not support those of earlier reports suggesting that splenectomy protects against polymicrobial sepsis or septic shock. Regarding most effectiveness criteria (28- and 90-d estimated mortality, duration of mechanical ventilation, length of stay in ICU and in hospital), patients having undergone splenectomy fared as well as did those who had not undergone that procedure; regarding some (need for renal replacement), they fared worse. The effect of splenectomy is not large enough to be proven or ruled out with a limited number of cases.
    Journal of Surgical Research 11/2010; 167(2):e345-55. · 2.02 Impact Factor
  • T Müller, T Topp, K Weismüller, M Kwapisz, J Engel
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    ABSTRACT: Various studies have shown that dietary glutamine can modify the course of an immune response, through altering the release of cytokines. Nutritional supplementation of glutamine may therefore be of advantage to patients, particularly those with compromised immunity. Given that polymorphisms in cytokine genes can also affect cytokine levels, we have undertaken a study to identify whether there was a differential effect of glutamine supplementation in the context of different IL-2 -330 (T/G) and TNF-α -308 (A/G) genotypes. Overall, there was no significant impact of glutamine supplementation on IL2 release. However, analysing low, medium and high expressors independently, there was an effect of high glutamine levels on cytokine release from the low and medium expressors. Likewise, there was no effect of glutamine supplementation on the TNF-α release, although a tendency to lower cytokine release at high levels of glutamine. Irrespective of the glutamine concentrations, there was no difference in IL2 release between the IL2 -330 genotypes; there was an effect of the TNF-α genotypes, with the AG and GG genotypes showing greater cytokine release than from the AA genotype.
    Scandinavian Journal of Immunology 10/2010; 72(4):365-71. · 2.20 Impact Factor
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    ABSTRACT: The immune system and the central nervous system are able to affect each other. Proinflammatory cytokines induce the expression of CRH or AVP in the hypothalamus and ACTH in the pituitary gland. Thus, enhanced adrenal release of cortisol suppresses the activation of NF-κB and activates antiinflammatory cytokines. The cholinergic antiinflammatory pathway, the efferent arm of the inflammatory reflex, is another mechanism of the CNS to control inflammation. It consists of the efferent vagus nerve, the neurotransmitter actylcholine and the α7 subunit of the nicotinic acteylcholine receptor. Probably, the transmission of information takes place to postsynaptic sympathetic fibres in the celiac plexus which terminate in the spleen and act on splenic immune cells. Cholinesterase inhibitors have antiinflammatory effects in experimental sepsis when administered early.
    ains · Anästhesiologie · Intensivmedizin 09/2010; 45(9):574-8; quiz 579. · 0.39 Impact Factor
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    ABSTRACT: Critical care medicine plays an important role for the medical and economic success of hospitals. Knowledge and implementation of recent relevant studies are prerequisites for high quality intensive care medicine. The aim of the present manuscript is to present an overview of the most important publications in intensive care medicine in 2009 and comment on their clinical relevance. It has to be recognized that the cited studies are chosen according to the view of the authors. In 2009 many large randomized studies with high patient numbers were published. Main topics in 2009 were the therapy of lung failure, analgosedation and sepsis therapy. New trends are bedside echocardiography and telemedicine. Unfortunately, a magic bullet has not been identified last year. The focus is still on team education and guideline-assisted therapy.
    Der Anaesthesist 05/2010; 59(5):453-76. · 0.85 Impact Factor
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    ABSTRACT: Die Intensivmedizin hat eine bedeutende Rolle sowohl für den medizinischen als auch den ökonomischen Erfolg eines Krankenhauses. Eine qualitativ hochwertige Intensivmedizin setzt die Kenntnis und Umsetzung relevanter neuer klinischer Studien voraus. Die vorliegende Arbeit hat das Ziel, einen Überblick über die wichtigsten intensivmedizinischen Publikationen des Jahres 2009 zu geben und diese im Hinblick auf die klinische Relevanz einzuordnen. Anzumerken ist, dass die ausgewählten Studien eine subjektive Auswahl der Autoren darstellt. Im Jahr 2009 sind viele große randomisierte Studien mit großen Patientenzahlen veröffentlicht worden. Schwerpunkte waren die Therapie des Lungenversagens, die Analgosedierung und die Sepsistherapie. Neue Trends hin zur bettseitigen Echokardiographie oder der Telemedizin sind erkennbar. Ein „magic bullett“ konnte leider auch im vergangenen Jahr nicht identifiziert werden. Im Vordergrund stehen nach wie vor die Ausbildung des gesamten Teams und eine konsequent leitlinienorientierte Therapie. Critical care medicine plays an important role for the medical and economic success of hospitals. Knowledge and implementation of recent relevant studies are prerequisites for high quality intensive care medicine. The aim of the present manuscript is to present an overview of the most important publications in intensive care medicine in 2009 and comment on their clinical relevance. It has to be recognized that the cited studies are chosen according to the view of the authors. In 2009 many large randomized studies with high patient numbers were published. Main topics in 2009 were the therapy of lung failure, analgosedation and sepsis therapy. New trends are bedside echocardiography and telemedicine. Unfortunately, a magic bullet has not been identified last year. The focus is still on team education and guideline-assisted therapy. SchlüsselworteIntensivmedizin-Analgosedierung-Beatmung-Sepsistherapie-Infektiologie KeywordsCritical care medicine-Analgosedation-Ventilation-Therapy of sepsis and septic shock-Infections
    Der Anaesthesist 01/2010; 59(5):453-476. · 0.85 Impact Factor
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    ABSTRACT: The aim of this study was to determine the effects of alpha-ketoglutarate on neutrophil (PMN), free alpha-keto and amino-acid profiles as well as important reactive oxygen species (ROS) produced [superoxide anion (O(2) (-)), hydrogen peroxide (H(2)O(2))] and released myeloperoxidase (MPO) activity. Exogenous alpha-ketoglutarate significantly increased PMN alpha-ketoglutarate, pyruvate, asparagine, glutamine, asparatate, glutamate, arginine, citrulline, alanine, glycine and serine in a dose as well as duration of exposure dependent manner. Additionally, in parallel with intracellular alpha-ketoglutarate changes, increases in O(2) (-) formation, H(2)O(2)-generation and MPO activity have also been observed. We therefore believe that alpha-ketoglutarate is important for affecting PMN "susceptible free amino- and alpha-keto acid pools" although important mechanisms and backgrounds are not yet completely explored. Moreover, our results also show very clearly that changes in intragranulocytic alpha-ketoglutarate levels are relevant metabolic determinants in PMN nutrition considerably influencing and modulating the magnitude and quality of the granulocytic host defense capability as well as production of ROS.
    Amino Acids 02/2009; 38(1):167-77. · 3.91 Impact Factor
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    ABSTRACT: Patients encountering severe trauma are at risk of developing sepsis syndrome and subsequent multiple organ failure. This is often associated with fatal outcome despite survival of the initial injury. We postulate that variation of the gene coding for tumor necrosis factor (TNF)-alpha is associated with increased occurrence of sepsis syndrome and mortality in trauma patients. Prospective cohort study; validation in an external replication sample. Tertiary academic medical center. We included 159 severely traumatized patients from a single center. Serial blood samples were analyzed for serum concentrations of TNF-alpha and lymphotoxin-alpha (LTA). We genotyped nine polymorphisms in the TNF gene and tested for an association with sepsis syndrome and outcome. Genetic associations were validated in an external replication sample (n = 76). We examined the peripheral blood transcriptome in 28 patients by whole genome-based profiling and validated the results. None. Carriage of the TNF rs1800629 A allele was associated with higher TNF-alpha serum concentrations on the first day after trauma and during follow-up (two-sided p = 5.0 x 10(-5)), with development of sepsis syndrome (odds ratio 7.14, two-sided p = 1.2 x 10(-6); external validation sample [n = 76]: odds ratio 3.3, one-sided p = .03), and with fatal outcome (odds ratio 7.65, two-sided p = 1.9 x 10(-6)). Carriage of the TNF rs1800629 A allele was associated with differential expression of genes representing stronger proinflammatory and apoptotic responses compared with carriage of the wild-type allele. Common TNF gene variants are associated with sepsis syndrome and death after severe injury. These findings are strongly supported by functional data and may be important for developing preemptive anti-inflammatory interventions in carriers of the risk-associated allele.
    Critical care medicine 06/2008; 36(5):1456-62, e1-6. · 6.37 Impact Factor
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    ABSTRACT: Procedures for the analysis of free alpha-keto acids in human fluids (i.e. plasma, cerebrospinal fluid, urine, etc.) as well as for studying the dynamic free alpha-keto acid pools in differentiated tissues and organ cells have been the subject of growing clinical interest in the study of metabolic regulatory and pathophysiological phenomena. Due to the high instability and polarity of the alpha-keto acids being examined, the development of a quantitative and reproducible analysis of metabolically relevant intracellular alpha-keto acids still presents a substantial methodological challenge. The aim of small sample size, rapid, non-damaging and "metabolism-neutral" cell isolation, careful sample preparation and stability, as well as reproducible analytics technology is not often achieved. Only few of the methods described can satisfy the rigorous demands for an ultra-sensitive, comprehensive and rapid intracellular alpha-keto acid analysis.
    Amino Acids 03/2008; 36(1):1-11. · 3.91 Impact Factor
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    ABSTRACT: We examined the effects of beta-alanine (taurine analogue and taurine transport antagonist), taurine (regarding its role in neutrophil (PMN) immunonutrition) and taurine combined either with L-NAME (inhibitor of *NO-synthase), SNAP (*NO donor), DON (glutamine-analogue and inhibitor of glutamine-requiring enzymes), DFMO (inhibitor of ornithine-decarboxylase) and beta-alanine on neutrophil amino- and alpha-keto acid profiles or important PMN immune functions in order to establish whether taurine transport-, nitric oxide-, glutamine- or ornithine-dependent mechanisms are involved in any of the taurine-induced effects. According to the present findings, the taurine-mediated effect appears to be based primarily on a modulation of important transmembraneous transport mechanisms and only secondarily on directly or indirectly induced modifications in intragranulocytic amino- and alpha-keto acid homoeostasis or metabolism. Although a direct relation to the parallel observed immunological modifications can only be presumed, these results show very clearly that compositional modifications in the free intragranulocytic amino- and alpha keto-acid pools coinciding with changes in intragranulocytic taurine levels are relevant metabolic determinants that can significantly influence the magnitude and quality of the granulocytic immune response.
    Amino Acids 03/2008; 34(2):257-70. · 3.91 Impact Factor
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    Critical Care 01/2006; 10. · 4.93 Impact Factor
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    Critical Care 01/2006; 10. · 4.93 Impact Factor
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    ABSTRACT: The development of medical research networks within the framework of translational research has fostered interest in the integration of clinical and biological research data in a common database. The building of one single database integrating clinical data and biological research data requires a concept which enables scientists to retrieve information and to connect known facts to new findings.Clinical parameters are collected by a Patient Data Management System and viewed in a database which also includes genomic data. This database is designed as an Entity Attribute Value model, which implicates the development of a data warehouse concept.For the realization of this project, various requirements have to be taken into account which has to be fulfilled sufficiently in order to align with international standards.Data security and protection of data privacy are most important parts of the data warehouse concept. It has to be clear how patient pseudonymization has to be carried out in order to be within the scope of data security law.To be able to evaluate the data stored in a database consisting of clinical data collected by a Patient Data Management System and genomic research data easily, a data warehouse concept based on an Entity Attribute Value datamodel has been developed.
    Studies in health technology and informatics 02/2005; 116:9-14.
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  • K. Weismüller, S. Hofer, M.A. Weigand
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    ABSTRACT: Der Gastrointestinaltrakt ist ein komplexes Organsystem. Störungen in diesem Organsystem können vielfältige Auswirkungen auf den Gesamtorganismus haben und insbesondere die Inflammationsreaktion beeinflussen. In der perioperativen Therapie können Ernährung, Prokinetika, Periduralanästhesie, Katecholamingabe und Volumentherapie dahingehend eingesetzt werden, die Funktion des Gastrointestinaltrakts zu verbessern oder zumindest nicht weiter zu verschlechtern. Insbesondere der frühen enteralen Ernährung kommt hier große Bedeutung zu. Die Dauer des postoperativen Ileus kann ebenfalls durch Prokinetika und thorakale Periduralanästhesie günstig beeinflusst werden. Noradrenalin, ggf. in Kombination mit Dobutamin, scheint im septischen Schock weniger negative Auswirkungen auf die Splanchnikusdurchblutung zu haben als Adrenalin.
    Der Anaesthesist 61(8). · 0.85 Impact Factor

Publication Stats

39 Citations
82 Downloads
1k Views
40.73 Total Impact Points

Institutions

  • 2012
    • Universitätsklinikum Gießen und Marburg
      Marburg, Hesse, Germany
  • 2011
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • Department of Anaesthesia
      Liverpool, England, United Kingdom
  • 2010
    • Justus-Liebig-Universität Gießen
      • Department of Anaesthesiology and Intensive Care Medicine
      Gießen, Hesse, Germany