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Biomedical subjects

Claudia Spies

Publications and source records attributed to Claudia Spies.

At least 37 records · Page 2Linked to original sources
PubMed2006

Thawing procedures and the time course of clotting factor activity in fresh-frozen plasma: a controlled laboratory investigation.

BACKGROUND: In this study, we evaluated the effects of the thawing process of 2 commercially available devices on the activity of clotting factors, inhibitors and activation markers of the hemostatic system in fresh-frozen plasma (FFP). In an experimental procedure, FFP was thawed under running warm water at 42 degrees C. METHODS: Plasma of 20 healthy donors was sampled, separated, and distributed in 3 plasma bags. Within 2 h after sampling plasma bags was frozen at a temperature of -30 degrees C to -40 degrees C and stored for at least 8 wk. After sampling (baseline) as well as immediately and 1, 2, 4, and 6 h after thawing, the activity of FV, FVII, FVIII, fibrinogen, fibrin monomers (FM), d-dimers (DD), alpha2-antiplasmin (alpha2-AP), and protein S (PS) was determined from each plasma bag. RESULTS: From 1 h to 6 h after thawing, no significant differences in the activity of the investigated coagulation markers dependent on the thawing procedure were found. However, immediately after thawing and independent of the thawing procedure, the activity of FVII was significantly decreased (P < 0.01), whereas FM were significantly increased (P = 0.001). CONCLUSION: The thawing procedures studied exhibited no significant influence on activity and stability of the investigated markers of coagulation over the study period. The decreased activity of FVII and the clinical significance of the increase in FM require further research.

Adult↗
PubMed2006

Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.

BACKGROUND: Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). METHODS: After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery. RESULTS: Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P < 0.0001 in all cases). Time until able to turn in bed was achieved earlier in the PCEA group (P < 0.05). Patients in the PCEA group were significantly more satisfied with pain therapy (P < 0.01). CONCLUSION: We conclude that PCEA with ropivacaine and sufentanil, using intraoperatively placed epidural catheters, provides superior analgesia and higher patient satisfaction when compared with PCIA after spinal fusion surgery.

Adult↗
PubMed2006

Volume-reduced platelet concentrates.

Volume-reduced platelet concentrates (PCs) can be a useful option for transfusing a high number of platelets in the smallest possible plasma volume, especially in neonatal and other pediatric patients. In addition to decreasing the risk of circulatory overload, volume-reduced PCs contain less plasma, which may reduce the likelihood of adverse plasma-related transfusion reactions. Volume reduction can be achieved either during collection and processing of apheresis PCs (primary volume reduction) or, subsequently, by recentrifugation of stored PCs (secondary volume reduction). There is no standard method for preparing volume-reduced PCs. Although in vitro data suggest impaired platelet function with some methods of volume-reducing PCs, in vivo studies show acceptable hemostatic function, posttransfusion recovery, and platelet count increments for both primary and secondary volume-reduced PCs. This review presents an overview of recent studies on functional characteristics of different types of volume-reduced PCs.

Blood Platelets↗
PubMed2005

Health-related quality of life in urban surgical emergency department patients: comparison with a representative German population sample.

BACKGROUND: Patients in emergency departments show a high prevalence of substance use. Quality of life is associated with substance use as well as socioeconomic status. Little is known about quality of life in substance-abusing young patients with minor trauma. METHODS: An investigation in an Emergency Department in an inner city university hospital was conducted during 8 months. Overall, 1,596 patients completed the SF-36 and an established SES-questionnaire and were screened for substance use (harmful alcohol consumption (>or= 8 points in men and >or= 5 points in women on the Alcohol Use Disorders Identification Test (AUDIT), smoking and illicit drug use). Results were compared with a representative German population sample (German Federal Health Survey 1998). RESULTS: Median age of participants was 32 years and 61.8% were male. Mean physical component summary score (PCS) of the Short Form-36 Health Survey (SF-36) was 53.4 +/- 8.3 points and significantly higher than the age and gender-stratified German Federal Health Survey-data. Mean mental component summary score (MCS) was 47.9 +/- 10.0 points and significantly lower than the age and gender-stratified German Federal Health Survey-data. In Emergency Department patients, prevalence of substance use was high and harmful alcohol consumption and illicit drug use were strongly associated with impaired mental health. Education and occupational status were strongly positively associated with physical health. CONCLUSION: We conclude that there is a high prevalence of substance use in young patients with minor trauma and mental quality of life is impaired. Screening and brief intervention strategies to reduce substance-use associated disorders should consider these findings.

Adult↗
PubMed2005

Hazardous alcohol consumption and sense of coherence in emergency department patients with minor trauma.

BACKGROUND: The concept of sense of coherence (SOC) measures the extent to which people are able to cope with stressful life events. Since excessive alcohol consumption may be, in part, the result of failed coping strategies, further investigations between hazardous alcohol consumption and SOC are necessary. METHODS: Survey in an Emergency Department in an inner city university hospital. Overall, 1,833 patients were screened for hazardous alcohol consumption, illicit drug use, smoking status, socioeconomic status and sense of coherence. RESULTS: Mean age of participants was 34+/-12 years and 62% were male. Overall, 23% of patients showed a pattern of hazardous alcohol consumption, 23% had abused illicit drugs and 46% were smokers. Mean SOC score was 48.9+/-8.6 points, with no difference between genders. Lower SOC-quartiles were associated with significantly higher prevalence of hazardous alcohol consumption as well as illicit drug abuse and smoking. Lower SOC-quartiles were associated with significantly lower values on socioeconomic variables (e.g. lower income, less education). The negative association between SOC and alcohol consumption was independent of age, gender, smoking, illicit drug use and all socioeconomic variables. CONCLUSION: SOC and hazardous alcohol consumption were significantly associated. Our data support Antonovsky's original concept of increased alcohol consumption as a result of failed coping strategies.

Adult↗
PubMed2005

Predictors of pain behaviors in fibromyalgia syndrome.

OBJECTIVE: To evaluate the contributions of physical, pain-related, cognitive, stress-related, affective, and spouse-related variables to differences in pain behaviors in subgroups of patients with fibromyalgia syndrome (FMS). METHODS: One hundred forty FMS patients underwent medical, physical, and psychological evaluation. Patients and 30 pain-free controls performed a routine physical activity (window-washing task) to elicit pain behaviors with or without the presence of their spouses. The behaviors and spouses' responses during this task were videotaped and subsequently rated. Patients were classified as dysfunctional (DYS), interpersonally distressed (ID), or adaptive copers (AC) based on responses to the Multidimensional Pain Inventory. Hierarchical regression analyses were used to identify predictors of pain behaviors for the total group and subgroups of patients. RESULTS: Patients classified as DYS demonstrated the highest number of pain behaviors compared with those classified as ID or AC. This difference was observable when the spouse was present. Spouse responses and physical variables were significantly related to pain behaviors in the DYS and ID groups with the model accounting for 77.1% and 41.9% of the variance, respectively. In contrast, for the AC group, stress factors were the most significant predictor of pain behaviors, accounting for 22.8% of the variance. CONCLUSION: The results indicate that different variables account for the presence of pain behaviors in different subgroups of patients. The data provide support for the heterogeneity of the diagnosis of FMS and have implications for treatment of subgroups of patients.

Behavior↗
PubMed2005

Time course of endothelial damage in septic shock: prediction of outcome.

INTRODUCTION: Endothelial damage accounts greatly for the high mortality in septic shock. Higher expression of mediators (IL-6, IL-8, soluble intercellular adhesion molecule 1 [sICAM-1], soluble endothelial-linked adhesion molecule 1 [sELAM-1]) have been described for non-survivors in comparison with survivors. We investigated the predictive value of the mediators IL-6, IL-8, sELAM-1 and sICAM-1 and their time course in intensive care unit patients who developed septic shock with respect to outcome. MATERIALS AND METHODS: We measured serum levels of IL-6, IL-8, sELAM-1 and sICAM-1 in 40 intensive care unit patients who developed septic shock. Measurements were performed until death or until resolution of septic shock. Clinical and laboratory data were also recorded. RESULTS: After 48 hours the levels of sELAM-1 and sICAM-1 increased in non-survivors and decreased in survivors. sELAM-1 was predictive for outcome on the third day (P = 0.02) and the fourth day (P = 0.02) after diagnosis of septic shock. This difference in the time course between survivors and non-survivors occurred 7 days before death of the patients (median, 10 days). sICAM-1 levels increased significantly in non-survivors over the study period (P < 0.001). sELAM-1 (P = 0.04), IL-6 (P = 0.04) and IL-8 (P = 0.008) were significantly higher in non-survivors over the whole study period. The age and norepinephrine dose >0.5 mug/kg/min were significantly different between the groups. CONCLUSION: sELAM-1 showed a markedly opposing course after 48 hours of septic shock. This adhesion molecule may be a useful early predictor of disease severity in the course of septic shock after early initial treatment of the patients, and might suggest considering endothelial-restoring therapy.

Adult↗
PubMed2005

Practice of sedation and analgesia in German intensive care units: results of a national survey.

INTRODUCTION: Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany. METHODS: A survey was sent by mail to 261 hospitals in Germany. The anesthesiologists running the intensive care unit were asked to fill in the structured questionnaire about their use of sedation and analgesia. RESULTS: A total of 220 (84%) questionnaires were completed and returned. The RAMSAY sedation scale was used in 8% of the hospitals. A written policy was available in 21% of hospitals. For short-term sedation in most hospitals, propofol was used in combination with sufentanil or fentanyl. For long-term sedation, midazolam/fentanyl was preferred. Clonidine was a common part of up to two-thirds of the regimens. Epidural analgesia was used in up to 68%. Neuromuscular blocking agents were no longer used. CONCLUSION: In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.

Analgesia↗
PubMed2005

Emerging biomarkers: new directions and clinical applications.

This article summarizes content proceedings of a symposium held at the 2004 Research Society on Alcoholism Scientific Annual Meeting in Vancouver, Canada. The chairs were Friedrich M. Wurst and Raye Litten. The presentations were (1) Introduction, by Raye Litten; (2) Direct Ethanol Metabolites--On the Threshold From Science to Routine Use, by Friedrich M. Wurst; (3) Sialic Acid Index of Plasma Apolipoprotein J (SIJ) as a Viable Marker for Chronic Alcohol Consumption, by Philippe Marmillot; (4) The Emergence of Ethyl Glucuronide (EtG) Testing as a Tool in Monitoring Healthcare Professionals, by Gregory E. Skipper; (5) Application of Biomarkers for Alcohol Use Disorders in Clinical Practice, by Tim Neumann; (6) Utility of Biomarkers in Assessing the Efficacy of Medications for Treating Alcoholism, by Marty Javors; and (7) Discussion, by Raye Litten.

Alcoholism↗
PubMed2005

Recombinant activated factor VII for refractory bleeding after cardiac surgery--a retrospective analysis of safety and efficacy.

OBJECTIVE: Analysis of safety and efficacy of recombinant activated factor VII (rFVIIa) used as the last resort for refractory bleeding after cardiac surgery. DESIGN: Retrospective cohort analysis and matched pairs analysis with historic controls were performed. In the rFVIIa group, which also received conventional hemostatic therapy, data were collected for a median of 14 hrs from admission to the intensive care unit (ICU) to the administration of rFVIIa and for the following 24 hrs. In the control group, which received only conventional hemostatic therapy, data were collected for 14 and then for 24 hrs after admission to the ICU. SETTING: University hospital. PATIENTS: Twenty-four patients matched with historic controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: No thromboembolic complications were observed in the rFVIIa group. Blood loss and transfusion requirements were significantly reduced in the period after the administration of rFVIIa. However, in the 24-hr period after rFVIIa administration, blood loss (p = .140) and transfusion of packed red blood cells (p = .442) and fresh frozen plasma (p = .063) were not different between the rFVIIa and control groups. Platelet concentrates (p = .004) were transfused less in the control group. Mortality and 6-month survival rates were not different between the groups. CONCLUSIONS: When used as a last resort, rFVIIa was safe but not incrementally efficacious over conventional hemostatic therapy.

Aged↗
PubMed2005

Protracted bleeding after hirudin anticoagulation for cardiac surgery in a patient with HIT II and chronic renal failure.

Heparin-induced thrombocytopenia type II (HIT II) requires alternative anticoagulation. Hirudin has been effectively used in patients with HIT II scheduled for cardiac surgery. However, bleeding complications were observed in patients with renal impairment. In vitro hemodialysis (HD) has been questioned over its efficacy in eliminating hirudin. Another approach to stop bleeding is the application of recombinant factor VIIa (rFVIIa). We report on a patient with HIT II and chronic renal failure who suffered from severe hirudin-induced bleeding after cardiac surgery who was safely treated with a combined approach of surgical hemostasis, substitution of blood products, HD, and rFVIIa to stop finally bleeding.

Anticoagulants↗
PubMed2005

The functional integrity of platelets in volume-reduced platelet concentrates.

Premature and low-birth-weight infants usually require small-volume platelet transfusions to treat thrombocytopenia. Also, infants undergoing open-heart surgery with extracorporeal circulation and with compromised cardiac function are at risk for excessive intravascular volume. The small-volume platelet substitution can be achieved by dispensing an aliquot from the unit of a standard single-donor platelet concentrate (PC). Alternatively, there is an indication for volume reduction of PCs to maximize the number of platelets transfused in the smallest possible volume. We determined the spontaneous and induced activation of platelets before and after volume reduction in 20 consecutive single-donor-apheresis PCs. After a mean storage time of 2 days, the PCs were plasma-depleted by centrifugation. Spontaneous, adenosine diphosphate (ADP)-induced, and collagen-induced activation were determined by flow cytometry. Furthermore, ADP- and collagen-induced aggregation were measured. A total of 33.8% of platelets in standard PCs were activated spontaneously. Volume reduction of PCs led to a mild but significant increase of spontaneous activation of platelets (43.2%). Additionally, volume reduction resulted in an impaired ADP-induced aggregability of platelets, whereas collagen induction was unaffected. Transfusion of volume-reduced PCs is an effective alternative to use of standard PCs in patients at frequent risk for excessive intravascular volume, because equal volumes increase the platelet count twice as effectively.

Adenosine Diphosphate↗
PubMed2005

Validity and reliability of the DDS for severity of delirium in the ICU.

INTRODUCTION: Until now, there has been no gold standard for monitoring delirium in intensive care unit (ICU) patients. In this prospective cohort study, a new score, the Delirium Detection Score (DDS), for severity of delirium in the ICU was evaluated. METHODS: After ethical approval and written informed consent, intensive care doctors and nurses assessed 1073 consecutive patients in surgical ICUs using the DDS together with the Ramsay Sedation Scale (RSS). The DDS is composed of eight criteria (orientation, hallucination, agitation, anxiety, seizures, tremor, paroxysmal sweating, and altered sleep- wake rhythm). Additionally, intensive care doctors had to document the Sedation-Agitation Scale (SAS) combined with a defined clinical assessment. For interrater reliability, pair of evaluators assessed patients in a blinded fashion at the same time. RESULTS: RSS1 (9%) was associated with a significantly (p < 0.001) higher DDS than RSS levels 2-6. The DDS increased with the severity of delirium (p < 0.001). The receiver operating characteristics (ROC) for the differentiation between no delirium (SAS < 4) and symptoms of delirium at all (SAS 5-7) showed an area under the curve (AUC) of 0.802 (95% confidential interval (CI): 0.719-0.898; p < 0.001) and 69% sensitivity and 75% specificity was determined. For reliability, a Cronbach's alpha of 0.667 was calculated. The paired comparisons revealed an intraclass correlation between 0.642 and 0.758. CONCLUSION: The DDS demonstrated good validity with excellent sensitivity and specificity for delirium. The severity of delirium can be more accurately estimated by the DDS. By its composition of several items, the DDS might help to start a symptom-guided therapy immediately.

Aged↗
PubMed2004

Mild hypothermia after near drowning in twin toddlers.

INTRODUCTION: We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes. METHODS AND RESULTS: Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome. CONCLUSION: Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.

Bradycardia↗
PubMed2004

N-acetylcysteine decreases lactate signal intensities in liver tissue and improves liver function in septic shock patients, as shown by magnetic resonance spectroscopy: extended case report.

BACKGROUND: N-acetylcysteine (NAC) has been shown to improve splanchnic blood flow in experimental studies. This report evaluates the effects of NAC on liver perfusion and lactate signal intensities in the liver tissue of septic shock patients using proton magnetic resonance imaging and spectroscopy. Furthermore, the monoethylglycinexylidide (MEGX) test was used to investigate hepatic function. METHODS: Five septic shock patients received 150 mg/kg body weight NAC as an intravenous bolus injection over 15 min. Lidocaine was injected both prior to and following NAC administration in order to determine MEGX formation. Measurements (hemodynamics, oxygen transport-related variables, blood samples for lactate, liver-related markers) were performed 1 hour before and 1 hour after NAC injection. In addition to the proton magnetic resonance imaging patients received two proton magnetic resonance spectra, one prior to and one 30 min subsequent to the onset of the NAC infusion at a 1.5 Tesla clinical scanner, for measurement of liver perfusion and liver lactate signal intensity. MAIN FINDINGS: Following NAC infusion, the lactate signal intensity in the liver tissue showed a median decrease of 89% (11-99%), there was a median increase in liver perfusion of 41% (-14 to 559%), and the MEGX serum concentration increased three times (1.52-5.91). CONCLUSIONS: A decrease in the lactate signal intensity in the liver tissue and an increase in the MEGX serum concentration and in liver perfusion might indicate improved liver function as a result of NAC administration. Patients with compromised hepatosplanchnic function, such as patients with septic shock due to peritonitis, may therefore benefit from NAC therapy.

Acetylcysteine↗
PubMed2004

Intermittent hirudin versus continuous heparin for anticoagulation in continuous renal replacement therapy.

BACKGROUND: Besides possible bleeding complications a further problem in anticoagulation during continuous renal replacement therapy (CRRT) is the development of heparin-induced thrombocytopenia type II (HIT II) where further anticoagulation with heparin is contraindicated. The application of continuous hirudin as alternative for heparin caused bleeding complications by comparable filter efficacy. Aim of this prospective-controlled pilot study was to compare the efficacy and safety of intermittent hirudin and continuous heparin for anticoagulation during CRRT in critically ill patients. METHODS: 26 patients receiving CRRT were randomly allocated to two groups: Heparin group (14 patients): continuous administration of 250 IU/h heparin, dose was adjusted in 125 IU/h steps with a targeted activated clotting time (ACT) of 180-210 s. Hirudin group (12 patients): initial bolus application of 2-2-5 microg/kg hirudin, dose was adjusted in 2 microg/kg bolus steps with a targeted ecarin clotting time (ECT) >80 s. Observation time was 96 hours. RESULTS: Measured filter run time was virtually longer for heparin. No bleeding complications were observed in the hirudin group, two bleeding complications in the heparin group. CONCLUSIONS: Intermittent hirudin can be used safely for anticoagulation in CRRT. However, the in tendency better filter survival for heparin elucidates the need for further investigations to find the right dosage equilibrium between filter clotting and bleeding complications.

Acute Kidney Injury↗