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K Dalhoff

Publications and source records attributed to K Dalhoff.

At least 19 recordsLinked to original sources
PubMed2006

Disseminated mycobacterium bovis infection in an immunocompetent host.

We report about a rare case of disseminated Mycobacterium bovis infection in a 61 year old female immunocompetent patient with involvement of the lung, the brain, the spleen and spine. The patient had intracerebral tuberculomas with paradoxical enlargement during the first weeks of therapy. We reviewed the data of our microbiological department and found five other patients with Mycobacterium bovis infection diagnosed between 1999 and 2004, which are 5.8 % of all diagnoses of tuberculosis during this period.

Aged↗
PubMed2006

[Antibiotic therapy for exacerbation].

Bacterial infections are involved in approximately 50% of acute exacerbations of chronic bronchitis (AECB). Pneumococci, Haemophilus influenzae and Moraxella catarrhalis are the main pathogens. Studies using quantitative cultures and molecular typing suggest a causal relationship between bacterial infection and exacerbation. Furthermore, an association between infection and bronchial inflammation has been demonstrated. In contrast to steroid therapy and non-invasive ventilation, the benefits of antibiotic treatment are not well established. Current guidelines recommend antimicrobial therapy for AECB in type I exacerbations, for patients needing ventilatory support and for patients with cardiac comorbidity. Bacterial eradication is able to prolong the infection free interval.

Anti-Bacterial Agents↗
PubMed2006

[Results of a comparison: active versus passive reporting in cases of community acquired pneumonia. Results of the German Competence Network CAPNETZ].

INTRODUCTION: Since 2002, the German competence network CAPNETZ has been collecting data from inpatients and outpatients with community acquired pneumonia (CAP) at eight local clinical centres. Contrary to the literature reports, the proportion of outpatients in CAPNETZ averages out at 28 %. Therefore, this study determines whether an active reporting system can increase the number of cases reported in medical practices. METHOD: In ten medical practices in Lübeck, the passive reporting system was changed to an active reporting system consisting of a) a weekly announcement of CAP cases including negative reporting, b) a study nurse who was responsible for the reporting, c) additional payment, d) a telephone call after two weeks by absent announcements and e) incentives like benchmarking or additional information. The number of the reported cases between the active reporting period (2004) and the same period in the year before was recorded. RESULTS: The number of reported cases increased in eight of the ten medical practices. Overall 72 CAP cases were reported, 33 % more than in the period of passive reporting. The number of patients encompassed in CAPNETZ increased from 17 to 34. CONCLUSION: We did not find a comparable increase of CAP cases either in Lübeck overall (including inpatients) or in all the local clinical centres together. Thus, it is assumed that the increase of reported cases depends on the methodical effect.

Community Networks↗
PubMed2006

Optimizing lithium dosing in hemodialysis.

We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario in which we developed an algorithm based on a 2-compartment distribution without elimination. The GFR estimate led to plasma concentrations 3-4 times lower than those anticipated. In contrast, the estimates based on V(d) and the algorithm derived from pharmacokinetic modeling led to comparable loading dose estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated immediately postdialysis. Further observations are necessary to obtain robust long-term safety data and to optimize the monitoring schedule.

Aged↗
PubMed2005

Neutrophil apoptosis, activation and anti-inflammatory cytokine response in granulocyte colony-stimulating factor-treated patients with community-acquired pneumonia.

BACKGROUND: Despite antibiotic treatment, the mortality of severe community-acquired pneumonia (CAP), especially in patients with severe comorbidity, remains high. Innate defense mechanisms including polymorphonuclear neutrophil (PMN) activation and survival, orchestrated by cytokines, are primarily responsible for the elimination of bacterial organisms from the alveolus. OBJECTIVES: The aim of this study was to evaluate the effect of granulocyte colony-stimulating factor (G-CSF) on PMN activation, apoptosis and cytokine response in patients with CAP. METHODS: Patients received a single dose of G-CSF (1 x 300 or 480 microg s.c.) prior to standard antibiotic treatment (n=8) or standard treatment only (n=8). Apoptosis rate and expression of CD11b, CD66b, CD64 and CD114 surface molecules on systemic PMN were assessed using fluorescence-activated cell sorter analysis. Levels of the interleukin-1 receptor antagonist (IL-1 RA), the soluble tumor necrosis factor receptor inhibitor (sTNF-p55) and G-CSF were measured by ELISA. RESULTS: In the treatment group, 12 h after G-CSF application, neutrophil count increased, neutrophil activation marker CD11b was stimulated (CD11b: 48.6+/-9.7 vs. 71.2+/-17.7, p<0.01), neutrophil apoptosis decreased (apoptosis: 1.36+/-0.27 vs. 0.2+/-0.12%, p <.01) and the concentration of IL-1RA and sTNF-p55 increased (IL-1RA 136.4+/-72.2 vs. 340.1+/-194.6 ng/ml, p<0.01; sTNF-p55,382+/-4,243 vs. 632+/-4,714 ng/ml, p<0.01; control group nonsignificant). These effects were not seen in the control group. CONCLUSIONS: The application of a single dose of G-CSF in patients with CAP caused a prolonged survival and increased activation of neutrophils combined with a sustained release of anti-inflammatory cytokines.

Aged↗
PubMed2005

Effect of intravenous N-acetylcysteine infusion on haemostatic parameters in healthy subjects.

BACKGROUND AND AIMS: N-acetylcysteine is used to treat paracetamol overdose but depresses the activity of plasma coagulation factors II, VII, and X, which are often used to assess liver injury. The aim of this study was to investigate the effect of N-acetylcysteine on haemostasis in normal volunteers. METHODS: Haemostatic parameters in 10 healthy subjects were analysed before and following intravenous infusion of therapeutic doses of N-acetylcysteine, as well as in vitro. RESULTS: N-acetylcysteine induced significant decreases in plasma levels of vitamin K dependent haemostatic proteins in vivo, being maximal at one hour following the start of infusion, with maximal decreases from 1.00 to 0.73 (0.67-0.79) (mean (95% confidence interval)), 0.66 (0.58-0.73), 0.81 (0.73-0.90), 0.64 (0.57-0.70), 0.74 (0.65-0.82), and 0.61 (0.54-0.67) for factor II, VII, IX, and X activities, protein C activity, and free protein S reactivity, respectively. These data suggest that N-acetylcysteine induces protein modifications affecting activity. Five subjects developed an adverse reaction to infusion of N-acetylcysteine and these were associated with a rapid increase in levels of factor VIII and its carrier protein von Willebrand factor (vWf) from 1.0 to 1.85 (1.08-2.62) and 1.77 (0.83-2.71), respectively, which suggests that the allergic reaction induced release of vWf from endothelial cells. N-acetylcysteine did not affect factor VIII or vWf in subjects without adverse reactions, and nor did it affect factor V or antithrombin in any of the subjects. CONCLUSION: Therapeutic doses of N-acetylcysteine cause abnormal haemostatic activity, and this should be taken into account when using haemostatic function tests as an indicator of hepatic injury.

Acetylcysteine↗
PubMed2004

Hyperamylasaemia and acute pancreatitis in paracetamol poisoning.

BACKGROUND: Hyperamylasaemia and even acute pancreatitis have been reported in patients with paracetamol poisoning. AIMS: To describe the incidence, clinical characteristics, and prognostic implications of hyperamylasaemia in paracetamol poisoning. PATIENTS: Six hundred and two patients transferred to a specialized unit with severe paracetamol poisoning and 212 unselected patients admitted from the local region. METHODS: Retrospective study based on hospital charts. The optimum threshold of serum amylase to discriminate non-survivors was identified. RESULTS: An elevated serum amylase (>100 U/L) occurred in 28 of the unselected patients (13%), in 218 of the transferred patients (36%), and in 118 of 148 patients (80%) with fulminant hepatic failure. Only 33 cases of paracetamol-associated acute pancreatitis were diagnosed. A threshold serum amylase of 150 U/L to discriminate non-survivors had sensitivity 76%, specificity 85%, positive predictive value 33%, and negative predictive value 97%. In a logistic regression analysis, a serum amylase > 150 U/L was associated with an excess mortality (odds ratio 5.0, 2.6-9.7). CONCLUSIONS: Hyperamylasaemia is frequent in patients with paracetamol poisoning, whereas clinical acute pancreatitis occurs rarely. The incidence of hyperamylasaemia increases with the degree of hepatic dysfunction. A serum amylase exceeding 1.5 times the upper normal limit indicates a poor prognosis.

Acetaminophen↗
PubMed2004

Randomized phase III study of gemcitabine and vinorelbine versus gemcitabine, vinorelbine, and cisplatin in the treatment of advanced non-small-cell lung cancer: from the German and Swiss Lung Cancer Study Group.

PURPOSE: To evaluate whether cisplatin-based chemotherapy (gemcitabine, vinorelbine, and cisplatin [GVP]) prolongs overall survival in comparison to cisplatin-free chemotherapy (gemcitabine and vinorelbine [GV]) as first-line treatment in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Between September 1999 and June 2001, 300 patients with NSCLC stage IIIB with malignant pleural effusion or stage IV disease were randomly assigned to receive GV (gemcitabine 1000 mg/m(2) + vinorelbine 25 mg/m(2) on days 1 and 8 every 3 weeks) or GVP (gemcitabine 1000 mg/m(2) + vinorelbine 25 mg/m(2) on days 1 and 8 + cisplatin 75 mg/m(2) on day 2 every 3 weeks). Primary end point of the study was overall survival. RESULTS: Two hundred eighty-seven patients (GV, 143 patients; GVP, 144 patients) were eligible for analysis. At the time of analysis, April 15, 2002, 209 patients (GV, 103 patients; GVP, 106 patients) of 287 patients had died (73%). No statistically significant difference was observed for overall survival (P =.73; median survival, 35.9 versus 32.4 weeks; 1-year survival rate, 33.6% versus 27.5%) as well as for event-free survival (P =.35; median time-to-event, 19.3 versus 22.3 weeks) between GV and GVP. Two hundred fourteen patients were assessable for best response. The overall response rates were 13.0% for GV versus 28.3% for GVP (P =.004; complete responders, 0% versus 3.8%; partial responders, 13.0% versus 24.5%). Hematologic and nonhematologic toxicity was significantly lower in the GV treatment arm compared with GVP. No statistically significant difference in quality of life was observed. CONCLUSION: In this phase III study, the cisplatin-based GVP regimen showed no survival benefit as first-line chemotherapy in advanced NSCLC when compared with the cisplatin-free GV regimen, which was substantially better tolerated.

Adolescent↗
PubMed2004

[HIV and lung].

HIV-infection is characterized by a progressive immunodeficiency that predisposes affected persons to opportunistic infections and neoplasias. Pulmonary co-infections play a key role in HIV-infection as the airways are constantly exposed to aerosolized microorganisms during ventilation. In addition to the spectrum of microorganisms that are responsible for the development of community acquired pneumonia in immunocompetent hosts, persons with HIV-infection are vulnerable to infections with organisms that profit from the progressive cellular immune defects. Examples are infections with Pneumocystis jirovecii, non-tuberculous mycobacteria and viral pathogens. In contrast, tuberculosis can occur in all stages of HIV-infection. Following the HIV-pandemic, the incidence of tuberculosis has increased again in many areas of the world. The advent of antiretroviral therapies (ART) in recent years had resulted in a dramatic decrease of HIV-related morbidity and mortality in industrialized countries. As a result of the reconstitution of the immune-system under ARTs the incidence of pulmonary co-infections has also declined substantially in persons living with HIV in countries where these therapies are available.

AIDS-Related Opportunistic Infections↗
PubMed2004

Enhanced PMN response in chronic bronchitis and community-acquired pneumonia.

Chronic bronchitis is a frequent underlying disease in community-acquired pneumonia (CAP). It is unclear to what extent an impaired or exaggerated innate immune response contributes to disease manifestations and severity. To assess the role of neutrophil activation and recruitment during acute pneumonic episodes, peripheral polymorphonulcear neutrophil (PMN) activation, chemotactic activity, interleukin-8 (CXCL-8) and CXCL-8 receptor (CXCR) expression and apoptosis rate were evaluated in CAP patients with and without chronic bronchitis. In addition, the expression of CXCRs and CXCL-8 was assessed on pulmonary neutrophils in chronic bronchitis patients to compare the activation of the chemokine system in different compartments. CAP severity was assessed by the simplified acute physiology score II and the prognosis of disease was assessed by the pneumonia severity index (PSI). An increased chemotactic activity of PMN from chronic bronchitis patients with CAP was found, which was not related to the expression of CXCRs. In addition, a decreased apoptosis rate of PMN was observed. Chemotactic activity was related to the PSI. Comparison of peripheral and pulmonary PMN revealed enhanced CXCL-8 levels and a decreased CXCR expression in the lung. In conclusion, neutrophil function in patients with chronic bronchitis and community-acquired pneumonia is characterised by an increased chemotactic activity combined with a decreased apoptosis rate. The downregulation of interleukin-8 receptors in the pulmonary compartment deserves further investigation.

Aged↗
PubMed2004

Life-threatening Dobrava hantavirus infection with unusually extended pulmonary involvement.

In Europe, hantavirus infections usually present as hemorrhagic fever with renal syndrome and its mild form nephropathia epidemica, while clinical cases with severe pulmonary affections are extremely rare and appear to be confined to infections by New World hanta viruses in the Americas. We report on a female patient from Northern Germany, who suffered primarily from severe acute respiratory distress syndrome-like pulmonary failure due to Dobrava hantavirus infection that was complicated by acute renal insufficiency.

Female↗
PubMed2003

The impact of current tobacco use on the outcome of paracetamol poisoning.

BACKGROUND: Tobacco smoke contains a number of substances that are capable of inducing cytochrome P450. Consequently, current tobacco use may enhance the hepatotoxicity from a paracetamol overdose by increasing the oxidative metabolism of paracetamol. AIM: To evaluate, by multivariate analysis, the effect of current tobacco use on the morbidity and mortality from paracetamol-induced hepatotoxicity. METHODS: A retrospective study was carried out on the basis of the hospital charts of 602 patients admitted with single-dose paracetamol poisoning for whom information on current tobacco use was available. RESULTS: In patients admitted with paracetamol poisoning, the rate of current daily tobacco use of 70% (424 of 602 patients) was considerably higher than the rate of 31% in the background population (chi-squared test: P < 0.0001). Current tobacco use was an independent risk factor for the development of hepatic encephalopathy (odds ratio, 2.68; 95% confidence interval, 1.28-5.62) and mortality (odds ratio, 3.64; 95% confidence interval, 1.23-10.75). Current tobacco use was independently associated with high peak values of alanine transaminase and the international normalized ratio. CONCLUSIONS: Current tobacco use was very frequent in patients admitted with paracetamol poisoning. It was an independent risk factor of severe hepatotoxicity, acute liver failure and death following paracetamol overdose.

Acetaminophen↗