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Search Results: 1 - 10 of 193832 matches for " G von Bernuth "
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Systemic inflammatory response to cardiac surgery: does female sex really protect?
Marie-Christine Seghaye, Ma Qing, G?tz von Bernuth
Critical Care , 2001, DOI: 10.1186/cc1047
Abstract: In a report published in this issue of Critical Care, Trotter et al. [1] draw attention to the possibility that sex might play a role in modulation of the systemic inflammatory response to cardiac surgery. In that study, girls indeed had higher preoperative and postoperative levels of the natural anti-inflammatory cytokine IL-10, and exhibited lower postoperative morbidity than did boys. Could it be assumed then that female sex, because of the influence of oestrogen, protects against systemic inflammation? This question merits further investigation, the outcome of which could have implications for the timing of corrective cardiac surgery in children.The exact mechanisms that initiate and control the systemic inflammatory reaction associated with cardiac surgery have not yet been fully elucidated. It is generally accepted, however, that contact between blood and the foreign surfaces of the extracorporeal circulation circuit, and ischaemia of almost all tissues followed by their reperfusion trigger a cascade of inflammatory events that may finally result in cell damage and cell death [2,3]. Cytokines are central in this scenario. They are synthesized by circulating leucocytes, resident macrophages, and endothelial and parenchymatous cells of various organs, and they play an important role in the initiation and termination of the systemic inflammatory response (Table 1). Proinflammatory cytokines such as IL-1β and tumour necrosis factor-α are representative of the first category of cytokines. IL-10 (the natural anti-inflammatory, macrophage-deactivating cytokine) controls and terminates inflammation, whereas IL-6 (the main regulator of the acute-phase reaction) possesses both proinflammatory and anti-inflammatory properties [4].Cytokines are not exclusively inflammatory mediators, and play important roles in the regulation of interactions between the nervous, endocrine and immune systems. In this regard, IL-10 enhances corticotropin-releasing factor and adrenocorticotr
Does cardiac surgery in newborn infants compromise blood cell reactivity to endotoxin?
Kathrin Schumacher, Stefanie Korr, Jaime F Vazquez-Jimenez, G?tz von Bernuth, Jean Duchateau, Marie-Christine Seghaye
Critical Care , 2005, DOI: 10.1186/cc3794
Abstract: We investigated 17 newborn infants with transposition of the great arteries undergoing arterial switch operation. Ex vivo production of the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α), of the regulator of the acute-phase response IL-6, and of the natural anti-inflammatory cytokine IL-10 were measured by enzyme-linked immunosorbent assay in the cell culture supernatant after whole blood stimulation by the endotoxin lipopolysaccharide before, 5 and 10 days after the operation. Results were analyzed with respect to postoperative morbidity.The ex vivo production of TNF-α and IL-6 was significantly decreased (P < 0.001 and P < 0.002, respectively), whereas ex vivo production of IL-10 tended to be lower 5 days after the operation in comparison with preoperative values (P < 0.1). Ex vivo production of all cytokines reached preoperative values 10 days after cardiac surgery. Preoperative ex vivo production of IL-6 was inversely correlated with the postoperative oxygenation index 4 hours and 24 hours after the operation (P < 0.02). In contrast, postoperative ex vivo production of cytokines did not correlate with postoperative morbidity.Our results show that cardiac surgery in newborn infants is associated with a transient but significant decrease in the ex vivo production of the pro-inflammatory cytokines TNF-α and IL-6 together with a less pronounced decrease in IL-10 production. This might indicate a transient postoperative anti-inflammatory shift of the cytokine balance in this age group. Our results suggest that higher preoperative ex vivo production of IL-6 is associated with a higher risk for postoperative pulmonary dysfunction.Cardiac surgery is associated with a systemic inflammatory reaction comprising activation of the complement system, stimulation of leukocytes, synthesis of cytokines, and increased interactions between leukocytes and endothelium [1,2]. In children, contact activation, ischemia/reperfusion injury and endotoxin released from the gut [
Relationship between cardiac troponin I (cTnI) release during cardiac operations and myocardial cell death
JF Vazquez-Jimenez, Ma Qing, B Klosterhalfen, O Liakopoulos, G von Bernuth, BJ Messmer, M-C Seghaye
Critical Care , 2000, DOI: 10.1186/cc722
Abstract: Eighteen young pigs were operated on with standardized cardiopulmonary bypass (CPB). Release of cTnI in the cardiac lymph (CL), coronary sinus (CS), and arterial blood (A) was related to postoperative myocardial cell death by both necrosis and apoptosis. Apoptotic cells were detected by a TUNEL detection kit. Necrotic cells were counted by light microscopy.In all animals, cTnI was significantly released and reached peak values observed simultaneously in A (cTnI, 20.1 ± 2.6 ng/ml) (mean ± SEM), CS (19.5 ± 3.2 ng/ml) and CL (5202 ± 2500 ng/ml). Percentage of total myocardial cell death was 3.1 ± 0.5%, including 1.2 ± 0.35% necrosis and 1.9 ± 0.5% apoptosis. cTnI release during and after CPB did not correlate with the degree of myocardial apoptosis or necrosis.Cardiac operations with CPB are related to myocardial cell damage including myocardial cell death due to both necrosis and apoptosis. As the loss of cTnI is not related to the amount of cell death, our results suggest that increased cardiac myocyte membrane permeability more than cell death is responsible for intraoperative and postoperative cTnI release.
Influences of pre-, peri- and postoperative risk factors in neonatal cardiac surgery on neurodevelopmental status in preschool-age children
HH H?vels-Gürich, M-C Seghaye, M Sigler, A Bartl, F Kotlarek, J Neuser, BJ Messmer, G von Bernuth
Critical Care , 2000, DOI: 10.1186/cc676
Abstract: Thirty-three unselected children operated on as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were examined at an age of 3.0–4.6 years [3.6 ± 0.5 (mean ± standard deviation)]. The control group for developmental outcome consisted of 32 age-matched healthy children, who were 3.0–4.8 years [3.8 ± 0.6 (mean ± standard deviation)] of age. Evaluation of socioeconomic status and a standardised test comprising all areas of child development (Vienna developmental test), including scores of motor and cognitive functions, perception, language, learning and behaviour, were carried out in patients and controls, and clinical neurological status was assessed in patients. Results of patients were related to those of the control group and to pre-, peri-, and postoperative cerebral risk factors of the control group and to pre-, peri-, and postoperative cerebral risk factors as described in the context.Neurological impairment was more frequent (6.1%) than in the normal population. Compared with published norms, complete developmental score and the subtests for motor function, visual perception and visual motor integration, learning and memory, cognitive function, language, and socioemotional functions were not different. Compared with the control group, complete developmental score, cognitive score and language were reduced (P < 0.01), but socioeconomic status was significantly lower in the patient group (P = 0.0001). Motor function was weakly, but significantly inversely related to the duration of circulatory arrest (Pearson correlation coefficient -0.37; P = 0.049), but not to the duration of bypass. The other developmental parameters were not related to the duration of the support techniques. Serum levels of the biochemical marker neuron-specific enolase, although significantly elevated at the end of bypass (P = 0.0002) and 4 h after surgery (P = 0.0012) compared with preoperative values, were not correlated to developmental test re
Myocardial cell damage related to arterial switch operation in neonates with transposition of the great arteries
HH H?vels-Gürich, JF Vazquez-Jimenez, A Silvestri, K Schumacher, S Kreitz, J Duchateau, BJ Messmer, G von Bernuth, M-C Seghaye
Critical Care , 2001, DOI: 10.1186/cc1009
Abstract: Sixty-three neonates (age 2-28 [8.1 ± 4.6] days), who were operated on under combined deep hypothermic (15°C) circulatory arrest and low-flow cardiopulmonary bypass (CPB), were studied. Inclusion criteria were transposition of the great arteries with or without ventricular septal defect (VSD) that was suitable for arterial switch operation (VSD-; n = 53), and if necessary additional VSD closure (VSD+; n = 10). Patients were differentiated clinically into two groups by presence or absence of MD within 24 h after surgery. MD was defined as myocardial ischaemia after coronary reperfusion and/or myocardial hypocontractility as assessed by echocardiography. MD was related to clinical outcome parameters and to perioperative release of cardiac troponin-T (cTnT) and production of interleukin-6 and interleukin-8.MD was observed in 11 patients (17.5%). Two patients died early after surgery from myocardial infarction, and two died late after surgery (6.3%). CPB and cross-clamping, but not deep hypothermic circulatory arrest times, were correlated with MD; MD was more frequent in the VSD+ than in the VSD- group because of longer support times. Coronary status and age at surgery were not related to MD. Patients with MD had more frequently impaired cardiac, respiratory and renal functions. cTnT, interleukin-6 and interleukin-8 were significantly elevated at the end of CPB, and 4 and 24 h after surgery, as compared with preoperative values in both groups. Postoperative cTnT, interleukin-6 and interleukin-8 concentrations were significantly higher in MD patients than in the others. Multivariable analysis of independent risk factors for MD revealed interleukin-6 4 h after surgery to be significant (P = 0.04; odds ratio 1.24 [95% confidence interval 1.01-1.52] per 10 pg/ml). The cutoff point for prediction of MD was set at 500 pg/ml (specificity 95.4%, sensitivity 72.7%).Cardiac operations in neonates induce the production of the proinflammatory cytokines interelukin-6 and interleuki
Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation
HH H?vels-Gürich, MC Seghaye, M Sigler, A Bartl, F Kotlarek, J Neuser, BJ Messmer, G von Bernuth
Critical Care , 1999, DOI: 10.1186/cc330
Abstract: Protracted birth (PB), perinatal asphyxia (PA), intraventricular cerebral haemorrhage (IVH) evaluated by pre/peri/postoperative cranial ultrasound, clinical seizures (CS) and high levels of the neuron-specific enolase (NSE) prior to as well as immediately after and 4 and 24 h after CPB in 25 neonates (mean age 7 days) were defined as cerebral risk factors. Correlation analyses (Fisher's Exact Test, Pearson Coefficient) were performed to the results of formalized clinical neurological (CNS) and complete developmental score (CDS) including 7 subtests (Vienna developmental test, standard values defined normal 100 ± 10, mean ± SD) at mean age 3.7 ± 0.5 years.PB was found in 16%, PA 0%, IVH 48%, residual IVH at discharge 24%, CS prior to surgery 16%, CS > 24 h after CPB 12%. NSE, elevated prior to surgery (11.3 ± 4.5 ng/ml, mean ± SD), increased to peak values 4 h after CPB (17.3 ± 6.0) and individual peak values within 24 h after CPB (19.9-7.0). CNS was normal in 84%, 16% had strabism. CDS was normal in 88% (100 ± 8), motor score 96% (99 ± 6), visual perception 88% (100 ± 9), learning and memory 96% (102 ± 7), cognitive score 100% (101 ± 8), language 100% (99 ± 5), socioemotional score 100% (103 ± 7). Developmental scores did not differ significantly from normal children. None of the considered risk factors had significant influence on any outcome parameter (P > 0.1 in all).In our study, neurodevelopmental outcome was not found dependent on cerebral risk factors as elevated NSE indicative of neuronal cell damage, intraventricular haemorrhage, seizures or pre-/perinatal asphyxia. Rare incidence of reduced test results might have masked significant correlations.
The effect of temperature during extracorporeal circulation on ultrastructure of cardiomyocytes
R Chakupurakal, B Hermanns, JF Vazquez-Jiminez, Ma Qing, S Lücking, BJ Messmer, G von Bernuth, M-C Seghaye
Critical Care , 2001, DOI: 10.1186/cc1001
Abstract: Fifteen pigs were randomly assigned to one of three temperature groups (37, 28 and 20°C) during ECC (n = 5 each). ECC time was 120 min and myocardial ischaemia time was 60 min. Cardioplegia was achieved by injecting a crystalloid solution (4°C cold Bretschneider solution, 30 ml/kg) into the aortic root. Flow index was set at 2.7 l/m2 per min. Six hours after ECC, myocardial samples were taken from the left ventricle for ultrastructural examination by electron microscopy.All animals showed intact contractile apparatus, with normal texture of the myofibrils and normal configuration of the Z-bands. Quantitative and structural changes of mitochondria were frequent. Animals from the 37°C group showed marked interstitial oedema and dehiscence of the cytoplasmatic membrane with ruptures, whereas lesser damage to the membrane was observed in the other two groups. The 28°C group showed the least pronounced ultrastructural changes.These results show that cardiac operations with ECC are associated with ultrastructural lesions of the cardiomyocytes. In this experimental setup, these lesions were most pronounced under normothermic and least pronounced under moderate hypothermic ECC.
Effect of temperature on leukocyte activation during cardiopulmonary bypass (CPB) and postoperative organ damage
M Qing, M-C Seghaye, JF Vazquez-Jimenez, RG Grabitz, B Klosterhalfen, M Sigler, BJ Messmer, G von Bernuth
Critical Care , 1999, DOI: 10.1186/cc331
Abstract: 18 young pigs were randomly assigned to a T°- group during CPB: normothermia (T° 37°C; n = 6), mild hypothermia (T° 28°C; n = 6) and deep hypothermia (T° 20°C; n = 6). Leukocyte count and plasma levels of tumor necrosis factor (TNFα) were measured before, during and after CPB. At the end of the experimentation (6 h post-CPB), probes of heart, lungs, liver, kidney, and intestine were taken for histological examination.There was a significant fall of leukocyte count at induction of CPB, without any intergroup difference. During and at the end of CPB, leukocyte count was significantly higher in group 37°C as compared with the other groups. At a later stage after CPB, group 20°C showed significantly higher leukocyte count than group 28°C and group 37°C, respectively. The course of neutrophils was similar.TNF-α was not released in group 28°C neither during nor after CPB. By contrast, there was a significant production of TNF-α in groups 37°C and 20°C, the circulating levels being significantly higher in group 37°C. Histological examination showed that the most important tissue damage in terms of interstitial edema and leukostasis in heart, lung, liver, kidney, and small intestine was seen in group 37°C followed by group 20°C while the least important damage was present in group 28°C.CPB-induced postoperative organ damage, probably related to leukocyte activation and TNF-α production, is highest in pigs operated on in normothermia and lowest in those operated on in mild hypothermia.
Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery
Lars Grosse-Wortmann, Suzanna Kreitz, Ralph G Grabitz, Jaime F Vazquez-Jimenez, Bruno J Messmer, Goetz von Bernuth, Marie-Christine Seghaye
Journal of Cardiothoracic Surgery , 2010, DOI: 10.1186/1749-8090-5-85
Abstract: 494 consecutive patients, including 96 neonates, were studied with serial 24-hour Holter electrocardiograms before as well as uninterruptedly during the first 72 hours after surgery and prior to discharge.Within 24 hours of surgery 59% of the neonates and 79% of the older children developed arrhythmias. Junctional ectopic tachycardia occurred in 9% of neonates and 5% of non-neonates and ventricular tachycardia in 3% and 15%, respectively.For neonates, male sex and longer cross-clamping time independently increased the risk for arrhythmias (odds ratios 2.83 and 1.96/minute, respectively). Ventricular septal defect repair was a strong risk factor for junctional ectopic tachycardia in neonates and in older children (odds ratios 18.8 and 3.69, respectively). For infants and children, older age (odds ratio 1.01/month) and closure of atrial septal defects (odds ratio 2.68) predisposed to arrhythmias of any type.We present the largest cohort of neonates, infants and children that has been prospectively studied for the occurrence of arrhythmias after cardiac surgery. Postoperative arrhythmias are a frequent and transient phenomenon after cardiopulmonary bypass, provoked both by mechanical irritation of the conduction system and by humoral factors.Arrhythmias are common in the early postoperative period after cardiac surgery for congenital heart disease[1-3]. Although transient and treatable in most cases, they are the cause of substantial morbidity and mortality during a vulnerable phase of hemodynamic instability.Thus far the overall incidence and risk factors of transient early postoperative arrhythmias in neonates and children undergoing cardiac surgery have only been addressed in a limited number of studies,[3,4] each using overhead bedside monitoring. While this method is sensitive enough for sustained and hemodynamically significant arrhythmias, shorter or more subtle rhythm disorders that may still reflect electrical instability of the myocyctes and a propensity to d
Analytic Philosophy: a Historico-Critical Survey (translated from English by L. B. Makeeva)
Wright, G. H. von.
Kantovskij Sbornik , 2013,
Abstract:
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