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Search Results: 1 - 10 of 5955 matches for " Herbert Sch?chl "
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FIBTEM provides early prediction of massive transfusion in trauma
Herbert Schchl, Bryan Cotton, Kenji Inaba, Ulrike Nienaber, Henrik Fischer, Wolfgang Voelckel, Cristina Solomon
Critical Care , 2011, DOI: 10.1186/cc10539
Abstract: This retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, Austria, with an injury severity score ≥16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM? analyses (extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) tests) were performed. We divided patients into two groups: massive transfusion (MT, those who received ≥10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0 to 9 units).Of 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, P < 0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (P < 0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0 to 3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83).FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings.Trauma-induced coagulopathy (TIC) affects 25 to 34% of all trauma patients upon emergency room (ER) admission and can be observed even before fluid resuscitation [1-3]. TIC increases the risk of massive transfusion (MT) which is associated with mortality rates up to 54% [1,4-6].MT
Early and individualized goal-directed therapy for trauma-induced coagulopathy
Herbert Schchl, Marc Maegele, Cristina Solomon, Klaus G?rlinger, Wolfgang Voelckel
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-15
Abstract: Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality [1-3]. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC) [4,5], which is associated with increased rates of massive transfusion (MT) and multiple organ failure (MOF), prolonged intensive care unit and hospital stays, and a four-fold increase in mortality [4]. Most patients with coagulopathy also have uncontrolled bleeding, and early diagnosis of the underlying coagulation disorder is paramount for effective treatment.One major challenge in treating severely bleeding trauma patients is to determine whether the blood loss is attributable to surgical causes or coagulopathy. If the patient is coagulopathic, it is paramount to characterize the cause of the coagulopathy and whether thrombin generation is impaired or clot quality or stability is diminished. Recent data suggest that whole-blood viscoelastic tests, such as thromboelastometry (ROTEM?, Tem International GmbH, Munich, Germany) or thrombelastography (TEG?, Haemonetics Corp., Braintree, MA, USA) portray trauma induced coagulopathy (TIC) more accurately and substantially faster than standard coagulation tests [6-8]. There is increasing evidence that these coagulation monitoring devices are helpful in guiding coagulation therapy for heavily bleeding trauma patients according to their actual needs [9].The intention of this review is to examine the concept of individualized, early, goal-directed therapy for TIC, using viscoelastic tests and targeted coagulation therapy. In addition, the AUVA Trauma Hospital algorithm for managing TIC is presented.Fast, reliable diagnosis and characterization of TIC is important. Standard coagulation tests (e.g. prothrombin time [PT], international normalized ratio [INR], prothrombin time index [PTI] and activated partial thromboplastin time [aPTT]) fail to accurately describe the complex nature of TIC for several reasons [4,5]. In vivo coagula
Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM?)-guided administration of fibrinogen concentrate and prothrombin complex concentrate
Herbert Schchl, Ulrike Nienaber, Georg Hofer, Wolfgang Voelckel, Csilla Jambor, Gisela Scharbert, Sibylle Kozek-Langenecker, Cristina Solomon
Critical Care , 2010, DOI: 10.1186/cc8948
Abstract: This retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM?). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score.Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014).ROTEM?-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted.Coagulopathy has been shown to be present in approximately 25 to 35% of all trauma patients on admission to the emergency room (ER) [1,2]. This represents a serious problem for major trauma patients and accounts for 40% of all trauma-related deaths [3]. Coagulopathy forces a strategy of early and rapid haemostatic treatment to prevent exsanguination. F
In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch
Alexander A Hanke, Stephanie Maschler, Herbert Schchl, Felix Fl?ricke, Klaus G?rlinger, Klaus Zanger, Peter Kienbaum
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-12
Abstract: The study was designed as experimental non-randomized comparative in vitro study. Following institutional review board approval and informed consent blood samples were taken from 10 healthy volunteers and diluted in vitro with either HH (HyperHaes?, Fresenius Kabi, Germany), hypertonic saline (HT, 7.2% NaCl), hydroxyethylstarch (HS, HAES6%, Fresenius Kabi, Germany) or NaCl 0.9% (ISO) in a proportion of 5%, 10%, 20% and 40%. Coagulation was studied in whole blood by rotation thrombelastometry (ROTEM) after thromboplastin activation without (ExTEM) and with inhibition of thrombocyte function by cytochalasin D (FibTEM), the latter was performed to determine fibrin polymerisation alone. Values are expressed as maximal clot firmness (MCF, [mm]) and clotting time (CT, [s]). Platelet aggregation was determined by impedance aggregrometry (Multiplate) after activation with thrombin receptor-activating peptide 6 (TRAP) and quantified by the area under the aggregation curve (AUC [aggregation units (AU)/min]). Scanning electron microscopy was performed to evaluate HyperHaes induced cell shape changes of thrombocytes.Statistics: 2-way ANOVA for repeated measurements, Bonferroni post hoc test, p < 0.01.Dilution impaired whole blood coagulation and thrombocyte aggregation in all dilutions in a dose dependent fashion. In contrast to dilution with ISO and HS, respectively, dilution with HH as well as HT almost abolished coagulation (MCFExTEM from 57.3 ± 4.9 mm (native) to 1.7 ± 2.2 mm (HH 40% dilution; p < 0.0001) and to 6.6 ± 3.4 mm (HT 40% dilution; p < 0.0001) and thrombocyte aggregation (AUC from 1067 ± 234 AU/mm (native) to 14.5 ± 12.5 AU/mm (HH 40% dilution; p < 0.0001) and to 20.4 ± 10.4 AU/min (HT 40% dilution; p < 0.0001) without differences between HH and HT (MCF: p = 0.452; AUC: p = 0.449).HH impairs platelet function during in vitro dilution already at 5% dilution. Impairment of whole blood coagulation is significant after 10% dilution or more. This effect can be pinpoin
Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy
Herbert Schchl, Ulrike Nienaber, Marc Maegele, Gerald Hochleitner, Florian Primavesi, Beatrice Steitz, Christian Arndt, Alexander Hanke, Wolfgang Voelckel, Cristina Solomon
Critical Care , 2011, DOI: 10.1186/cc10078
Abstract: This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥2 mmol/L, injury severity score (ISS) ≥16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥3, and for head/neck < 5.For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69).TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.In patients with severe trauma, coagulopathy represents a frequent cause of death [1,2]. Prompt haemostatic intervention is necessary to prevent and correct life-threatening bleeding. Standard coagulation therapy consists of fresh frozen plasma (FFP), platelet concentrate and, in some countries, cryoprecipitate [3,4]. One approach proposed for preventing exsanguination has been to treat patients with a fixed ratio of FFP to red blood cells (RBC), but the optimal value of this ratio is still under debate [5-8]. It has been recently suggested that the time to intervention may also be an important determinant of patient outcomes [9,10].Our group has been exp
Unterscheiden sich die Ergebnisse unterschiedlicher Prüfungsformate grundlagenwissenschaftlicher Inhalte hinsichtlich ihrer pr diktiven Validit t für den Erfolg im weiteren Medizinstudium? []
Huenges, Bert,Sch?fer, Thorsten,Rusche, Herbert
GMS Zeitschrift für Medizinische Ausbildung , 2007,
Abstract:
Orbital and spin Kondo effects in a double quantum dot
Teemu Pohjola,Herbert Schoeller,Gerd Sch?n
Physics , 2000, DOI: 10.1209/epl/i2001-00301-2
Abstract: Motivated by recent experiments, in which the Kondo effect has been observed for the first time in a double quantum-dot structure, we study electron transport through a system consisting of two ultrasmall, capacitively-coupled dots with large level spacing and charging energy. Due to strong interdot Coulomb correlations, the Kondo effect has two possible sources, the spin and orbital degeneracies, and it is maximized when both occur simultaneously. The large number of tunable parameters allows a range of manipulations of the Kondo physics -- in particular, the Kondo effect in each dot is sensitive to changes in the state of the other dot. For a thorough account of the system dynamics, the linear and nonlinear conductance is calculated in perturbative and non-perturbative approaches. In addition, the temperature dependence of the resonant peak heights is evaluated in the framework of a renormalization group analysis.
Ambient Assistive Technologies (AAT): socio-technology as a powerful tool for facing the inevitable sociodemographic challenges?
Astrid M Schülke, Herbert Plischke, Niko B Kohls
Philosophy, Ethics, and Humanities in Medicine , 2010, DOI: 10.1186/1747-5341-5-8
Abstract: Results of an earlier survey revealed that the elderly perceived their current lighting situation as satisfactory, whereas interviewers assessed in-house lighting as too dark and risk-laden. The overall results of ALADIN showed a significant increase in well-being from the baseline final testing with the new adaptive lighting system.Positive results for wellbeing and life quality suggest that the outcome effects may be attributed to the introduction of technology as well as to social contacts arising from participating in the study. The technological guidance of the study supervisors, in particular, may have produced a strong social reactivity effect that was first observed in the famous Hawthorne experiments in the 1930s. As older adults seem to benefit both from meaningful social contacts as well as assistive technologies, the question arises how assistive technology can be socially embedded to be able to maximize positive health effects. Therefore ethical guidelines for development and use of new assistive technologies for handicapped/older persons have to be developed and should be discussed with regard to their applicability in the context of AAT.In most developed Western societies two long-term socio-demographic trends are becoming gradually more visible: First, the birth rate is below that which is necessary to retain a sustainable population. Second, individual life expectancy is steadily increasing due to improvements in medical science and health care. Even though the speed and course of demographic change, and social and economic contexts may vary throughout different parts of the world, the aging of the population has already become a global trend in many Western societies that will gradually have profound impact upon the life circumstances of many individuals [1]. Thus, governments will have to find culturally and ethically sustainable ways to deal with an aging and shrinking population and the economic consequences.According to the Congressional Resear
Wissensfortschritt und Erfolgsraten im ersten Studienabschnitt eines reformierten Regelstudiengangs im Vergleich zu einem problembasierten Modellstudiengang [Progress of knowledge and success rates in the first section of medical training in a traditional versus problem-based curriculum ]
Sch?fer, Thorsten,Huenges, Bert,Burger, Andreas,Rusche, Herbert
GMS Zeitschrift für Medizinische Ausbildung , 2007,
Abstract:
Triple Jump Exercise: Vergleich zweier Verfahren
Burger, Andreas,Huenges, Bert,Sch?fer, Thorsten,Rusche, Herbert
GMS Zeitschrift für Medizinische Ausbildung , 2005,
Abstract:
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