Michael Christ - Academia.edu (original) (raw)
Papers by Michael Christ
Deutsches Ärzteblatt international, Jan 6, 2015
Medizinische Klinik, Intensivmedizin und Notfallmedizin, 2012
Emergency department (ED) triage systems facilitate the categorization of emergency patients acco... more Emergency department (ED) triage systems facilitate the categorization of emergency patients according to their disease severity and determine both treatment priority and treatment location. Four different five-level triage systems are internationally accepted. The Australasian Triage Scale (ATS, Australasia) allows categorization based on symptoms using specific descriptors. The Manchester Triage System (MTS, UK) uses defined presentational flow charts combined with indicators. The Canadian Triage and Acuity Scale (CTAS, Canada) is based on the ATS, but also includes diagnoses. The Emergency Severity Index (ESI, USA) first excludes life-threatening and severe disease before stratification according to estimated resource utilization. The goal of all triage systems is to reduce the in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization.
Deutsches Ärzteblatt international, 2012
We studied the characteristics and resource utilization of patients with syncope in a German emer... more We studied the characteristics and resource utilization of patients with syncope in a German emergency department (ED). We carried out a single-center retrospective analysis of patients with syncope who presented to the ED of the Klinikum Nürnberg (a municipal hospital in Nuremberg, Germany). Among the 28 477 patients who presented to the ED from 15 May 2009 to 30 September 2009, 440 (1.5%) presented with syncope. Their mean age was 62 years (standard deviation, 20 years); 50.4% were women, 43.4% were over age 70, 11.8% had cardiogenic and 4.8% neurological syncope, and 18.2% had more than two comorbid conditions. 20.7% were discharged after evaluation in the ED, 14.1% were brielfly hospitalized in the ED's clinical observation unit, and 56.6% were admitted to one of the hospital's specialty wards. 8.6% left the ED against medical advice. All of the syncope patients were evaluated by history-taking, physical examination, and 12-lead electrocardiogragraphy (ECG); ECG revealed...
Therapeutische Umschau, 2009
Das Vorhandensein einer chronisch obstruktiven Lungenerkrankung (COPD) gilt als wichtiger Risikof... more Das Vorhandensein einer chronisch obstruktiven Lungenerkrankung (COPD) gilt als wichtiger Risikofaktor für kardiovaskuläre Begleiterkrankungen. Deshalb ist die hohe Sterblichkeit bei COPD-Patienten zum einen auf maligne Tumorerkrankungen aber auch auf die kardiovaskuläre Komorbidität zurückzuführen. Patienten mit COPD weisen in etwa 20 – 30 % der Fälle eine akute Herzinsuffizienz auf. Sie wird jedoch häufig unter- oder verspätet diagnostiziert und damit nicht adäquat therapiert. Das diagnostische Dilemma lässt sich durch das vergleichbare Beschwerdebild und die Ähnlichkeit der klinischen Untersuchungsbefunde erklären. Deshalb ist es wichtig, dass bei COPD-Patienten mit akuter Atemnot die wichtige Differentialdiagnose einer akuten Herzinsuffizienz berücksichtigt wird. Die Bestimmung natriuretischer Peptide ist hervorragend geeignet, auch bei Patienten mit bekannter COPD und akuter Atemnot zwischen pulmonaler und kardialer Ursache der Atemnot zu differenzieren. Bei BNP Werten unter 10...
Zeitschrift für Gerontologie und Geriatrie, 2014
Journal of the American College of Cardiology, 2014
The Journal of Clinical Endocrinology & Metabolism, 2001
International Journal of Cardiology, 2010
Objectives: This study aimed to examine the influence of history of heart failure (HF) on circula... more Objectives: This study aimed to examine the influence of history of heart failure (HF) on circulating levels, diagnostic accuracy and prognostic value of B-type natriuretic peptide (BNP) in patients presenting with all cause dyspnea at the emergency department. Background: BNP has been shown to be very helpful in diagnosis and prognosis of HF. Due to chronically elevated cardiac filling pressures, patients with a history of HF might have higher BNP levels and therefore diagnostic and prognostic properties of BNP may be affected. Methods: We analyzed circulating levels, diagnostic accuracy and prognostic value of BNP in 388 patients without a previous history of HF and compared these to data to 64 patients with a history of HF included in the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) Study. Results: Baseline BNP levels were higher in patients with a history of HF (median 814 pg/ml [353-1300 pg/ml] vs. 216 pg/ml [45-801 pg/ ml], p b 0.001). Diagnostic accuracy of BNP to identify HF was comparable in patients with (AUC = 0.804; 95% CI 0.628-0.980) and in patients without history of HF (AUC = 0.883; 95% CI 0.848-0.919, p = 0.389). Prognostic ability of BNP to predict one-year mortality was lower in overall patients with history of HF (AUC = 0.458; 95%CI 0.294-0.622) compared to patients without history of HF (AUC = 0.710; 95% CI 0.653-0.768, p b 0.05). Conclusions: In patients with history of HF, BNP levels retain diagnostic accuracy. Ability to predict one-year mortality was decreased in unselected patients, but not in patients with acute HF-induced dyspnea.
Circulation, 1999
Background —Steroid-induced gene regulation in the endocrine tissues and vascular wall is achieve... more Background —Steroid-induced gene regulation in the endocrine tissues and vascular wall is achieved through the interaction of specific receptor proteins and promoters of target genes. In addition to these delayed steroid actions, rapid effects of steroids have been reported in various tissues that were clearly incompatible with the classic theory of genomic steroid action. Methods and Results —Because high doses of 17β-estradiol have been shown to modulate intracellular cAMP levels in vascular smooth muscle cells, steroid-induced stimulation of adenylate cyclase stimulation and phosphorylation of cAMP response element binding protein was investigated in porcine coronary artery vascular smooth muscle cells. Aldosterone induces a ≈1.5- to 2.5-fold increase in intracellular cAMP levels (EC 50 ≈0.01 to 0.1 nmol/L) within 1 minute, whereas 17β-estradiol and hydrocortisone act only at supraphysiological concentrations (10 μmol/L). Aldosterone-induced changes in intracellular cAMP are calc...
Biochemical and Biophysical Research Communications, 1999
In addition to genomic effects of aldosterone, rapid nongenomic effects of steroids have been rep... more In addition to genomic effects of aldosterone, rapid nongenomic effects of steroids have been reported in various tissues that were clearly incompatible with a genomic action of aldosterone. Rapid effects of aldosterone involve second messengers such as calcium and cAMP. Specific high affinity binding sites for aldosterone have been characterized in membranes for different cells, which probably transmit those rapid steroid effects. To date, it is unclear if these binding sites are modified classical mineralocorticoid receptors (MR) or if they represent an unrelated receptor protein. The aim of the present study was to investigate whether rapid aldosterone action still occurs in the absence of the classical MR. For this purpose we used the model of MR knockout mice. Rapid effects were analyzed in skin cells, measuring intracellular calcium and cAMP levels after stimulation with aldosterone. We found that rapid effects are not only present in MR knockout mice, but that the effects are even larger than in wild-type mice cells. The results of the present study demonstrate that the classic MR is dispensable for rapid aldosterone action. The study, thus, proves that a receptor different from the classic intracellular receptor is involved in rapid aldosterone signaling.
Biochemical and Biophysical Research Communications, 1996
Archives of Internal Medicine, 2006
Annals of Clinical Biochemistry, 2012
In their case report, Sami et al. 1 state that very high ferritin concentrations (greater than 10... more In their case report, Sami et al. 1 state that very high ferritin concentrations (greater than 10,000 mg/L) have only been described in adult Still's disease, multiple blood transfusions and severe acute hepatocellular damage. It may be of interest to the authors that such marked hyperferritinaemia has also been documented in patients with the human immunodeficiency virus (HIV) complicated by superinfection with a range of opportunistic organisms, particularly disseminated histoplasmosis. 2 We would also like to emphasize that haemophagocytic syndromes, such as haemophagocytic lymphohistiocytosis (HLH), may also produce ferritin concentrations of this magnitude. 3,4 A variety of drugs, infections and rheumatological diseases, including but not exclusively adult Still's disease, may precipitate a haemophagocytic process, 5 or it may be a primary disorder. The diagnosis of HLH relies on the patient satisfying sufficient criteria, of which serum ferritin is a part. 6 As an aside, it appears that haemophagocytosis is associated with lower glycosylation of circulating ferritin, 7 a feature that may extend to other circulation proteins, notably transferrin, 8 possibly due to liver involvement by the pathological process. As an illustrative example, a recent case from our laboratory of a five-year-old girl with HLH secondary to Epstein-Barr virus (EBV) infection demonstrated a serum ferritin concentration of 29,600 mg/L at diagnosis and detectable serum asialotransferrin on isoelectric focusing. A review of all ferritin results greater than 10,000 mg/L from our laboratory network in the past year found 35 results from 30 patients (0.06% of all ferritin requests). Most patients had received multiple transfusions for a variety of reasons (14 cases) or had severe acute hepatocellular damage (9 cases); however, there were four cases of HLH: two adult, both fatal, and two paediatric, both secondary to EBV infection. Three cases of high ferritin were not clearly explained.
American Heart Journal, 2013
Biochemical and Biophysical Research Communications, 1994
Deutsches Ärzteblatt international, Jan 6, 2015
Medizinische Klinik, Intensivmedizin und Notfallmedizin, 2012
Emergency department (ED) triage systems facilitate the categorization of emergency patients acco... more Emergency department (ED) triage systems facilitate the categorization of emergency patients according to their disease severity and determine both treatment priority and treatment location. Four different five-level triage systems are internationally accepted. The Australasian Triage Scale (ATS, Australasia) allows categorization based on symptoms using specific descriptors. The Manchester Triage System (MTS, UK) uses defined presentational flow charts combined with indicators. The Canadian Triage and Acuity Scale (CTAS, Canada) is based on the ATS, but also includes diagnoses. The Emergency Severity Index (ESI, USA) first excludes life-threatening and severe disease before stratification according to estimated resource utilization. The goal of all triage systems is to reduce the in-hospital mortality and to minimize time to treatment, length of stay, and resource utilization.
Deutsches Ärzteblatt international, 2012
We studied the characteristics and resource utilization of patients with syncope in a German emer... more We studied the characteristics and resource utilization of patients with syncope in a German emergency department (ED). We carried out a single-center retrospective analysis of patients with syncope who presented to the ED of the Klinikum Nürnberg (a municipal hospital in Nuremberg, Germany). Among the 28 477 patients who presented to the ED from 15 May 2009 to 30 September 2009, 440 (1.5%) presented with syncope. Their mean age was 62 years (standard deviation, 20 years); 50.4% were women, 43.4% were over age 70, 11.8% had cardiogenic and 4.8% neurological syncope, and 18.2% had more than two comorbid conditions. 20.7% were discharged after evaluation in the ED, 14.1% were brielfly hospitalized in the ED's clinical observation unit, and 56.6% were admitted to one of the hospital's specialty wards. 8.6% left the ED against medical advice. All of the syncope patients were evaluated by history-taking, physical examination, and 12-lead electrocardiogragraphy (ECG); ECG revealed...
Therapeutische Umschau, 2009
Das Vorhandensein einer chronisch obstruktiven Lungenerkrankung (COPD) gilt als wichtiger Risikof... more Das Vorhandensein einer chronisch obstruktiven Lungenerkrankung (COPD) gilt als wichtiger Risikofaktor für kardiovaskuläre Begleiterkrankungen. Deshalb ist die hohe Sterblichkeit bei COPD-Patienten zum einen auf maligne Tumorerkrankungen aber auch auf die kardiovaskuläre Komorbidität zurückzuführen. Patienten mit COPD weisen in etwa 20 – 30 % der Fälle eine akute Herzinsuffizienz auf. Sie wird jedoch häufig unter- oder verspätet diagnostiziert und damit nicht adäquat therapiert. Das diagnostische Dilemma lässt sich durch das vergleichbare Beschwerdebild und die Ähnlichkeit der klinischen Untersuchungsbefunde erklären. Deshalb ist es wichtig, dass bei COPD-Patienten mit akuter Atemnot die wichtige Differentialdiagnose einer akuten Herzinsuffizienz berücksichtigt wird. Die Bestimmung natriuretischer Peptide ist hervorragend geeignet, auch bei Patienten mit bekannter COPD und akuter Atemnot zwischen pulmonaler und kardialer Ursache der Atemnot zu differenzieren. Bei BNP Werten unter 10...
Zeitschrift für Gerontologie und Geriatrie, 2014
Journal of the American College of Cardiology, 2014
The Journal of Clinical Endocrinology & Metabolism, 2001
International Journal of Cardiology, 2010
Objectives: This study aimed to examine the influence of history of heart failure (HF) on circula... more Objectives: This study aimed to examine the influence of history of heart failure (HF) on circulating levels, diagnostic accuracy and prognostic value of B-type natriuretic peptide (BNP) in patients presenting with all cause dyspnea at the emergency department. Background: BNP has been shown to be very helpful in diagnosis and prognosis of HF. Due to chronically elevated cardiac filling pressures, patients with a history of HF might have higher BNP levels and therefore diagnostic and prognostic properties of BNP may be affected. Methods: We analyzed circulating levels, diagnostic accuracy and prognostic value of BNP in 388 patients without a previous history of HF and compared these to data to 64 patients with a history of HF included in the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) Study. Results: Baseline BNP levels were higher in patients with a history of HF (median 814 pg/ml [353-1300 pg/ml] vs. 216 pg/ml [45-801 pg/ ml], p b 0.001). Diagnostic accuracy of BNP to identify HF was comparable in patients with (AUC = 0.804; 95% CI 0.628-0.980) and in patients without history of HF (AUC = 0.883; 95% CI 0.848-0.919, p = 0.389). Prognostic ability of BNP to predict one-year mortality was lower in overall patients with history of HF (AUC = 0.458; 95%CI 0.294-0.622) compared to patients without history of HF (AUC = 0.710; 95% CI 0.653-0.768, p b 0.05). Conclusions: In patients with history of HF, BNP levels retain diagnostic accuracy. Ability to predict one-year mortality was decreased in unselected patients, but not in patients with acute HF-induced dyspnea.
Circulation, 1999
Background —Steroid-induced gene regulation in the endocrine tissues and vascular wall is achieve... more Background —Steroid-induced gene regulation in the endocrine tissues and vascular wall is achieved through the interaction of specific receptor proteins and promoters of target genes. In addition to these delayed steroid actions, rapid effects of steroids have been reported in various tissues that were clearly incompatible with the classic theory of genomic steroid action. Methods and Results —Because high doses of 17β-estradiol have been shown to modulate intracellular cAMP levels in vascular smooth muscle cells, steroid-induced stimulation of adenylate cyclase stimulation and phosphorylation of cAMP response element binding protein was investigated in porcine coronary artery vascular smooth muscle cells. Aldosterone induces a ≈1.5- to 2.5-fold increase in intracellular cAMP levels (EC 50 ≈0.01 to 0.1 nmol/L) within 1 minute, whereas 17β-estradiol and hydrocortisone act only at supraphysiological concentrations (10 μmol/L). Aldosterone-induced changes in intracellular cAMP are calc...
Biochemical and Biophysical Research Communications, 1999
In addition to genomic effects of aldosterone, rapid nongenomic effects of steroids have been rep... more In addition to genomic effects of aldosterone, rapid nongenomic effects of steroids have been reported in various tissues that were clearly incompatible with a genomic action of aldosterone. Rapid effects of aldosterone involve second messengers such as calcium and cAMP. Specific high affinity binding sites for aldosterone have been characterized in membranes for different cells, which probably transmit those rapid steroid effects. To date, it is unclear if these binding sites are modified classical mineralocorticoid receptors (MR) or if they represent an unrelated receptor protein. The aim of the present study was to investigate whether rapid aldosterone action still occurs in the absence of the classical MR. For this purpose we used the model of MR knockout mice. Rapid effects were analyzed in skin cells, measuring intracellular calcium and cAMP levels after stimulation with aldosterone. We found that rapid effects are not only present in MR knockout mice, but that the effects are even larger than in wild-type mice cells. The results of the present study demonstrate that the classic MR is dispensable for rapid aldosterone action. The study, thus, proves that a receptor different from the classic intracellular receptor is involved in rapid aldosterone signaling.
Biochemical and Biophysical Research Communications, 1996
Archives of Internal Medicine, 2006
Annals of Clinical Biochemistry, 2012
In their case report, Sami et al. 1 state that very high ferritin concentrations (greater than 10... more In their case report, Sami et al. 1 state that very high ferritin concentrations (greater than 10,000 mg/L) have only been described in adult Still's disease, multiple blood transfusions and severe acute hepatocellular damage. It may be of interest to the authors that such marked hyperferritinaemia has also been documented in patients with the human immunodeficiency virus (HIV) complicated by superinfection with a range of opportunistic organisms, particularly disseminated histoplasmosis. 2 We would also like to emphasize that haemophagocytic syndromes, such as haemophagocytic lymphohistiocytosis (HLH), may also produce ferritin concentrations of this magnitude. 3,4 A variety of drugs, infections and rheumatological diseases, including but not exclusively adult Still's disease, may precipitate a haemophagocytic process, 5 or it may be a primary disorder. The diagnosis of HLH relies on the patient satisfying sufficient criteria, of which serum ferritin is a part. 6 As an aside, it appears that haemophagocytosis is associated with lower glycosylation of circulating ferritin, 7 a feature that may extend to other circulation proteins, notably transferrin, 8 possibly due to liver involvement by the pathological process. As an illustrative example, a recent case from our laboratory of a five-year-old girl with HLH secondary to Epstein-Barr virus (EBV) infection demonstrated a serum ferritin concentration of 29,600 mg/L at diagnosis and detectable serum asialotransferrin on isoelectric focusing. A review of all ferritin results greater than 10,000 mg/L from our laboratory network in the past year found 35 results from 30 patients (0.06% of all ferritin requests). Most patients had received multiple transfusions for a variety of reasons (14 cases) or had severe acute hepatocellular damage (9 cases); however, there were four cases of HLH: two adult, both fatal, and two paediatric, both secondary to EBV infection. Three cases of high ferritin were not clearly explained.
American Heart Journal, 2013
Biochemical and Biophysical Research Communications, 1994