Wie balanciert sollte eine kristalloide Lösung sein?

Die Anaesthesiologie -     

Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha)

Ohne Zusammenfassung Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR) in Zusammenarbeit mit der Deutschen Gesellschaft für Rehabilitationswissenschaften e.V. (DGRW) und der Deutschen Gesellschaft für Sportmedizin und Pr?vention e.V. (DGSP) Unter Mitarbeit von: Stephan B?hmen Kardiologische Abteilung, Reha-Zentrum Oldenburg, Oldenburg Gerd B?nner · Christian Holubarsch MEDIAN Kliniken Bad Krozingen, Klinik Lazariterhof/Klinik Baden – Privatklinik, Bad Krozingen Curt Diehm Innere Medizin, Klinikum Karlsbad-Langensteinbach, Karlsbad Hermann Faller Institut für Psychotherapie und medizinische Psychologie, Universit?t Würzburg Helmut Gohlke · Christa Gohlke-B?rwolf Wolfgang Langosch Herzzentrum Bad Krozingen, Bad Krozingen Gesine Grande Hochschule für Technik, Wirtschaft und Kultur (HTWK), Leipzig Klaus G?tzmann Postfach 468, Waldkirch bei Freiburg Harry Hahmann Klinik Schwabenland, Isny-Neutrauchburg Rainer Hambrecht Klinik für Kardiologie, Klinikum Links der Weser, Bremen Christoph Herrmann-Lingen Klinik für Psychosomatische Medizin und Psychotherapie, Universit?t Marburg Stephan Jacob Forum für Vaskul?re Medizin, Brombeerweg 6, Villingen-Schwenningen Ulrich Keil Institut für Epidemiologie und Sozialmedizin, Universit?tsklinikum Münster Ellen Kuhlmann Zentrum für Sozialpolitik, Abt. Geschlechterpolitik im Wohlfahrtsstaat, Uni Bremen Wolfgang Mayer-Berger Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, Leichlingen Olaf Schulz Kardiologische Praxisgemeinschaft am Klinikum Spandau, Berlin Joachim Thiery Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universit?tsklinikum Leipzig, Leipzig Diethelm Tsch?pe Herz- und Diabeteszentrum NRW, Bad Oeynhausen Helmut Teschler Abt. Pneumologie, Ruhrlandklinik – Universit?tsklinik, Essen Claudia Wilhelm Klinik Falkenburg, Bad Herrenalb Alfred Wirth Teutoburger-Wald-Klinik, Bad Rothenfelde Horst Zebe Am Unterscheid 2, Bad Wildungen Redaktionelle Assistenz: Kristina Korinth · Erika Winterhalter Deutsche Gesellschaft für Pr?vention und Rehabilitation von Herz-Kreislauferkrankungen e.V., DGPR     

Craniosynostosis in cherubism

Cherubism is a rare autosomal dominant fibro‐osseous disorder that affects almost exclusively maxilla and mandible. Extracranial skeletal involvement is rare. We report on three affected males in three generations. The youngest affected relative was examined at age 4 months. He also had craniosynostosis. His affected father and grandfather had cherubism and clubbing of the fingers. Cherubism was mapped to region 4p16. Because of the associated craniosynostosis, we excluded the FGFR3 gene as a candidate gene for cherubism. Am. J. Med. Genet. 95:325–331, 2000. © 2000 Wiley‐Liss, Inc.     

Application of mycobacterial proteomics to vaccine design: improved protection by Mycobacterium bovis BCG prime-Rv3407 DNA boost vaccination against tuberculosis

Information from comparative proteome analysis of Mycobacterium tuberculosis and Mycobacterium bovis bacillus Calmette-Guerin (BCG) principally allows prediction of potential vaccine candidates. Thirty-six M. tuberculosis DNA vaccine candidates identified by comparative proteome analysis were evaluated in the mouse model for protection against low-dose aerosol M. tuberculosis infection. We identified the DNA vaccine candidate Rv3407 as a protective antigen and analyzed putative major histocompatibility complex class I epitopes by computational predictions and gamma interferon Elispot assays. Importantly, we discovered that the DNA vaccine Rv3407 improved the efficacy of BCG vaccination in a heterologous prime-boost vaccination protocol. Our data demonstrate the rationale of a combination of proteomics, epitope prediction, and broad screening of putative antigens for identification of novel DNA vaccine candidates. Furthermore, our experiments show that heterologous prime-boost vaccination with a defined antigen boost "on top" of a BCG primer provides superior protection against tuberculosis over vaccination with BCG alone.     

Diagnostic value of ambulatory Holter monitoring for the detection of coronary artery disease in patients with variable threshold angina pectoris

Patients with chronic stable angina pectoris may present with either fixed or variable threshold symptoms. To evaluate the diagnostic value of ambulatory Holter monitoring for the detection of coronary artery disease (CAD) in patients with variable threshold angina, 216 consecutive candidates for coronary angiography were investigated prospectively. For comparison, a group of 55 consecutive patients with fixed threshold angina was studied under the same conditions. Patients with prior myocardial infarction or angiographically documented CAD were excluded. Within 4 months of Holter monitoring, the advised coronary angiography was performed in 77% of the patients with variable threshold angina and in 89% of the patients with fixed threshold angina (p less than 0.05). The prevalence of CAD was markedly lower in patients with variable threshold angina compared to patients with fixed threshold angina (54 vs 90%, p less than 0.001). CAD patients of both subgroups, however, did not differ significantly with respect to the number of obstructed vessels, the Gensini coronary score, the number with impaired left ventricular function (ejection fraction less than 50%) or the duration of ischemic episodes during Holter monitoring. Diagnostic accuracy of Holter monitoring did not differ between variable and fixed threshold angina groups (67 vs 78%). In 91% of the patients results obtained by Holter monitoring could be compared to the results of a bicycle stress test. In patients with fixed threshold angina the diagnostic accuracy was similar for both tests (80 vs 80%). In patients with variable threshold angina, the diagnostic accuracy of Holter monitoring exceeded that of the exercise stress test (68 vs 55%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous coronary intervention for acute coronary syndrome due to graft failure

Objectives : To describe clinical outcome after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) due to graft failure. Background : Limited data are available on outcome after PCI for graft failure‐induced ACS in the drug‐eluting stent (DES) era. Methods : Patients were identified who underwent PCI either with DES or BMS for ACS due to graft failure between January 2003 and December 2008. Follow‐up was performed at 1 year and April 2011. The primary endpoint was the composite of death, myocardial infarction (MI), or target vessel revascularization (TVR). Kaplan–Meier estimates were calculated at 1 and 5‐year follow‐up. Predictors were identified by backward selection in Cox proportional hazards models. Results : A total of 92 patients underwent PCI, of which 77 were treated with bare metal stents (BMS) and 15 with DES. Patient and procedural characteristics were similar in both groups. Mean follow‐up was 3.2 years. Five‐year composite event rate was 65.9% after BMS vs. 43.4% after DES implantation (P = 0.17). Individual endpoints were comparable in both groups. Recurrence of angina, hospitalization, and repeat interventions were similar. After multivariable adjustment, the use of DES was not associated with a significant reduction in the primary endpoint (HR = 0.44, 0.18–1.04, p = 0.06). Conclusion : In patients presenting with ACS due to acute graft failure, long‐term outcomes remain poor. In a nonrandomized comparison with BMS, DES use was not associated with significant improved long‐term clinical outcomes. © 2012 Wiley Periodicals, Inc.     

Disturbed function of the blood–cerebrospinal fluid barrier aggravates neuro-inflammation

Multiple sclerosis (MS) is a chronic neuro-inflammatory disorder, which is marked by the invasion of the central nervous system by monocyte-derived macrophages and autoreactive T cells across the brain vasculature. Data from experimental animal models recently implied that the passage of leukocytes across the brain vasculature is preceded by their traversal across the blood–cerebrospinal fluid barrier (BCSFB) of the choroid plexus. The correlation between the presence of leukocytes in the CSF of patients suffering from MS and the number of inflammatory lesions as detected by magnetic resonance imaging suggests that inflammation at the choroid plexus contributes to the disease, although in a yet unknown fashion. We here provide first insights into the involvement of the choroid plexus in the onset and severity of the disease and in particular address the role of the tight junction protein claudin-3 (CLDN3) in this process. Detailed analysis of human post-mortem brain tissue revealed a selective loss of CLDN3 at the choroid plexus in MS patients compared to control tissues. Importantly, mice that lack CLDN3 have an impaired BCSFB and experience a more rapid onset and exacerbated clinical signs of experimental autoimmune encephalomyelitis, which coincides with enhanced levels of infiltrated leukocytes in their CSF. Together, this study highlights a profound role for the choroid plexus in the pathogenesis of multiple sclerosis, and implies that CLDN3 may be regarded as a crucial and novel determinant of BCSFB integrity.