Biomedical subjects

Ehud Klein

Publications and source records attributed to Ehud Klein.

At least 19 recordsLinked to original sources

PubMed2006

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury.

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.

Brain Injuries↗

PubMed2006

Injury increases the risk for PTSD: an examination of potential neurobiological and psychological mediators.

A growing number of common traumatic events involve both physical and emotional injuries. In contrast to previously held beliefs, the rapidly growing body of literature shows quite convincingly that physical injury, over and above exposure to the traumatic event itself, increases rather than decreases the risk for posttraumatic stress disorder (PTSD). A pertinent question becomes how bodily injury contributes to the risk of developing PTSD. In this article, we review contemporary findings regarding the neurobiological and psychological mechanisms by which bodily injury may augment or independently contribute to chronic posttraumatic stress. In addition, we propose three theoretical pathways through which physical injury can increase the risk for PTSD. These pathways are: additive, unique, and recovery impeding. Finally, we highlight unresolved issues pertaining to each one of these pathways and propose directions for future research to address them.

Amygdala↗

PubMed2005

Alterations in cell adhesion molecule L1 and functionally related genes in major depression: a postmortem study.

BACKGROUND: Current research in depression aims to delineate genes involved in neuronal plasticity that are altered in the disease or its treatment. We have shown antidepressant induced increases in three interrelated genes, cell adhesion molecule L1 (CAM-L1), laminin, and cAMP response element binding protein (CREB), and a reciprocal decrease in these genes consequent to stress. Presently we hypothesized that CAM-L1, CREB, and laminin may be altered in post mortem brains of depressed subjects. METHODS: Studies were performed in the prefrontal and in the ventral parieto-occipital cortices, of 59 brains from depressed, bipolar, and schizophrenic subjects, and normal controls, obtained from the Stanley Foundation Brain Collection. mRNA and protein levels were determined by RT-PCR and Western blot analysis, respectively. RESULTS: Levels of CAM-L1 and of phosphorylated CREB (pCREB) were increased in the prefrontal cortex of the depressed group, while CAM-L1, laminin and pCREB were decreased in the parieto-occipital cortex. Depressed subjects receiving antidepressants differed from subjects not receiving antidepressants in the expression of CAM-L1 and laminin in the parieto-occipital cortex, and in the expression of pCREB in the prefrontal cortex. CONCLUSIONS: The present findings of specific alterations in depression and antidepressant treatment particularly in CAM-L1 suggest that this gene may play an important role in the pathophysiology and treatment of depression.

Adult↗

PubMed2005

Effect of electroconvulsive therapy on cortical excitability in patients with major depression: a transcranial magnetic stimulation study.

OBJECTIVE: The antidepressant action of electro-convulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) may be related to their ability to modulate cortical excitability. The aim of this study was to investigate changes in cortical excitability following ECT in patients with major depression (MD) and to compare therapeutic efficacy of ECT combined with rTMS to that of ECT alone. METHODS: Twenty-two patients with MD were assigned to receive ECT and right prefrontal 1 Hz rTMS (n=12) or ECT with sham rTMS (n=10). ECT was given twice weekly and rTMS was applied on the remaining 4 days, throughout 3 weeks. The resting motor threshold (rMT) and motor evoked potential (MEP)/M-wave area ratio were evaluated before and 6 h after the first, third and sixth ECT session. The active motor threshold (aMT), intra-cortical inhibition (ICI) and intra-cortical facilitation (ICF) were measured at baseline and 24 h after the last ECT. RESULTS: There were no significant differences in the degree of clinical improvement and measures of cortical excitability in the ECT+active rTMS group as compared to the ECT+sham rTMS group. Marked clinical improvement observed in 19 out of the 22 patients was associated with a significant increase of the MEP/M-wave area ratio, decrease of the aMT and reduction of the ICI in the left hemisphere. CONCLUSIONS: The antidepressant effect of ECT was associated with an enhancement of left hemispheric excitability. rTMS did not add to the beneficial effect of ECT. However, the small sample size and the robust effect of ECT might have obscured a potential therapeutic effect of rTMS. SIGNIFICANCE: Measures of cortical excitability may provide insight to our understanding of the mechanism of action of ECT and might be useful for the assessment of treatment response.

Aged↗

PubMed2005

Risk factors associated with the development of postpartum mood disorders.

BACKGROUND: Various factors have been reported to be associated with the development of postpartum mood disorders. The relationship between postpartum mood disorders and putatively hormone-related phenomena such as premenstrual dysphoric disorder (PMDD) is unclear. This study attempts to determine whether such mood phenomena are risk factors for postpartum mood disorders. METHODS: Postpartum women (n=1800) were assessed for risk factors for postpartum mood disorders during the first 2-4 days after parturition. Of these, 133 were defined as "high risk" and 109 as "low risk" according to fixed criteria. A structured phone diagnostic interview was performed at 6-8 weeks postpartum to assess for the presence of postpartum depression or the blues. RESULTS: Premenstrual dysphoric disorder (PMDD), mood symptoms during the first 2-4 days postpartum, a past history of depression and mood symptoms during past oral contraceptive use, were found to be significant risk factors for postpartum mood disorders. Women at high risk for postpartum mood disorders had a 9.3-, 1.5-, 1.6- and 2.6-fold increase in risk for major depression, minor depression, the blues and adjustment disorder respectively compared to women at low risk. LIMITATIONS: While the study design is prospective, it is limited by the retrospective assessment of risk factors. CONCLUSIONS: This study provides preliminary evidence that putatively hormone-related phenomena such as PMDD are related to the occurrence of postpartum mood disorders. The results go some way to support the hypothesis that the etiology for postpartum mood disorders may be related to differential hormonal sensitivity. Such risk factors should be included in any assessment of the risk for these disorders.

Adult↗

PubMed2005

Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study.

OBJECTIVE: The present study examined prospectively the relationship between memory of the traumatic event and subsequent development of posttraumatic stress disorder (PTSD). More specifically, the aims of this study were to 1) investigate the possibility that lack of memory of the traumatic event might be a protective factor; 2) assess whether memory of the traumatic event equally affects the three symptom clusters of PTSD: reexperiencing, avoidance, and hyperarousal; and 3) explore the predictive value of memory of the traumatic event for the development of subsequent PTSD in the immediate aftermath of the event. METHOD: One hundred twenty subjects with mild traumatic brain injury who were hospitalized for observation were assessed immediately after the trauma and followed up 1 week, 3 months, and 6 months later. All participants underwent psychiatric evaluation and self-assessment of their memory of the traumatic event. RESULTS: Overall, 17 (14%) of the participants met full criteria for PTSD at 6 months. Subjects with memory of the traumatic event were significantly more likely to develop PTSD than those without memory of the traumatic event; the difference between the groups resulted primarily from the reexperiencing cluster. Logistic regression analysis revealed that memory of the traumatic event within the first 24 hours is a strong predictor of PTSD 6 months after the event. CONCLUSIONS: Our study indicated that memory of a traumatic event is a strong predictor and a potential risk factor for subsequent development of PTSD. Future studies are needed to show whether these findings can be generalized to other traumatic conditions.

Adult↗

PubMed2004

Antidepressant effects of different schedules of repetitive transcranial magnetic stimulation vs. clomipramine in patients with major depression: relationship to changes in cortical excitability.

The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) that have been demonstrated in recent studies could be related to its ability to modulate cortical excitability. Yet, the relationship between stimulus location and frequency and treatment outcome has not been established. The aim of the present study was to compare efficacy of rTMS in various configurations and clomipramine treatment in patients with major depression (MD) and to evaluate the relationship between clinical outcome and changes in cortical excitability. Fifty-nine MD patients were randomized to receive (1) left (n = 12) or right (n = 12) 3 Hz rTMS with placebo medication; (2) left (n = 10) or right (n = 9) 10 Hz rTMS with placebo medication; (3) active medication (clomipramine) with sham rTMS (n = 16). Both 3 Hz and 10 Hz rTMS were administered to the prefrontal cortex by a circular coil at an intensity of 110% and 100% of the resting motor threshold (rMT) respectively. Measurements of cortical excitability were performed prior to and 24 h after completion of 2 wk of daily rTMS or pharmacological treatments. These included the rMT, silent period threshold (SPT), inter-threshold difference (ITD), MEP/M-wave amplitude ratio and silent period duration (SPD). Severity of depression was blindly assessed by the Hamilton Depression Rating Scale (HDRS). The best improvement scores were seen in patients who received left 3 Hz rTMS. The 10 Hz rTMS treatment was less tolerated resulting in a significantly higher dropout rate. A significant increase of the MEP/M wave amplitude ratio accompanied by a shortening of the SPD was evidenced in patients who showed marked clinical improvement (reduction in HDRS by 50% or more) following left rTMS regardless of stimulation frequency. Our results suggest that 3 Hz left rTMS has a higher therapeutic efficacy and tolerability in patients with MD. The enhancement of cortical excitability may be related to the antidepressant action of rTMS.

Aged↗

PubMed2004

The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study.

The aim of the present study was to explore the neuropsychological basis of insight in first-episode schizophrenia, by evaluating its differential and joint links with cognitive vs. metacognitive performance. Thirty first-episode patients were assessed with the Scale of Unawareness of Mental Disorder (SUMD) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback), and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "volunteered" sort received a bonus of 10 cents if correct, but an equal penalty if wrong. Insight into illness had higher correlations with free-choice metacognitive indices derived from confidence ratings and volunteered sorts than with the conventional scores from the WCST. Moreover, prediction of poor insight was significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures, but not the other way around. These preliminary results suggest that metacognition is an important mediator between basic cognitive deficits and poor insight, and might be even more relevant to poor insight than cognitive deficits per se.

Adult↗

PubMed2004

Mitochondrial complex I subunits expression is altered in schizophrenia: a postmortem study.

BACKGROUND: Several independent lines of evidence indicate mitochondrial dysfunction in schizophrenia in the brain and periphery, including mitochondrial hypoplasia, dysfunction of the oxidative phosphorylation system, and altered mitochondrial-related gene expression. METHODS: In this study, three subunits of mitochondrial complex I were analyzed at the level of mRNA and protein in postmortem brain specimens from the prefrontal and the ventral parietooccipital cortex of patients with schizophrenia, major depression, bipolar disorder, and normal control subjects. RESULTS: Both mRNA and protein levels of the 24-kDa and 51-kDa subunits of complex I were significantly decreased in the prefrontal cortex, but increased in the ventral parietooccipital cortices of schizophrenia patients compared with normal control subjects. In the latter region, protein levels of both subunits were increased in bipolar patients as well, being in line with the significant overlap in clinical symptoms between schizophrenia and bipolar patients. No change was observed in the 75-kDa subunit expression in the prefrontal cortex. CONCLUSIONS: The schizophrenia-specific reduction in complex I subunits in the prefrontal cortex is consistent with one of schizophrenia's most prominent deficits, namely, hypofrontality, thus further supporting the hypothesis of mitochondrial dysfunction in this disorder. The abnormal, bidirectional expression of complex I in various brain regions, rather than in a circumscribed area, supports the idea of impaired cerebral circuitry in schizophrenia.

Adult↗

PubMed2004

Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias.

BACKGROUND: Minimally invasive laparoscopic total extraperitoneal (LTEP) repair of bilateral and/or recurrent groin hernias has been popularized as one of the procedures of choice in the past decade. The early postoperative course is uneventful in most cases. A few patients, however, will develop temporary postoperative groin swelling. The aim of our study was to evaluate clinical and sonographic findings in the groin during the early postoperative period following LTEP. METHOD: One hundred and five consecutive patients with primary bilateral (n = 90), recurrent unilateral (n = 12), and primary unilateral (n =3) groin hernias operated on during an 18-month period underwent clinical and sonographic examination two to three weeks after LTEP. RESULTS: On clinical examination, a localized groin swelling was found in 21 patients (20%). The most frequent sonographic findings were localized groin collections compatible with seroma or hematoma, found in 35 patients (33%). Hypoechoic diffuse tissue swelling around the mesh, lipomas, and residual hernias was found in four patients each (4%). None of the patients with hypoecoic mass had any clinical manifestations postoperatively. Extraperitoneal close suction drains were left for 8-12 hours in 46 patients. The average volume of fluid drained was 62 mL (range, 30-200 mL). There was no correlation between the use of suction drains and the frequency of fluid collections detected on sonography. Cord lipoma was detected postoperatively in four patients and was excised in one using an open anterior approach. Residual or recurrent hernia was detected postoperatively on sonography in four patients, but only one developed a symptomatic and clinically detectable hernia during eight months of follow-up. Overall, postoperative ultrasonographic findings following LTEP repair were found in 37% of patients. CONCLUSION: Clinical and sonographic findings such as localized fluid collections compatible with seroma or hematoma are common following LTEP. Postoperative suction drains did not reduce the frequency of sonographically detected collections. The clinical relevance of suspected postoperative hernia detected on sonography without clinical manifestations remains uncertain, and has to be determined on long-term follow-up.

Female↗

PubMed2003

Modulation of frequency and duration of repetitive magnetic stimulation affects catecholamine levels and tyrosine hydroxylase activity in human neuroblastoma cells: implication for the antidepressant effect of rTMS.

Transcranial magnetic stimulation (TMS), which is produced by strong non-static magnetic fields, is a non-invasive means to stimulate the cerebral cortex. Studies from recent years show that TMS affects mood in healthy subjects and improves depressive symptoms in patients with major depression. However, the relationship between the clinical efficacy of TMS and stimulation parameters is still obscure. In the present study we have investigated the effects of different stimulation frequencies and number of treatments on catecholamine turnover in SH-SY5Y cell cultures. A single session of magnetic stimulation (1.7 T) caused a significant decrease in intracellular dopamine and L-DOPA and in noradrenaline (NE) release at a rate of 3 Hz for 10 s but increased NE release at a rate of 9 Hz. These alterations were associated with a reduction (47.8%) or an increase (48%) in tyrosine hydroxylase (TH) activity after 3 and 9 Hz magnetic stimulation, respectively. The latter may be related to the known sensitivity of TH to neuronal firing rates and NE concentrations. Higher stimulation frequencies (15, 20, 45 Hz) had no effect on catecholamine metabolism. Unlike 3 Hz acute treatment, chronic treatment (3 Hz, 11 sessions, for 4 d) had no effect on monoamines and TH activity was increased by 54.5% with no change in its protein level. The results of the present study demonstrate that in tissue culture system frequency and treatment duration of the magnetic stimulation are important factors in affecting catecholamine turnover. Considering the major role of catecholamine in the pathophysiology of depression, these findings may be of relevance to the application of rTMS in humans with major depression.

Blotting, Western↗

PubMed2003

Sleep complaints are not corroborated by objective sleep measures in post-traumatic stress disorder: a 1-year prospective study in survivors of motor vehicle crashes.

Disturbed sleep is a common complaint among patients with post-traumatic stress disorder (PTSD). However, laboratory studies of sleep in PTSD have provided inconsistent evidence of objective sleep disturbances. A major shortcoming of most previous studies is the fact that they were performed retrospectively in patients with chronic PTSD, often complicated by comorbid psychiatric disorders and drug abuse. Thus, little is known about the development of sleep disturbances in recently traumatized subjects. In this study, 102 motor vehicle collision (MVC) survivors were followed from the time of collision throughout 1 year. Nineteen subjects hospitalized for elective surgery served as a comparison group. Subjective quality of sleep was assessed using the mini-Sleep Questionnaire and the Sleep Habit Questionnaire. In addition, a 48-h actigraphic recording was obtained 1 week, 3 and 12 months after the collision. At 12 months, a structured clinical interview (SCID) was administered to reach a formal diagnosis of PTSD. Twenty-six of the MVC survivors, but none of the comparison subjects, met the diagnostic criteria for PTSD. While MVC survivors with PTSD reported markedly poorer sleep as reflected by significantly higher scores on the mini-Sleep Questionnaire, there were no significant differences between the three groups on the actigraphic measures that were largely normal. These results, which were obtained in subjects with no evidence of active psychiatric symptoms at the time of trauma and free of psychotropic or hypnotic medications, further support previous polysomnographic (PSG) studies suggesting that altered sleep perception, rather than sleep disturbance per se, may be the key problem in PTSD.

Accidents, Traffic↗

PubMed2003

The relation between memory of the traumatic event and PTSD: evidence from studies of traumatic brain injury.

OBJECTIVE: This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occurring model for traumatic exposure that is often associated with memory impairment. METHOD: We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group. RESULTS: The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors--even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD. CONCLUSIONS: The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of traumatic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired--or even old--traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.

Brain Injuries↗

PubMed2002

Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines.

DBCP who are aware of their increased risk of developing breast cancer may suffer from high emotional distress. Chronic stress may interfere with NCA and low NCA is associated with increased cancer risk. We studied 80 DBCP and 47 age- and education-matched healthy females (controls). Heparinized venous blood (30 ml) was drawn from all subjects between 8 and 9 A.M., and each participant answered a set of psychologic questionnaires. In addition, the first-morning urine sample was collected. DBCP scored significantly higher in emotional distress compared to controls. Levels of stress hormones in DBCP were higher and in vitro secretion of IL-2, IL-12 and IFN-gamma lower compared to controls. NCA against NK-resistant (MCF-7, COLO-205, U937) and NK-sensitive (K562) cell lines was significantly lower in DBCP and much less augmented by in vitro preincubation with IL-2 or IL-12 compared to controls. NCA and in vitro Th1 cytokine secretion were inversely correlated with the degree of emotional distress and the level of stress hormones in blood or urine. High emotional distress and elevated levels of stress hormones are associated with impaired immune surveillance functions in DBCP. This may contribute to the increased risk of DBCP to develop breast cancer. An interventional trial to enhance coping and reduce stress levels may help to decrease the risk for breast cancer onset in DBCP.

Adult↗

PubMed2002

Norepinephrine alters the expression of genes involved in neuronal sprouting and differentiation: relevance for major depression and antidepressant mechanisms.

Recent research into depression has focused on the involvement of long-term intracellular processes, leading to abnormal neuronal plasticity in brains of depressed patients, and reversed by antidepressant treatment. Given a suggested decrease in noradrenergic transmission in depression, and an antidepressant induced increase in norepinephrine (NE) level, a possible role for NE in mediating alterations in neuronal morphology and plasticity was examined. Human neuroblastoma SH-SY5Y cells treated with 10-5 m NE presented an elongated granule-rich cell-body and increased number of neurites, when compared with non-treated cells. Moreover, cell survival was enhanced in the presence of NE, while proliferation was inhibited. The above effects suggest a role for NE in cell differentiation. Indeed similar effects on cell survival and neurite outgrowth were induced in SH-SY5Y cells by retinoic acid (RA), an established differentiating agent. Finally, NE treatment resulted in a progressive decrease in the pluripotent marker Oct4 and an increase in the neuronal growth cone marker, growth-associated-protein 43 (GAP-43). Alongside these effects, NE-treated cells presented alterations in the expression of 44 genes as observed in a neurobiology cDNA microarray. Among the altered genes, an increase in the expression level of two neurite-outgrowth promoting genes, neural cell adhesion molecule L1 and laminin, was confirmed by RT-PCR. Taken together, the results support a role for NE in processes of synaptic connectivity, and may point to a role for this neurotransmitter in mediating the suggested neuronal plasticity in depression and in antidepressant treatment.

3,4-Dihydroxyphenylacetic Acid↗

PubMed2002

Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents.

OBJECTIVE: Disturbed sleep is a common complaint among patients with posttraumatic stress disorder (PTSD) that appears in the reexperiencing and hyperarousal symptom clusters in DSM-IV. The causal relationship between sleep complaints and PTSD is unclear. METHOD: Self-reported insomnia and excessive daytime sleepiness were assessed in 102 victims of motor vehicle accidents and 19 comparison subjects 1 week and 1, 3, 6, and 12 months after the trauma. At 12 months the Structured Clinical Interview for DSM-III-R was administered to determine diagnoses of PTSD. RESULTS: Twenty-six of the accident victims but none of the comparison subjects met the criteria for PTSD. Logistic regression models indicated that sleep complaints from 1 month on were significant in predicting PTSD at 1 year. CONCLUSIONS: These results suggest that on the basis of sleep complaints as early as 1 month after the trauma, it is possible to detect subjects who will later develop chronic PTSD.

Accidents, Traffic↗

PubMed2002

No evidence of sleep disturbance in post-traumatic stress disorder: a polysomnographic study in injured victims of traffic accidents.

BACKGROUND: Disturbed sleep is a common complaint among patients with PTSD. This complaint can be found in both the reexperiencing and hyperarousal symptom clusters in the DSM-IV. However, laboratory studies of sleep in PTSD have provided inconsistent evidence of objective sleep disturbances. Shortened REM latency, reduced sleep efficiency, restless sleep and increased prevalence of sleep apnea have been reported, but were not confirmed by all. A major shortcoming of most previous studies is the fact that they were done retrospectively in patients with chronic PTSD, often complicated by psychiatric comorbidity and drug abuse. Thus, little is known about the development of sleep disturbances in recently traumatized subjects. METHOD: Eight injured victims of traffic accidents with PTSD and 6 injured victims without PTSD participated in a 3-night polysomnographic study one year after the accident. RESULTS: No significant differences between PTSD and non-PTSD patients were noted on any of the PSG measures. In addition, the two groups did not differ significantly from each other with respect to awakening thresholds during REM sleep. CONCLUSION: Considering that the present sample was free of active psychiatric comorbidity at the time of trauma and free of hypnotic medications, these results strengthen previous PSG studies suggesting that altered sleep perception, rather than sleep disturbance per se, may be the key problem in PTSD. More research is needed in order to examine whether this problem is specific to sleep or generalizes to other domains as well.

Accidents, Traffic↗

PubMed2002

Should aspirin therapy be withheld before insertion and/or removal of a permanent peritoneal dialysis catheter?

The necessity of withdrawal of aspirin [acetylsalicylic acid (ASA)] for fear of perioperative or postoperative bleeding in patients about to undergo surgery is as yet controversial. In this study we prospectively evaluated the effect of ASA on postoperative bleeding in end-stage renal failure patients who underwent insertion, removal, and/or replacement of a peritoneal dialysis (PD) catheter at our institution from November 1999 to March 2001. During the study period 52 of the above procedures were consecutively performed in 46 patients. Patients whose catheters were removed as a result of refractory peritonitis were excluded from the study. In all cases the PD catheter used was the coiled two-cuff Tenckhoff (NIPRO, Manchester, GA) catheter and the surgery was performed in the operating room under local anesthesia. No drains were left in the operating wound. Postoperative bleeding (wound hematoma or persistent oozing from the incision or exit site) was classified as either minor (requiring no professional intervention and/or blood replacement) or major [necessitating blood transfusion (> or = 1 unit red blood cells). Of the 52 procedures 29 (in 24 patients) were performed while the patient was receiving aspirin at the time of operation (aspirin group). The remaining 23 were without aspirin and constituted the control group. ASA dose was 100 mg/day in all but three who were on buffered ASA (325 mg/day). The groups were well matched with regard to age; sex; mean residual renal function; and preoperative international normalized ratio, activated partial thromboplastin time, and platelet count. In no case was there significant intraoperative bleeding. There were five (17.2%) and three (13.0%) minor bleeds in the aspirin group and control group, respectively. One major bleed occurred in the control group ending in an exploratory laparotomy. Of the nine bleeding complications six were observed after catheter removal. From these data we conclude that PD catheter insertion/removal can be safely performed under conventional low-dose aspirin therapy.

Aged↗