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Claudia Spies

Publications and source records attributed to Claudia Spies.

45 records · Page 3Linked to original sources
PubMed2004

Molecular adsorbents recirculating system dialysis for liver insufficiency and sepsis following right ventricular assist device after cardiac surgery.

We report a case of right heart failure (RHF) and sepsis with liver insufficiency in a 70-year-old patient after coronary artery bypass graft surgery. Three hours after surgery the patient suddenly developed therapy refractory cardiac arrest caused by RHF. He had to have emergency surgery, under which the graft to the right coronary artery was revised and a right ventricular assist device was implanted. Heart function recovered and the assist device was explanted on day 1 after surgery. Thoracic closure was performed on day 5 after surgery. The patient went into septic shock on day 11. Liver dysfunction developed postoperatively and worsened the course of sepsis. Therefore, MARS (molecular adsorbents recirculating system) dialysis was performed once on day 20 after surgery. Liver function improved after MARS therapy and the patient recovered from sepsis. On day 46 the patient was transferred from the ICU of another hospital to one of the peripheral wards, to be finally discharged on day 67.

Aged↗
PubMed2003

Effects of C1 esterase inhibitor administration on intestinal functional capillary density, leukocyte adherence and mesenteric plasma extravasation during experimental endotoxemia.

OBJECTIVE: To determine the effects of C1 esterase inhibitor (C1-INH) administration on intestinal functional capillary density, leukocyte adherence, and mesenteric plasma extravasation during experimental endotoxemia. DESIGN AND SETTING: Prospective, randomized, controlled animal study in the experimental laboratory of a university. SUBJECTS: 42 male Wistar rats. INTERVENTIONS: The animals were divided into three groups. One half of the animals of each group underwent studies of intestinal functional capillary density and leukocyte adherence on venular endothelium by intravital fluorescence microscopy. In the other half of the animals mesenteric plasma extravasation (FITC albumin) was determined by intravital fluorescence microscopy. Treatment groups received endotoxin infusion of 2.5 mg/kg per hour (group 2 and 3) and 100 U/kg b.w. C1-INH (group 3) during the 2 h of endotoxemia. MEASUREMENTS AND RESULTS: Endotoxemia resulted in a significant decrease in mucosal functional capillary density (18.5% vs. controls), which was reduced by C1-INH administration (9.5%). Treatment with C1-INH also significantly attenuated intestinal leukocyte adherence in submucosal venules (35% vs. endotoxin group) and mesenteric plasma extravasation (44% vs. endotoxin group). CONCLUSIONS: C1-INH administration diminishes endotoxin-induced changes in the intestinal microcirculation during experimental endotoxemia.

Animals↗
PubMed2003

[The alcoholic patient in the daily routine].

Chronic alcohol abuse is of significant clinical and economic relevance. A major part of internal medical pathology is associated with chronic alcoholism. 50% of all accidents with subsequent traumatic injuries are related to alcohol intake. Patients who are chronic alcohol abusers have prolonged hospital stays and substantial increases in postoperative morbidity. A sophisticated diagnosis of alcoholism within standard clinical routine is often difficult, and in most cases the treatment of alcohol-related diseases and complications is protracted and requires increased energy expenditure by the treating physicians. In surgical patients, chronic alcohol abuse is associated with a 3- to 4-fold risk of infections, sepsis, cardiac and bleeding complications. Therefore, the patients themselves, along with the general practitioner and an in-hospital interdisciplinary team should cooperate in medical and operative treatment in order to attain better clinical outcome. Each patient history should include a detailed assessment of the quantity of daily alcohol intake. Alcoholic diagnostic regimens including questionnaires (i.e. CAGE, AUDIT) in combination with specific laboratory markers (CDT, GGT, MCV), if implemented, could prove valuable, especially in cases where major surgical procedures are considered. Strict abstinence by alcoholic patients with organ pathology in medical and elective surgical settings as well as the prophylactic treatment of pre-operative alcohol withdrawal appear to be useful strategies to reduce the risk of complications. Short-term interventions are associated with reduced alcohol intake and decreased incidence of re-trauma. Considering the clinical relevance of alcohol abuse, sufficient screening, interventions, and open approaches to address alcohol problems should be important components of the daily clinical routine in outpatient clinics, emergency rooms, in GPs' offices and in general hospitals.

Acute Disease↗
PubMed2003

Use of biomarkers for alcohol use disorders in clinical practice.

BACKGROUND: Biomedical markers may provide additive objective information in screening and confirmation of acute or recent consumption, intoxication, relapse, heavy drinking, hazardous/harmful use/abuse and dependence and alcohol use related organ dysfunction (alcohol use-related disorders: AUDs). AIMS: To review the use of biomarkers in clinical practice to detect AUDs. FINDINGS: About one-fifth of the patients seen in clinical practice have AUDs, which offer a variety of treatment options if diagnosed. The diagnosis of AUDs relies on clinical and alcohol-related history, physical examination, questionnaires and laboratory values. No clinical available laboratory test [e.g. for acute abuse: alcohol in blood or breath; for chronic alcohol abuse: gamma-glutamyl transferase (GGT), mean corpuscular volume (MCV), carbohydrate-deficient transferrin (CDT)] is reliable enough on its own to support a diagnosis of alcohol dependence, harmful use or abuse. Sensitivities, specificities and the predictive values may vary considerably according to patient and control group characteristics (e.g. gender, age or related comorbidity). In patient groups with limited cooperation markers may be helpful when considering treatment options. CONCLUSIONS: More research is needed to determine the value of markers (single or combined, with questionnaires) in the context of clinical decision-making algorithms in defined settings and with defined dichotomous outcome variables.

Age Factors↗
PubMed2002

Uncoupling protein 2 in primary pain and temperature afferents of the spinal cord.

Uncoupling protein 2 (UCP2) is a mitochondrial protonophore that regulates cellular energy homeostasis. In this study, we explored the expression of UCP2 in the spinal cord. UCP2 was expressed in the substantia gelatinosa and ventral horn of the rodent and primate spinal cord. In all of these areas, UCP2 expression was associated with axons and axon terminals and direct appositions between UCP2-immunoreactive fibers and NMDA glutamate receptors-containing perikarya were frequently detected. All of the UCP2-labeled processes were also immunoreactive for substance P. The expression of UCP2 in primary sensory afferents of the spinal cord suggests that this mitochondrial uncoupler is involved in the mechanism of pain and temperature sensation.

Afferent Pathways↗
PubMed2002

Uncoupling protein 2 (UCP2) lowers alcohol sensitivity and pain threshold.

Abuse of ethanol is a major risk factor in medicine, in part because of its widespread effect on the activity of the central nervous system, including behavior, pain, and temperature sensation. Uncoupling protein 2 (UCP2) is a mitochondrial protonophore that regulates cellular energy homeostasis. Its expression in mitochondria of axons and axon terminals of basal forebrain areas suggests that UCP2 may be involved in the regulation of complex neuronal responses to ethanol. We employed a paradigm in which acute exposure to ethanol induces tolerance and altered pain and temperature sensation. In UCP2 overexpressing mice, sensitivity to ethanol was decreased compared to that of wild-type animals, while UCP2 knockouts had increased ethanol sensitivity. In addition, UCP2 expression was inversely correlated with the impairment of pain and temperature sensation induced by ethanol. Taken together, these results indicate that UCP2, a mitochondrial uncoupling protein previously associated with peripheral energy expenditure, is involved in the mediation of acute ethanol exposure on the central nervous system. Enhancement of UCP2 activation after acute alcohol consumption might decrease the time of recovery from intoxication, whereas UCP2 inhibition might decrease the tolerance to ethanol.

Alcohol Drinking↗
PubMed2002

Recombinant factor VIIa after aortic valve replacement in a patient with osteogenesis imperfecta.

A 26-year-old man with osteogenesis imperfecta and severe aortic regurgitation was scheduled for aortic valve replacement. As previously described by other authors the operation was difficult owing to the friability and weakness of the tissues. Mean blood losses of 153 mL per hour during the first 7 postoperative hours were observed. Despite normal coagulation indicators the bleeding did not stop and recombinant factor VIIa was applied at 40 microg/kg. Bleeding was successfully stopped after this single application.

Adult↗
PubMed2002

Posttraumatic immune modulation in chronic alcoholics is associated with multiple organ dysfunction syndrome.

BACKGROUND: Patients with chronic alcohol abuse constitute approximately 50% of trauma care patients, and these patients have a two- to fourfold increase in posttraumatic infectious complications. Cytokines such as interleukin-6 (IL-6) and interleukin-10 (IL-10) and the adhesion molecule soluble endothelial selectin (sE-selectin) have been found to play an important role in the initial inflammatory response to trauma and the development of early and late multiple organ dysfunction syndrome (MODS). The aim of this study was to compare the immune modulation and clinical relevance between chronic alcoholic and nonalcoholic patients following trauma. METHODS: Sixty-three patients (37 alcohol abusers, 26 nonalcoholics) were included in this prospective controlled study. IL-6, IL-10, and sE-selectin were determined on admission and on days 2, 4, and 7 following admission to the ICU. RESULTS: On admission to the ICU but not on the following days of the study period, plasma IL-6, IL-10, and sE-selectin were significantly elevated in chronic alcoholic patients compared with nonalcoholics. The incidence of MODS was significantly higher in chronic alcoholic patients (89% vs. 50%, p < 0.01), whereas the incidence of pneumonia (35% vs. 19%, p < 0.17) and sepsis (14% vs. 0%, p < 0.07) did not reach statistical significance. CONCLUSION: The significantly elevated levels of IL-6, IL-10, and sE-selectin in chronic alcoholic trauma patients on admission to the ICU could play an important role in the development of MODS in intensive care. In patients with high levels of inflammatory mediators, immune modulatory treatment before the development of MODS may be considered.

APACHE↗