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Bandorski D, Bogossian H, Ghofrani A, Schmitt J, Höltgen R. [Tachycardia and pulmonary arterial hypertension]. Herzschrittmacherther Elektrophysiol 2020; 31:33-38. [PMID: 32048010 DOI: 10.1007/s00399-020-00668-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022]
Abstract
Pulmonary hypertension is newly defined as an elevation of the mean pulmonary arterial pressure >20 mmHg and a pulmonary vascular resistance ≥3 Wood units. Arrhythmias are an increasing problem in patients with pulmonary hypertension. Pathophysiological aspects leading to supraventricular arrhythmias are atrial fibrosis caused by increased right atrial pressure and dilation. An increased sympathetic tone leads to prolongation of action potential and delayed polarisations causing arrhythmias. Therapy of arrhythmias includes drugs (preferred amiodarone) and electrophysiological therapy like electric cardioversion and ablation, which is safe in patients with pulmonary hypertension.
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Affiliation(s)
- D Bandorski
- Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Deutschland. .,Intensivmedizin und internistische Diagnostik, Neurologische Klinik Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Deutschland.
| | - H Bogossian
- Abteilung für Kardiologie, Elektrophysiologie und Angiologie, Märkische Kliniken GmbH, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515, Lüdenscheid, Deutschland.,Universität Witten/Herdecke, Witten, Deutschland
| | - A Ghofrani
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - J Schmitt
- Medizinische Klinik 1, Innere Medizin/Kardiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - R Höltgen
- St. Agnes-Hospital Bocholt Rhede, Medizinische Klinik, Kardiologie/Elektrophysiologie, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Deutschland
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2
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Abstract
The right ventricle (RV) is the main determinant of prognosis in pulmonary hypertension. Adaptation and maladaptation of the RV are of crucial importance. In the course of disease, RV contractility increases through changes in muscle properties and muscle hypertrophy. At a certain point, the point of "uncoupling," the afterload exceeds contractility, and maladaptation as well as dilation occurs to maintain stroke volume (SV). To understand the adaptational processes and to further develop targeted medication directly affecting load-independent contractility, an accurate and precise assessment of contractility and RV-pulmonary artery (PA) coupling should be performed. In this review, we shed light on existing methods to assess RV function, including the gold standard measurement of contractility and RV-PA coupling, and we evaluate existing surrogates of RV-PA coupling.
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Affiliation(s)
- K Tello
- Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany.
| | - H Gall
- Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany
| | - M Richter
- Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany
| | - A Ghofrani
- Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany
| | - R Schermuly
- Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany
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3
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Götte M, Gall H, Bunniger G, Tello K, Richter M, Sommer N, Ghofrani A, Müller V, Enzensberger C, Axt-Fliedner R. Rechtes Herz bei Risikoschwangerschaften – Erste Ergebnisse der EVA-Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Götte
- UKGM Gießen und Marburg, Standort Gießen, Zentrum für Frauenheilkunde und Geburtshilfe, Pränatalmedizin, Gießen, Deutschland
| | - H Gall
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - G Bunniger
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - K Tello
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - M Richter
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - N Sommer
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - A Ghofrani
- UKGM Gießen und Marburg, Standort Gießen, Medizinische Klinik II, Zentrum für Pneumologie, University of Gießen and Marburg Lung Center (UGMLC), Gießen, Deutschland
| | - V Müller
- UKGM Gießen und Marburg, Standort Gießen, Zentrum für Frauenheilkunde und Geburtshilfe, Pränatalmedizin, Gießen, Deutschland
| | - C Enzensberger
- UKGM Gießen und Marburg, Standort Gießen, Zentrum für Frauenheilkunde und Geburtshilfe, Pränatalmedizin, Gießen, Deutschland
| | - R Axt-Fliedner
- UKGM Gießen und Marburg, Standort Gießen, Zentrum für Frauenheilkunde und Geburtshilfe, Pränatalmedizin, Gießen, Deutschland
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Ghofrani A, Simonneau G, D'armini AM, Fedullo P, Martin N, Howard L, Jais X, Jenkins D, Jing ZC, Madani M, Mayer E, Papadakis K, Richard D, Kim N. Efficacy and safety of macitentan for inoperable chronic thromboembolic pulmonary hypertension (CTEPH): Results from the randomized controlled MERIT study. Pneumologie 2018. [DOI: 10.1055/s-0037-1619324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - G Simonneau
- Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - N Martin
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - X Jais
- Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | | | - ZC Jing
- Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College
| | - M Madani
- University of California San Diego Medical Center
| | - E Mayer
- Kerckhoff-Clinic, Bad Nauheim
| | | | - D Richard
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - N Kim
- University of California, San Diego
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5
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Ghofrani A, Hoeper MM, McLaughlin V, Channick R, Chin K, Delcroix M, Gaine S, Jansa P, Lang I, Mehta S, Pulido T, Sastry BKS, Simonneau G, Sitbon O, De Souza R, Torbicki A, Tapson V, Perchenet L, Preiss R, Verweij P, Rubin L, Galie N. Pulmonary arterial hypertension-related morbidity is prognostic for survival: Insights from the SERAPHIN and GRIPHON studies. Pneumologie 2018. [DOI: 10.1055/s-0037-1619325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - MM Hoeper
- Klinik für Pneumologie, Zentrum für Innere Medizin, Medizinische Hochschule Hannover
| | - V McLaughlin
- Health System Division of Cardiovascular Medicine, University of Michigan
| | - R Channick
- Massachusetts General Hospital; Harvard Medical School
| | - K Chin
- UT Southwestern Medical Center, Dallas, Texas
| | | | - S Gaine
- Mater Misericordiae Hospital, Dublin, Ireland
| | | | - I Lang
- Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Wien
| | - S Mehta
- Lhsc University Hospital, London, Ontario, Canada
| | - T Pulido
- Ignacio Chávez National Heart Institute, Mexico City
| | | | | | - O Sitbon
- Service de Pneumologie, Hôpital Bicêtre, Univ. Paris-Sud
| | - R De Souza
- Incor Heart Institute, University of Sao Paulo
| | | | - V Tapson
- Cedars-Sinai Medical Center, Los Angeles, California
| | - L Perchenet
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - R Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - P Verweij
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - L Rubin
- Division of Pulmonary and Critical Care Medicine University of California; San Diego Medical School
| | - N Galie
- Istituto DI Malattie Dell'apparato Cardiovascolare, Università DI Bologna, Italy
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6
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Richter MJ, Tello K, Rieth A, Ghofrani A, Seeger W, Gall H. Akute hämodynamische Effekte von 20 ug/ml Iloprost (Ventavis) vernebelt über das I-neb Adaptive Aerosol Delivery (AAD)-System: Eine Pilotstudie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- MJ Richter
- Abteilung Pneumologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH; Standort Gießen
| | - K Tello
- Abteilung Pneumologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH; Standort Gießen
| | - A Rieth
- Kardiologie, Kerckhoff-Klinik, Bad Nauheim
| | - A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH; Standort Gießen
| | - W Seeger
- Zentrum für Innere Medizin; Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH; Standort Gießen
| | - H Gall
- Abteilung Pneumologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg GmbH; Standort Gießen
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Becker L, Grimminger J, Ulrich S, Opitz C, Halank M, Klose H, Seeger W, Sommer N, Ghofrani A, Tello K, Richter MJ, Gall H. PEGASUS – Fliegen mit Pulmonaler Hypertonie, ein prospektive Beobachtungsstudie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - J Grimminger
- Abteilung Pneumologie, Medizinische Klink II, Universtitätklinikum Gießen
| | | | - C Opitz
- Klinik für Innere Medizin, Schwerpunkt Kardiologie, Drk-Kliniken Berlin-Köpenick
| | - M Halank
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf
| | - W Seeger
- Zentrum für Innere Medizin, Medizinische Klinik II, Universitätsklinikum Gießen
| | - N Sommer
- Abteilung Pneumologie, Medizinische Klink II, Universtitätklinikum Gießen
| | - A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - K Tello
- Abteilung Pneumologie, Medizinische Klink II, Universtitätklinikum Gießen
| | - MJ Richter
- Abteilung Pneumologie, Medizinische Klink II, Universtitätklinikum Gießen
| | - H Gall
- Abteilung Pneumologie, Medizinische Klink II, Universtitätklinikum Gießen
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Ghofrani A, Benza R, Uno H, Channick R, Delcroix M, Farber H, Galie N, Hennessy B, Jansa P, Mehta S, Perchenet L, Pulido T, Rosenberg D, Rubin L, Sastry BKS, Simonneau G, Sitbon O, De Souza R, Wei LJ, Torbicki A. Using controlled and real-world data in concert to assess survival in pulmonary arterial hypertension: Insights from SERAPHIN and REVEAL. Pneumologie 2018. [DOI: 10.1055/s-0037-1619326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Ghofrani
- Med. Klinik II/V, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - R Benza
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - H Uno
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - R Channick
- Massachusetts General Hospital; Harvard Medical School
| | | | - H Farber
- Boston University School of Medicine
| | - N Galie
- Istituto DI Malattie Dell'apparato Cardiovascolare, Università DI Bologna
| | - B Hennessy
- Actelion Pharmaceuticals Ltd, Allschwi, Switzerland
| | | | - S Mehta
- LHSC University Hospital, London, Ontario
| | - L Perchenet
- Actelion Pharmaceuticals Ltd, Allschwi, Switzerland
| | - T Pulido
- Ignacio Chávez National Heart Institute, Mexico City
| | - D Rosenberg
- Actelion Pharmaceuticals Ltd, Allschwi, Switzerland
| | - L Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego Medical School
| | | | | | - O Sitbon
- Service de Pneumologie, Hôpital Bicêtre, Univ. Paris-Sud
| | - R De Souza
- Incor Heart Institute, University of Sao Paulo
| | - LJ Wei
- Harvard University, Boston, Massachusetts
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Raubach C, Richter M, Sommer N, Seeger W, Ghofrani A, Gall H. Relevance of clinical trial endpoints – Prediction of long-term survival in patients with pulmonary (arterial) hypertension – A retrospective analysis. Pneumologie 2017. [DOI: 10.1055/s-0037-1598541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Raubach
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
| | - M Richter
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
| | - N Sommer
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
| | - W Seeger
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
| | - A Ghofrani
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
| | - H Gall
- Department of Internal Medicine, Justus Liebig University Gießen, Universities of Gießen and Marburg Lung Center (Ugmlc), Member of the German Center for Lung Research (Dzl)
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Chakrabarti B, Lastras-Montaño MA, Adam G, Prezioso M, Hoskins B, Payvand M, Madhavan A, Ghofrani A, Theogarajan L, Cheng KT, Strukov DB. A multiply-add engine with monolithically integrated 3D memristor crossbar/CMOS hybrid circuit. Sci Rep 2017; 7:42429. [PMID: 28195239 PMCID: PMC5307953 DOI: 10.1038/srep42429] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022] Open
Abstract
Silicon (Si) based complementary metal-oxide semiconductor (CMOS) technology has been the driving force of the information-technology revolution. However, scaling of CMOS technology as per Moore’s law has reached a serious bottleneck. Among the emerging technologies memristive devices can be promising for both memory as well as computing applications. Hybrid CMOS/memristor circuits with CMOL (CMOS + “Molecular”) architecture have been proposed to combine the extremely high density of the memristive devices with the robustness of CMOS technology, leading to terabit-scale memory and extremely efficient computing paradigm. In this work, we demonstrate a hybrid 3D CMOL circuit with 2 layers of memristive crossbars monolithically integrated on a pre-fabricated CMOS substrate. The integrated crossbars can be fully operated through the underlying CMOS circuitry. The memristive devices in both layers exhibit analog switching behavior with controlled tunability and stable multi-level operation. We perform dot-product operations with the 2D and 3D memristive crossbars to demonstrate the applicability of such 3D CMOL hybrid circuits as a multiply-add engine. To the best of our knowledge this is the first demonstration of a functional 3D CMOL hybrid circuit.
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Affiliation(s)
- B Chakrabarti
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA
| | - M A Lastras-Montaño
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA
| | - G Adam
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA
| | - M Prezioso
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA
| | - B Hoskins
- Materials Department, University of California, Santa Barbara, CA, 93106, USA
| | | | | | | | | | - K-T Cheng
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA.,School of Engineering, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - D B Strukov
- Electrical and Computer Engineering Department, University of California, Santa Barbara, CA, 93106, USA
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Wiedenroth CB, Breithecker A, Haas M, Guth S, Ghofrani A, Mayer E, Liebetrau C. Pulmonale Ballonangioplastie (BPA) zur Behandlung von Patienten mit inoperabler chronisch thromboembolischer pulmonaler Hypertonie (CTEPH). Pneumologie 2016. [DOI: 10.1055/s-0036-1583506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wittkämper G, Gall H, Reichenberger F, Seeger W, Ghofrani A, Mayer E, Guth S, Wiedenroth C, Richter MJ. Inspiratorische Kapazität bei operabler chronisch thromboembolischer pulmonaler Hypertonie vor pulmonaler Endarteriektomie: eine prospektive Beobachtungsstudie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ewert R, Sitbon O, Channick R, Chin K, Frey A, Galiè N, Ghofrani A, Hoeper MM, Lang I, Le Brun FO, McLaughlin V, Preiss R, Rubin LJ, Simonneau G, Tapson V, Gaine S. Effekt von Selexipag auf den primären kombinierten Morbiditäts- und Mortalitätsendpunkt in Abhängigkeit von vorbestehenden PAH-Therapien, Ätiologie, Alter und geographischer Region: Ergebnisse der GRIPHON Studie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gall H, Richter MJ, Tello K, Grimminger J, Grimminger F, Seeger W, Ghofrani A. Riociguat for pulmonary hypertension – experience from a referral center. Pneumologie 2016. [DOI: 10.1055/s-0036-1572023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ortwein J, Feustel A, Tiede H, Tanislav C, Seeger W, Ghofrani A, Reichenberger F. Pulmonale Hypertonie bei terminaler Niereninsuffizienz – eine Frage des Wassers? Pneumologie 2016. [DOI: 10.1055/s-0036-1572008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Weiss A, Gernert K, Schaefer S, Maegel L, Jonigk D, Ghofrani A, Weissmann N, Grimminger F, Seeger W, Schermuly R. MicroRNA-9 is a regulator of PDGFRβ expression in pulmonary arterial hypertension. Pneumologie 2015. [DOI: 10.1055/s-0035-1556634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Galiè N, Channick R, Chin K, Frey A, Gaine S, Ghofrani A, Hoeper M, Lang I, McLaughlin V, Preiss R, Rubin L, Sitbon O, Stefani M, Tapson V, Simonneau G. Effect of Selexipag on Morbidity/Mortality in Pulmonary Arterial Hypertension: Results of the GRIPHON Study. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ghofrani A, Simonneau G, D'Armini AM, Grimminger F, Hoeper MM, Jansa P, Kim NH, Wang C, Wilkins M, Fritsch A, Davie N, Colorado P, Mayer E. Riociguat zur Behandlung der chronisch thromboembolischen pulmonalen Hypertonie (CTEPH): 2-Jahres-Ergebnisse aus der Folgestudie zur Langzeitbeobachtung CHEST-2. Pneumologie 2015. [DOI: 10.1055/s-0035-1544866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Richter MJ, Ghofrani A, Voswinckel R, Seeger W, Schulz R, Reichenberger F, Tiede H. Akute hämodynamische Effekte von Iloprost vernebelt über das I-neb Adaptive Aerosol Delivery (AAD)-System bei pulmonaler Hypertonie. Pneumologie 2015. [DOI: 10.1055/s-0035-1544619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Behnk A, Tiede H, Reichert M, Ghofrani A, Tinneberg HR. Pulmonale Hypertonie in der Schwangerschaft – 4 klinische Fallberichte. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ghofrani A, Grünig E, Galiè N, Humbert M, Keogh AM, Langleben D, Rubin LJ, Speich R, Fritsch A, Davie N. Riociguat zur Behandlung der pulmonal arteriellen Hypertonie (PAH): eine Responder-Analyse aus der Phase-III-Studie PATENT-1. Pneumologie 2014. [DOI: 10.1055/s-0034-1368081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Richter MJ, Tiede H, Voswinckel R, Schulz R, Seeger W, Ghofrani A, Reichenberger F. Inspiratorische Kapazität als prognostischer Faktor bei pulmonal-arterieller Hypertonie. Pneumologie 2014. [DOI: 10.1055/s-0034-1367927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stille P, Richter MJ, Wiedenroth C, Zaatar M, Guth S, Voswinckel R, Ghofrani A, Mayer E. Hypoxämie im 6 Minuten Gehtest bei Patienten mit chronisch thromboembolischer pulmonaler Hypertonie. Pneumologie 2014. [DOI: 10.1055/s-0034-1367925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hörgele J, Tiede H, Steiner D, Voswinckel R, Schulz R, Kemkes-Matthes B, Olschewski H, Ghofrani A, Seeger W, Reichenberger F. Langzeitergebnisse eines Screenings auf pulmonale Hypertonie nach Lungenembolie. Pneumologie 2014. [DOI: 10.1055/s-0034-1368003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Richter MJ, Wiedenroth C, Zaatar M, Guth S, Mayer E, Beqiri S, Ghofrani A, Voswinckel R, Siemons T, Mitrovic V, Fink L, Bauer C. Ein seltener Fall einer in Arizona (USA) häufigen Erkrankung. Pneumologie 2014. [DOI: 10.1055/s-0034-1367855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eschenbrenner J, Janssen W, Kojonazarov B, Murmann K, Ghofrani A, Weissmann N, Grimminger F, Seeger W, Schermuly RT. Role of JAK-STAT pathway in pulmonary fibrosis. Pneumologie 2013. [DOI: 10.1055/s-0033-1345044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wilkens H, Grimminger F, Hoeper M, Stähler G, Ehlken B, Plesnila-Frank C, Berger K, Resch A, Ghofrani A. Burden of pulmonary arterial hypertension in Germany. Respir Med 2010; 104:902-10. [PMID: 20149617 DOI: 10.1016/j.rmed.2010.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 12/27/2009] [Accepted: 01/07/2010] [Indexed: 11/24/2022]
Abstract
This study aimed to describe health care provision, resource consumption and related costs, as well as treatment patterns and quality of life in adult patients with pulmonary arterial hypertension (PAH) in Germany. Data for this retrospective and prospective cost-of-illness-study were derived from hospitals, general practitioners and patients. Costs were evaluated from the perspective of third party payer and patient. Quality of life data were collected by using three validated instruments. A total of 167 patients were enrolled at 10 hospitals. Time period from first occurrence of symptoms to confirmed diagnosis of PAH was 2.3 years on average. Mean number of GP visits was 1.5 per patient per month, and within 15 months, inpatient stays were reported for 50% of patients. The ratio of combination therapy to single-drug therapy for endothelin receptor antagonists, phosphodiesterase-5-inhibitor and prostacyclin analogues increased significantly during 15 months. Treatment costs were, on average, euro47,400 per patient per year, arising mainly from drugs. Compared to the general population, quality of life of PAH patients was considerably impaired. This is the first study which evaluated aspects of the medical and economic consequences of PAH based on a large cohort of PAH patients in Germany.
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Affiliation(s)
- H Wilkens
- Department of Pneumology, Universitätsklinikum des Saarlandes/Homburg, Kirrberger Strasse 1, 66424 Homburg/Saar, Germany.
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Roth P, Attmann T, Ghofrani A, Scheffler M, Vician M, Böning A, Mayer E. Implementation of a new program for surgical treatment of chronic thrombembolic pulmonary hypertension –1 year follow up. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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große Kreymborg K, Weissmann N, Schermuly R, Voswinckel R, Kubin T, Seeger W, Kostin S, Grimminger F, Braun T, Ghofrani A. Strukturelle, funktionale und molekulare Charakterisierung des rechtsventrikulären Remodellings in drei pathophysiologisch unterschiedlichen Modellen. Pneumologie 2007. [DOI: 10.1055/s-2007-973397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nikolova S, Pullamsetti S, Ghofrani A, Weissmann N, Seeger W, Grimminger F, Schermuly R. Role of Phosphodiesterases in Idiopathic Pulmonary Fibrosis. Pneumologie 2006. [DOI: 10.1055/s-2006-933826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Schäfer RU, Schermuly R, Ghofrani A, Seeger W, Grimminger F, Weißmann N. Hypoxie-induzierte Freisetzung reaktiver Sauerstoffspezies (ROS) in isoliert perfundierten und ventilierten Mauslungen. Pneumologie 2006. [DOI: 10.1055/s-2006-933815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Woyda K, Köbrich S, Weissmann N, Ghofrani A, Seeger W, Grimminger F, Rudloff S, Reiss I, Schermuly R. Rolle der Phosphodiesterasen in der Hyperoxie-induzierten chronischen Lungenreifungsstörung der Maus. Pneumologie 2006. [DOI: 10.1055/s-2006-934054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Sommer N, Ghofrani A, Schermuly R, Seeger W, Grimminger F, Weissmann N. Etablierung einer neuen spektrophotometrischen Technik zur in vivo Beobachtung sauerstoffsensitiver Cytochrome in der isoliert perfundierten Lunge. Pneumologie 2006. [DOI: 10.1055/s-2006-933817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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34
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Ehlken N, Mereles D, Ghofrani A, Hoeper M, Halank M, Meyer J, Karger G, Wilkens H, Herth F, Olschewski H, Gruenig E. Niedrig dosierte Atem- und Bewegungstherapie verbessert die körperliche Leistungsfähigkeit und die Lebensqualität bei Patienten mit schwerer chronischer pulmonaler Hypertonie. Pneumologie 2006. [DOI: 10.1055/s-2006-933807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Dumitrascu R, Köbrich S, Traupe H, Dony E, Pullamsetti S, Savai R, Samidurai A, Weissmann N, Ghofrani A, Grimminger F, Seeger W, Schermuly R. Acute lung injury induced by the pyrrolizidine alkaloid monocrotaline in mice. Pneumologie 2006. [DOI: 10.1055/s-2006-934026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Pullamsetti S, Krick S, Ghofrani A, Schudt C, Weissmann N, Seeger W, Grimminger F, Schermuly R. Inhaled tolafentrine reverses pulmonary vascular remodeling via inhibition of smooth muscle cell migration. Pneumologie 2006. [DOI: 10.1055/s-2006-933800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Nikolova S, Pullamsetti S, Ghofrani A, Weissmann N, Seeger W, Grimminger F, Schermuly R. Role of Phosphodiesterases in Idiopathic Pulmonary Fibrosis. Pneumologie 2006. [DOI: 10.1055/s-2006-933798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Behr J, Borst MM, Winkler J, Hoeper M, Halank M, Ghofrani A, Klose H, Wilkens H, Stähler G. [A role for combination therapy in pulmonary arterial hypertension]. Pneumologie 2005; 59:730-5. [PMID: 16222588 DOI: 10.1055/s-2005-915556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For patients with pulmonary arterial hypertension (PAH) two first line therapies - iloprost inhalation (Ventavis) and bosentan (Tracleer) -- are available in Germany. A third substance, sildenafil, is already approved in the US and will be approved for this indication in the European Union soon. Patients with PAH can be stabilized or improved with a specific mono-therapy for a limited period of time only. Therefore, the question arises when and how to initiate treatment escalation. The available data from controlled clinical trials are insufficient to give a definite answer to these questions. Moreover, it is still unclear which combination of the above mentioned substances may be superior in the treatment of PAH. On the other hand, combination therapy is already reality in clinical practice. Based on this background experts from specialized centers dealing with PAH discussed the scientific basis of the role of combination therapy in PAH patients during a workshop held on April 22/23. 2005 in Wiesbaden. The goal of this workshop was to formulate a common position with regard to combination therapy of PAH on the basis of the available scientific data and clinical experience.
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Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik I, Schwerpunkt Pneumologie, Klinikum der Ludwig-Maximilians-Universität München-Grosshadern.
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Markart P, Hundack L, Ghofrani A, Grimminger F, Seeger W, Günther A. [Idiopathic interstitial pneumonias: pathomechanisms and therapeutic options]. Pneumologie 2005; 59:554-61. [PMID: 16110420 DOI: 10.1055/s-2005-870955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- P Markart
- University of Giessen Lung Center, Giessen.
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Schermuly R, Dumitrascu R, Stasch JP, Ghofrani A, Grimminger F, Seeger W, Weissmann N. Reversal of pulmonary vascular remodeling induced by hypoxia in mice by the soluble guanylate cyclase activator Bay 58–2667. Pneumologie 2005. [DOI: 10.1055/s-2005-864285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reichenbeger F, Kohstall M, Seeger T, Olschewski H, Grimminger F, Seeger W, Ghofrani A. Pulmonale Zirkulationsveränderungen bei Hypoxie und Höhenaufenthalt und der Einfluss von Sildenafil – Eine Doppler-Echokardiographische Untersuchung. Pneumologie 2005. [DOI: 10.1055/s-2005-864369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Olschewski H, Ghofrani A, Enke B, Reichenberger F, Voswinckel R, Kreckel A, Ghofrani S, Wiedemann R, Schulz R, Grimminger F, Seeger W. Medikament�se Therapie der pulmonalen Hypertonie. Internist (Berl) 2005; 46:341-9. [PMID: 15703889 DOI: 10.1007/s00108-004-1350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
New drugs for pulmonary arterial hypertension have shown efficacy in randomized controlled trials. Endothelin receptor antagonists (ERA) and prostanoids are most important for clinical practice. Bosentan represents the first approved orally active therapy for PAH. Besides its hepatotoxicity it is mostly well tolerated. The first approved prostanoid, epoprostenol, is currently first choice only for decompensated right heart failure in PAH. It has to be delivered continuously intravenously and is prone to complications, side effects and very high costs. Alternatively, subcutaneous treprostinil can be applied. It is less risky and expensive but may cause local pain at the infusion site. Inhaled iloprost combines the features of a prostanoid with pulmonary and intrapulmonary selectivity. Alternatively, iloprost is being used as continuous intravenous infusion. The phosphodiesterase-5 inhibitor sildenafil was effective in two randomized controlled trials but has not been approved for PAH therapy.
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Affiliation(s)
- H Olschewski
- Medizinische Klinik, Klinikum der Justus-Liebig-Universität Giessen
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Olschewski H, Ghofrani A, Wiedemann R, Rose F, Enke B, Gessler T, Voswinckel R, Kohstall M, Grimminger F, Seeger W. [Pulmonary hypertension]. Internist (Berl) 2002; 43:1498, 1501-9. [PMID: 12607389 DOI: 10.1007/s00108-002-0761-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Olschewski
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Giessen.
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Abstract
Defects of the skin and soft tissue in the region of the lateral malleolus of the ankle and the Achilles tendon, resulting in exposed bone, tendons, or osteosynthetic material, cannot be covered with free skin transplants. Local or free flaps must be employed. The authors present the construction of a peroneus brevis muscle flap with a distal pedicle as a useful alternative. Between 1993 and 1999, distal pedicled peroneus brevis muscle flaps were used in 19 patients with various types of defects. During construction of the flap, both the long peroneal muscle and the peroneal artery remained intact. In the region of the distal third of the fibula, consistently arranged branches run from the artery into the muscle, and these form the distal pedicle. The proximal portion of the muscle can be transposed distally and easily extends to the tip of the fibula and the attachment of the Achilles tendon to the calcaneus. Primary healing occurred in 16 patients undergoing flap construction. Donor-site morbidity was mostly limited to the donor-site scar. The distally pedicled peroneus brevis muscle flap is a reliable means for covering defects in the lower leg. This form of muscle flap has not yet been described in the known literature. In the authors' opinion, this flap constitutes a logical and valuable extension of local flap procedures for plastic surgery in the distal leg region.
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Affiliation(s)
- S Eren
- Division of Plastic and Hand Surgery, St. Agatha Hospital, Cologne, Germany
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Ghofrani A, Höller D, Schuhmann K, Saldern S, Messmer BJ. The influence of systemic growth hormone administration on the healing time of skin graft donor sites in a pig model. Plast Reconstr Surg 1999; 104:470-5. [PMID: 10654690 DOI: 10.1097/00006534-199908000-00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A more rapid healing of skin graft donor sites has often been observed during ultimoratio therapies with growth hormone in adults who have suffered extremely severe burns. The purpose of this animal experimental study was to examine the influence of systemic growth hormone administration on the healing time of skin graft donor sites under standardized conditions in pigs. The animals were 14 (7 experimental and 7 control) male, sexually mature, German domestic pigs, in which 30 skin graft donor sites 8 cm x 4 cm and 0.6 mm deep were created. Fifteen each of the skin graft donor sites were bandaged with the same material [hydrocolloid bandage (Varihaesive E) and PVP-iodine gauze (Braunovidon Gaze)]. The test period was 15 days for each pig, whereby recombinant growth hormone (0.5 IU/kg body weight per day) was applied subcutaneously in the experimental group. The bandages were changed under brief narcosis every 2 days, during which one skin-punch biopsy was taken per skin graft donor site, and blood samples were drawn for determination of the serum IGF-1 values. Photographic documentation was also recorded. The biopsies were examined histologically (hematoxylin and eosin stain) and immunohistochemically (collagen IV and VII, and laminin), whereby histologically the start of keratinization was assessed as a healing criterion. The serum IGF-1 values in the growth hormone group were statistically significantly higher than in the control group. Immunohistochemically, a complete basal membrane was observed in both the experimental and the control group after the 7th or 8th day. A clearly elevated serum IGF-1 level correlated in the growth hormone group with the skin graft donor sites healing. It could thus be demonstrated both clinically and histologically that systemic application of growth hormone results in a statistically significantly more rapid healing of the skin graft donor sites by 2 days earlier than in the control group.
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Affiliation(s)
- A Ghofrani
- Division of Plastic Surgery and Hand Surgery at St. Agatha Hospital, Cologne, Germany.
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Goldmann C, Ghofrani A, Hafemann B, Fuchs P, Khorram-Seffat R, Afify M, Küpper W, Pallua N. Combination anesthesia with ketamine and pentobarbital: a long-term porcine model. Res Exp Med (Berl) 1999; 199:35-50. [PMID: 10494673 DOI: 10.1007/s004330050131] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anesthesia of the pig poses great problems for experimental animal-based research and particularly in shock research. In this study, five mechanically ventilated domestic pigs were given long-term anesthesia with a combination of ketamine plus pentobarbital. Circulatory parameters were recorded every 2 h via an arterial catheter placed in the right common carotid artery, a Swan-Gans thermodilution catheter (7F), that was placed in the pulmonary artery of the right middle-lobe in a wedge position through the external jugular vein, and another catheter in the internal jugular vein for measuring central venous pressure. Moreover, body weight, blood gases, pH, blood cells, electrolytes and serum enzymes were measured. Further serum traits as total protein and glucose and pathological alterations in different organs were recorded. The animals were observed for a period of 96 h and then killed painlessly. It was shown that pigs can survive 96-h anesthesia with the combination of ketamine and pentobarbital. Optimum, carefully controlled anesthesia did not impair the integrity of the regulatory mechanisms of circulation.
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Affiliation(s)
- C Goldmann
- Department of Laboratory Animal Research, The Technical University of Aachen, Germany
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Abstract
OBJECTIVE To compare the effects of aerosolization of prostacyclin and its stable analog iloprost with those of nasal oxygen, inhaled nitric oxide, and intravenous prostacyclin on hemodynamics and gas exchange in patients with severe pulmonary hypertension. DESIGN Open uncontrolled trial. SETTING Justus-Liebig-University, Giessen Germany. PATIENTS 4 patients with primary pulmonary hypertension and 2 patients with severe pulmonary hypertension associated with calcinosis, the Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia (the CREST syndrome). All were classified as New York Heart Association class III or class IV. INTERVENTION Short-term applications of O2, inhaled nitric oxide, intravenous prostacyclin, aerosolized prostacyclin, and aerosolized iloprost during repeated catheter investigation of the right side of the heart within a 1-month period. One patient had long-term therapy with inhaled iloprost. RESULTS Aerosolized prostacyclin decreased pulmonary artery pressure in 6 patients from (mean +/- SE) 62.3 +/- 4.1 mm Hg to 50.8 +/- 5.5 mm Hg and reduced pulmonary vascular resistance from 1721 +/- 253 dyne/s cm-5 to 1019 +/- 203 dyne/s cm-5, and it increased cardiac output from 2.75 +/- 0.21 L/min to 4.11 +/- 0.54 L/min, mixed venous oxygen saturation from 51.1% +/- 3/4% to 66.3% +/- 4.1% and arterial oxygen saturation from 90.6% +/- 2.7% to 93.8% +/- 23% (P<0.05 for all changes). Mean systemic arterial pressure was only slightly affected. The responses lasted for 10 to 30 minutes after inhalation was terminated. Aerosolized iloprost had an identical efficacy profile but was associated with a longer duration of the pulmonary vasodilatory effect (60 min to 120 min). In comparison, intravenous prostacyclin reduced pulmonary vascular resistance with corresponding efficacy but produced a more pronounced decline in systemic artery pressure and no clinically significant decrease in pulmonary artery pressure. Nitric oxide and O2 were less potent pulmonary vasodilators in these patients. In one patient, 1 year of therapy with aerosolized iloprost (100 microgram/d in six aerosol doses) resulted in sustained efficacy of the inhaled vasodilator regimen and clinical improvement. CONCLUSION Aerosolization of prostacyclin or its stable analog iloprost causes selective pulmonary vasodilatation, increases cardiac output, and improves venous and arterial oxygenation in patients with severe pulmonary hypertension. Thus, it may offer a new strategy for treatment of this disease.
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Affiliation(s)
- H Olschewski
- Department of Medicine, Justus-Liebig-University, Giessen, Germany
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Abstract
Previous clinical observations have suggested that the application of glycerol-preserved donor skin as a temporary wound dressing provokes a weaker rejection reaction than fresh, vital donor skin. Like others, we frequently observed that considerable parts of the allodermis not only remained on the wound for an extended period of time, but even became re-epithelialized in some cases. In order to quantify this effect, we applied the mixed lymphocyte culture (MLC) test in a rat model, using the two highly inbred, histoincompatible rat strains DA and Lewis as donor and recipient respectively. Using the methodology of the Euro Skin Bank, Beverwijk, The Netherlands, split thickness skin, excised from the back of the rats, was equilibrated in 98 per cent glycerol. The immunological reaction after grafting vital DA-skin, glycerolized DA-skin onto Lewis rats, and vital as well as glycerolized Lewis-skin onto Lewis rats was compared. The results of these experiments do not support the clinical observations that the glycerolization procedure results in decreased immunogenicity of donor skin.
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Affiliation(s)
- R Hettich
- Clinic of Burns, Plastic and Reconstructive Surgery, Klinikum of the Rheinisch Westphälische Technische Hochschule, Aachen, Germany
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