Alterations of cell-mediated immunity following cardiac operations: clinical implications and open questions.

Cardiac surgery with cardiopulmonary bypass (CPB) is known to induce an immune response whose nature has been increasingly elucidated during the recent decade. Clinically, patients usually show two to three of the four symptoms, which define the so-called systemic inflammatory response syndrome (SIRS). In addition, all parameters of the innate, nonspecific immune system, e.

Detection of acute phase response and infection. The role of procalcitonin and C-reactive protein.

Objective: Established parameters, e.g. C-reactive protein (CRP), do not differentiate specifically enough between patients developing an infection and those exhibiting an acute phase response following cardiac surgery.

Early extubation after cardiac surgery: a prospective clinical trial including patients at risk.

Background: Recent evidence suggests that early extubation after cardiac surgery can be performed without increased morbidity, resulting in economic advantages. However, most studies on this subject exclude patients with preoperative risk factors described as predictors for prolonged mechanical ventilation. The purpose of our prospective clinical trial was to decide whether early extubation is feasible independent of preoperative patient status, in particular independent of preoperative risk factors.

In vitro studies on PMN-independent endothelial cell damage in trauma: decrease of PMN-endothelial cell adherence by fibrinogen degradation products and disturbance of endothelial cell membrane integrity by trauma serum.

Trauma favors the development of adult respiratory distress syndrome (ARDS). Adherence of polymorphonuclear leukocytes (PMN) to endothelial cells (EC) with subsequent EC damage by the respiratory burst products and proteases of the PMN is thought to be one of the basic mechanisms in the pathogenesis of ARDS. Recent studies have shown that there might also be PMN-independent mechanisms of EC damage.

Tc-99m HMPAO cerebral scintigraphy. A reliable, noninvasive method for determination of brain death.

To determine the usefulness of cerebral blood flow imaging for the diagnosis of brain death, 4 female and 12 male patients, aged 19 to 69 years and suffering from various intracranial lesions, were studied. In addition to neurologic examination, electroencephalographic recording, and cerebral angiography, tomographic brain scintigraphy was performed using a SPECT system with a LEAP collimator after the intravenous administration of 555 MBq Tc-99m HMPAO. The radioisotopic scanning procedure revealed no intracranial perfusion in 14 of the 16 patients.