Search PubMed⌕ Search

Biomedical subjects

B Seifert

Publications and source records attributed to B Seifert.

At least 91 records · Page 5Linked to original sources
PubMed1998

Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984-1996.

The outcomes of cardiovascular operations during pregnancy, at delivery, and post partum were reviewed from published material in the period 1984-1996. Surgery during pregnancy resulted in fetal-neonatal morbidity and mortality of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal outcome. Maternal complications and mortality of surgery immediately after delivery were 29% and 12%, respectively, and for surgery performed with a postpartum interval the respective rates were 38% and 14%. Hospitalization after week 27 of gestation and extreme emergency contributed significantly to poor maternal outcome. Maternal deaths were reported in 9% of valvular procedures and in 22% of aortic or arterial dissection repairs and pulmonary embolectomies. Fetal-neonatal risks of maternal surgery during pregnancy are high and unpredictable. Maternal risks of cardiovascular procedures during pregnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than those in nonpregnant cardiovascular surgical patients.

Cardiopulmonary Bypass↗
PubMed1998

Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques.

OBJECTIVE: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections. METHODS: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up. RESULTS: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P =.008), disease-related survival free of reoperation (P =.0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P =.001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P =.002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P =.002), incidence of complications (24% vs 63%; P =.005), and elimination of infection (91% vs 53%; P =.001). In addition, costs were 40% lower in the group treated by allografts (P =.005). CONCLUSIONS: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.

Adult↗
PubMed1998

Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996.

OBJECTIVES: Published reports were reviewed to evaluate the characteristics of peripartal management and the late pregnancy outcome in women with pulmonary vascular disease (PVD). BACKGROUND: Pulmonary hypertension poses one of the highest risks for maternal mortality, but actual data on the maternal and neonatal prognosis in this group are lacking. METHODS: Reports published from 1978 through 1996 of Eisenmenger's syndrome (n = 73), primary pulmonary hypertension (PPH) (n = 27) and secondary vascular pulmonary hypertension (SVPH) (n = 25) complicating late pregnancy were included and analyzed using logistic regression analysis. RESULTS: Maternal mortality was 36% in Eisenmenger's syndrome, 30% in PPH and 56% (p < 0.08 vs. other two groups) in SVPH. Except for three prepartal deaths due to Eisenmenger's syndrome, all fatalities occurred within 35 days after delivery. Neonatal survival ranging from 87% to 89% was similar in the three groups. Previous pregnancies, timing of the diagnosis and hospital admission, operative delivery and diastolic pulmonary artery pressure were significant univariate (p < 0.05) maternal risk factors. Late diagnosis (p = 0.002, odds ratio 5.4) and late hospital admission (p = 0.01, odds ratio 1.1 per week of pregnancy) were independent predictive risk factors of maternal mortality. CONCLUSIONS: In the last two decades maternal mortality was comparable in patients with Eisenmenger's syndrome and PPH; however, it was relevantly higher in SVPH. Maternal prognosis depends on the early diagnosis of PVD, early hospital admission, individually tailored treatment during pregnancy and medical therapy and care focused on the postpartal period.

Adolescent↗
PubMed1998

The effect of potato starch derived and corn starch derived hydroxyethyl starch on in vitro blood coagulation.

We have compared the effects of progressive in vitro haemodilution (30% and 60%) with potato starch derived hydroxyethyl starch and corn starch derived hydroxyethyl starch on blood coagulation in 80 patients using thrombelastography. Both solutions significantly compromised blood coagulation as evidenced by an increase in coagulation time and decrease in angle alpha, maximum amplitude and coagulation index (p < 0.05). Blood coagulation was more compromised during haemodilution with potato starch derived hydroxyethyl starch as compared with corn starch derived hydroxyethyl starch (p < 0.05). When taking the effect of haemodilution with 0.9% saline into account, haemodilution with both hydroxyethyl starch solutions also augmented clot lysis (p < 0.05), with potato starch derived hydroxyethyl starch having a greater effect than corn starch derived hydroxyethyl starch (p < 0.05). We conclude that potato starch derived hydroxyethyl starch compromises in vitro blood coagulation more than corn starch derived hydroxyethyl starch.

Adult↗
PubMed1998

Perioperative reliability of an on-site prothrombin time assay under different haemostatic conditions.

Perioperative use of laboratory coagulation assays is limited by the delay in obtaining results. The management of haemostasis during major surgical procedures requires rapid and accurate measurement of the prevailing coagulation status. In this prospective study, we have evaluated the reliability of on-site prothrombin time assessed by the portable coagulation monitor CoaguChek-Plus compared with standard laboratory assays during elective non-cardiac surgery. Sixty-two patients were assigned to one of three groups: group A = normal preoperative coagulation where minor intraoperative blood loss is expected; group B = normal preoperative coagulation where major intraoperative blood loss is expected; and group C = preoperative anticoagulation and minor intraoperative blood loss expected. On-site prothrombin time and laboratory prothrombin time showed poor correlation in group A (r2 = 0.24; bias (2 SD) 1.80 (3.34) S) and group B (r2 = 0.30; 1.43 (3.12) S). The correlation in group C was better (r2 = 0.71; 1.41 (1.92) S). We conclude that prothrombin time measured with the CoaguCheck-Plus monitor did not appear to be suitable for the management of haemostasis.

Blood Loss, Surgical↗
PubMed1998

Compromised blood coagulation: an in vitro comparison of hydroxyethyl starch 130/0.4 and hydroxyethyl starch 200/0.5 using thrombelastography.

UNLABELLED: We compared the effects of progressive in vitro hemodilution (30% and 60%) on blood coagulation in 80 patients receiving one of two different 6% hydroxyethyl starch (HES) solutions using thrombelastography (TEG). The newly developed solution has a mean molecular weight of 130 kD and a degree of substitution, defined as the average number of hydroxyethyl groups per glucose moiety, of 0.4 (HES 130/0.4); the conventional solution has a mean molecular weight of 200 kD and a degree of substitution of 0.5 (HES 200/0.5). Both HES solutions significantly compromised blood coagulation, as seen by an increase in reaction time and coagulation time and a decrease in angle alpha, maximal amplitude, and coagulation index (all P < 0.05). There was no difference between HES 130/0.4 and HES 200/0.5 diluted blood (P > 0.05 for all TEG variables). When analyzing the intrinsic HES effect by taking hemodilution with 0.9% saline into account, progressive hemodilution with both HES solutions resulted in an increasing clot lysis (P < 0.05 after 60 min). Again, there was no difference between HES 130/0.4 and HES 200/0.5 diluted blood. We conclude that HES 130/ 0.4 and HES 200/0.5 compromise blood coagulation to the same degree. IMPLICATIONS: Progressive in vitro hemodilution using hydroxyethyl starch (HES) compromises blood coagulation. We observed similar effects of a new HES solution with a mean molecular weight of 130 kD and a degree of substitution of 0.4 (HES 130/0.4), compared with the conventional HES 200/0.5.

Blood Coagulation↗
PubMed1998

Haemodilution tolerance in patients with mitral regurgitation.

Haemodynamic parameters and oxygen consumption were determined in 20 patients with mitral regurgitation before and after a 12 ml.kg-1 isovolaemic exchange of blood for 6% hydroxyethyl starch. During haemodilution, mean (SEM) haemoglobin concentration decreased from 13.0 (0.4) to 10.3 (0.4) g.dl-1 (p = 0.001). With cardiac filling pressures maintained at predilution levels, cardiac index increased from 1.84 (0.08) to 1.94 (0.08) l.min-1.m-2 (p = 0.025) while systemic vascular resistance decreased from 1556 (86) to 1425 (83) dyne.s.cm-5 (p = 0.002) and oxygen extraction increased from 31.7 (1.1) to 37.3 (1.4)% (p = 0.001) resulting in an unchanged oxygen consumption. The haemodynamic response to haemodilution was not affected by the patients' cardiac rhythm, i.e. whether it was sinus rhythm or atrial fibrillation. In conclusion, isovolaemic haemodilution to a haemoglobin of 10.3 g.dl-1 is well tolerated in patients with mitral regurgitation. Compensatory mechanisms include both an increase in cardiac index and an increase in oxygen extraction.

Aged↗
PubMed1998

Can collagen type II sustain a methotrexate-induced therapeutic effect in patients with long-standing rheumatoid arthritis? A double-blind, randomized trial.

OBJECTIVE: Based on the results of two recently published, randomized, double-blind and placebo-controlled studies, a possible improvement in rheumatoid arthritis disease activity after oral tolerization with triple helical collagen type II has been suggested. The goal of this study was to go one step further and ask the question whether collagen type II can sustain the therapeutic effect induced by methotrexate, the most widely accepted disease-modifying anti-rheumatic drug in patients with long-standing rheumatoid arthritis. METHODS: Ninety-two patients with rheumatoid arthritis on stable therapy with methotrexate were enrolled in a 3 month double-blind, randomized and comparative study to examine the efficacy of oral triple helical collagen type II as compared to continuing methotrexate. The dose of methotrexate (or the respective placebo drug) and of concomitant corticosteroids was not changed and intra-articular corticosteroids were not allowed during the 3 months. The primary study endpoint was disease activity as measured by physician and patients. RESULTS: While patients under ongoing therapy with methotrexate had, as expected, no change in disease activity, almost all parameters of disease activity and outcome in patients under a daily oral dose of 0.5 mg triple helical collagen type II worsened significantly (highly significant difference in swollen joints, between the two groups, P < 0.0001). No significant differences in side-effects between the two groups during the study period could be demonstrated. CONCLUSIONS: Substitution of methotrexate with daily 0.5 mg of triple helical collagen type II in patients with rheumatoid arthritis leads to a significant increase in disease activity, suggesting that oral collagen type II at the given dose is not capable of sustaining the methotrexate-induced anti-inflammatory effect in patients with long-standing rheumatoid arthritis.

Administration, Oral↗
PubMed1997

Prognostic value of serum 5-S-cysteinyldopa for monitoring human metastatic melanoma during immunochemotherapy.

The melanin metabolite 5-S-cysteinyldopa (5-S-CD) has been reported to be helpful in detecting occult melanoma metastases and as a prognostic marker in B16 melanoma-bearing mice. The goal of our study was to analyze the significance of the serum 5-S-CD level for the biochemical detection of metastases in human malignant melanoma (MM) and for monitoring the progression or the immunochemotherapeutically induced regression of MM. From 11 patients with metastatic MM observed between 1991 and 1995, serum samples were collected before and after each cycle of immunotherapy or immunochemotherapy. Samples were analyzed for 5-S-CD by automated high performance liquid chromatography with electrochemical detection. Cycles of immunochemotherapy consisted of human interleukin 2 and IFN-alpha (four patients) or of human interleukin 2, IFN-alpha, and dacarbazine (seven patients). Serum value of 5-S-CD in our normal controls was 1.9 +/- 0.6 ng/ml. All patients with metastatic MM showed 5-S-CD serum levels above the upper normal limit of 3.2 ng/ml (10 nM) and ranged from 2.3-fold (4.3 +/- 3.9 ng/ml) of the normal control values in early stages of metastases to more than 50-fold (94.3 +/- 220.3 ng/ml) of the normal control values in advanced stages of the disease. In 28 of 41 (68%) immunochemotherapeutical cycles, a decrease of 5-S-CD was seen during therapy, and in 13 cycles (31.7%), an increase was seen. Patients with more than 68% decreasing cycles (defined as responders; n = 5) showed significantly longer survival times (P = 0.008) than patients with less than 68% decreasing cycles (nonresponders; n = 6). High levels of 5-S-CD were also observed in metastasizing amelanotic melanoma. Serum 5-S-CD is a useful marker for monitoring the clinical course of MM patients, for discriminating between responders and nonresponders to immunochemotherapy, and as a prognostic factor concerning survival time and death risk.

Adult↗
PubMed1997

[Hypocalcemia as a rare cause of acute left heart failure. Case report and review of the literature].

We report the case of a 50-year-old female in whom the connection between hypocalcemia and heart failure was not made until a second hospital admission for left ventricular failure. Under appropriate calcium supplementation the symptoms were relieved within 2 days and the patient remained well thereafter. The hypocalcemia was found to be caused by autoimmune hypoparathyroidism. Heart failure due to hypocalcemia has been rarely reported, and even in textbooks the subject is poorly documented. The physiologic functions of calcium and the implications of deficiency for heart muscle are outlined, with a review of the literature. A treatment regimen for hypocalcemia is recommended.

Autoimmune Diseases↗
PubMed1997

Rapid prototyping (stereolithography) in the management of intra-articular calcaneal fractures.

The purpose of this study was to evaluate and compare the diagnostic performance of stereolithography vs workstation-based three-dimensional (3D) reformations in intra-articular calcaneal fractures. A total of 30 intra-articular calcaneal fractures were examined using standard radiographs, coronal CT scans, and 2D and 3D reformations. The CT data were transferred to an outside institution, and stereolithograms were produced from photopolymer resin employing a laser beam system. 3D reformations and stereolithograms were analyzed in a blinded fashion by two staff radiologists. Receiver-operating-characteristic (ROC) curves were obtained for six clinically significant fracture components. Standard radiographs, coronal CT scans, and 2D reformations served as the standard of reference. The area under the ROC curves for 3D reformations and stereolithograms were 1.0 and 0.98 for abnormal tuber angles, 0.91 and 0.91 for anterior and middle talo-calcaneal joint involvement, 0. 90 and 0.95 for involvement of the posterior talo-calcaneal joint, 0. 65 and 0.78 for the presence of a lateral bulge, 0.80 and 0.81 for the involvement of the calcaneocuboidal joint, and 0.62 and 0.67 for the presence of a "tongue-type" fracture. No statistically significant difference was demonstrated for the two methods (Wilcoxon signed-rank test, p = 0.138). Based on our results stereolithograms did not prove to be statistically superior to workstation-based 3D reformations. Stereolithograms may still be useful for teaching purposes and for surgical planning at a thinking-efficacy level.

Adult↗
PubMed1997

Covalent immobilization of hirudin improves the haemocompatibility of polylactide-polyglycolide in vitro.

A biodegradable polymer, poly(D,L-lactide-co-glycolide) RESOMER RG756, was modified by surface immobilization of recombinant hirudin (r-Hir) with glutaraldehyde as coupling reagent to improve the blood contacting properties of the polymer. The activity of immobilized hirudin on the polymer was estimated by a chromogenic assay to about 2.5 ATU r-Hir cm-2. The improvement of the haemocompatibility of the modified RG756 was evaluated in terms of platelet adhesion/activation, whole blood clotting times and clot formation rate. Fluorescence microscopy revealed that surface modification with r-Hir resulted in decreased platelet adhesion and activation. An ELISA for P-selectin, a marker of platelet activation, was used to confirm this result. Clotting time experiments demonstrated significantly prolonged non-activated partial thromboplastin times, and a decreased clot formation rate of whole blood in contact with r-Hir modified RG756 compared with the plain polymer. Comparison of immobilized r-Hir with bound heparin yielded equivalent improvement of blood-contacting properties of the investigated polymers. These in vitro investigations indicate that the immobilization of r-Hir on RG756 is a useful method to improve the blood contacting properties of polylactides/polyglycolides and other polymers as well.

Antithrombins↗
PubMed1997

Effects of intravenous and oral clonidine on hemodynamic and plasma-catecholamine response due to endotracheal intubation.

STUDY OBJECTIVE: To investigate the effects of intravenous (IV) versus oral clonidine on alterations of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and plasma-catecholamines due to endotracheal intubation. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: University hospital surgery operating room. PATIENTS: 33 ASA physical status I patients were randomly assigned to either receive clonidine 3 micrograms/kg IV immediately prior to anesthesia induction, clonidine 4 micrograms/kg orally 90 minutes prior to anesthesia induction, or placebo. INTERVENTIONS: Insertion of a 14 G cannula in a large cubital vein for the determination of plasma-catecholamines using local anesthesia. Insertion of a radial artery catheter for measuring blood pressure (BP) using local anesthesia. Transthoracic echocardiography determined CO. MEASUREMENTS AND MAIN RESULTS: Heart rate, MAP, CO, and plasma-catecholamine concentrations were measured. Measurements were performed prior to induction, during intubation, and 10 minutes after intubation. During endotracheal intubation, MAP was significantly lower in the IV clonidine group compared with the placebo and the oral clonidine groups. Cardiac output was significantly lower in the IV clonidine group only. In contrast to the placebo group, norepinephrine plasma concentrations did not increase in either clonidine group. Significant alterations of epinephrine plasma concentrations due to intubation were not observed in either group. Hemodynamics after intubation were not impaired by clonidine treatment. CONCLUSIONS: In conclusion, IV clonidine reduced stress response to endotracheal intubation compared with placebo. Oral clonidine at the dose used was less effective in blunting hemodynamic stress response than IV clonidine.

Administration, Oral↗
PubMed1997

Hemocue, an accurate bedside method of hemoglobin measurement?

OBJECTIVE: Evaluate the accuracy of this bedside method to determine hemoglobin (Hb) concentration in general surgery over a wide range of Hb values and to determine potential sources of error. METHODS: Accuracy of Hb measurement using HemoCue (AB Leo Diagnostics, Helsinborg, Sweden) was assessed in 140 surgical blood samples using 7 HemoCue devices in comparison with a CO-Oximeter (IL 482, Instrumentation Laboratory, Lexington, MA). To analyze potential sources of error, packed red cells and fresh frozen plasma were reconstituted to randomized Hb levels of 2-18 g/dL. RESULTS: In the surgical blood samples, the Hb concentration determined by the CO-Oximeter (HbCOOX) ranged from 5.1 to 16.7 g/dL and the Hb concentration measured by HemoCue (HbHC) from 4.7 to 16.0 g/dL. Bias (HbCOOX - HbHC) between HbCOOX and HbHC was 0.6+/-0.6 g/dL (mean +/- SD) or 5.4+/-5.0% (p < 0.001). Also in the reconstituted blood, the bias between HbCOOX and HbHC was significant (0.2+/-0.3 g/dL or 2.1+/-3.2%; p < 0.001). The microcuvette explained 68% of the variability between HbCOOX and HbHC. HemoCue thus underestimates the Hb concentration by 2-5% and exhibits a 8-10 times higher variability with only 86.4% of HbHC being within +/- 10% of HbCOOX. CONCLUSION. Although the mean bias between HbCOOX and HbHC was relatively low, Hb measurement by HemoCue exhibited a significant variability. Loading multiple microcuvettes and averaging the results may increase the accuracy of Hb measurement by HemoCue.

Evaluation Studies as Topic↗
PubMed1997

Haemodynamic effects of pneumoperitoneum in elderly patients with an increased cardiac risk.

We studied the haemodynamic changes induced by pneumoperitoneum (PP) in elderly patients with increased cardiac risk (ASA class III; n = 10; age 72.3 +/- 8.8 years, mean +/- SD, P < 0.05; group 2) and compared the results with patients at normal risk (ASA class I, II; n = 12; age 55.6 +/- 11.8 years; group 1). Thermodilution measurements were performed after induction of general anaesthesia (T1), after onset of PP (T2, intraabdominal pressure 14 mmHg) and after additional 15 degrees head-up tilt (T3). In both groups PP, as compared with T1, induced a significant increase in mean arterial pressure (MAP, mmHg, group 1: 77 +/- 14 to 96 +/- 18, P < 0.05/group 2: 75 +/- 10 to 102 +/- 18, P < 0.01), mean pulmonary artery pressure (MPAP, mmHg: 15 +/- 5 to 22 +/- 4, P < 0.01/18 +/- 3 to 25 +/- 5, P < 0.01), central venous pressure (CVP, mmHg: 7 +/- 2 to 15 +/- 3, P < 0.01/7 +/- 2 to 12 +/- 2, P < 0.01), pulmonary capillary wedge pressure (PCWP, mmHg: 9 +/- 4 to 16.3, P < 0.01/8 +/- 2 to 15 +/- 6, P < 0.01) and in systemic vascular resistance (SVR, dynes s cm-5: 1415 +/- 375 to 1873 +/- 412, P < 0.01/ 1502 +/- 360 to 2067 +/- 647, P < 0.01). Cardiac index (CI, L min-1 m-2: 2.3 +/- 0.3 to 1.9 +/- 0.3, P < 0.05/2.2 +/- 0.4 to 2.2 +/- 0.5 P = 0.76) and oxygen delivery index (DO2I, mL min-1 m-2: 388 +/- 54 to 324 +/- 61, P < 0.05/358 +/- 69 to 353 +/- 82, P = 0.77) decreased in group 1 but not in group 2. Heart rate, stroke Index, pulmonary vascular resistance, arteriovenous oxygen content difference and oxygen consumption index were unchanged. After head-up tilt MAP (mmHg, 92 +/- 15, P < 0.05/ 101 +/- 17, P < 0.01), MPAP (mmHg, 20 +/- 3, P < 0.01/22 +/- 4, P < 0.05), CVP (mmHg, 12 +/- 2, P < 0.01/10 +/- 2, P < 0.01) and PCWP (mmHg, 12 +/- 3, P < 0.05/12 +/- 5, P < 0.05) remained elevated compared with T1 in both groups, SVR (dynes s cm-5, 1575 +/- 372, P = 0.13/1793 +/- 528, P < 0.01) in group 2 only. No complications occurred. The results indicate that PP is associated with significant but relatively benign haemodynamic changes. Anaesthesia for laparoscopic cholecystectomy may be performed safely also in elderly ASA class III patients with increased cardiac risk. An adequate haemodynamic monitoring is recommended.

Aged↗
PubMed1997

The diagnostic value of the neutrophil left shift in predicting inflammatory and infectious disease.

The use of neutrophil left-shift parameters in the diagnosis of inflammatory and infective disease (ID) was evaluated. The level of C-reactive protein (CRP), currently the best quantitative parameter of inflammation, was used as the gold standard. Of 292 patients, 230 (79%) had a level of CRP of 1.0 mg/dL or greater and were classified as having inflammation, whereas 62 (21%) had normal levels. The neutrophil band count in each patient was determined by microscopic examination of 200 WBCs. The diagnostic value of the band count as an indicator for ID was evaluated in comparison to the WBC count, the neutrophil count, and the left-shift indicators of two automated hematologic analyzers, H*1 Technicon (Bayer Technicon Instruments, Tarrytown, NY) and Coulter MAX M (Coulter Electronics, Hialeah, Fla). When receiver operating characteristics were used, the band count was superior to the immature to total neutrophil count (I/T) ratio, the total WBC count, and the neutrophil count. The sensitivity and specificity in identifying ID at designated cutoff points were as follows: band count of 20% or greater of total WBC count (53% and 79%, respectively), I/T ratio of 0.25 or greater (59% and 63%), total WBC count of 9.6 x 10(6)/mL or greater (68% and 56%), and neutrophil count of 8.0 x 10(6)/mL or greater (60% and 58%). The performance of the H*1 Technicon left-shift flag was similar but slightly inferior to the band count (sensitivity, 44%; specificity, 79%), whereas the Coulter MAX M flags had a clearly higher sensitivity (79%) and lower specificity (53%). In addition, microscopic evaluation to determine the presence of reactive morphologic changes in neutrophils, such as toxic granules, Döhle bodies, and cytoplasmic vacuoles, had a high sensitivity (80%) but a low specificity (58%) in predicting ID. The diagnostic value of both microscopic and automated neutrophil left-shift parameters as indicators for ID is limited. Morphologic changes in neutrophils, however, either have a high specificity (band count) or a high sensitivity (toxic signs) in predicting ID and therefore may be a clinically useful tool.

Adolescent↗