1
|
Berg A, Greve G, Hirth A, Norgård G. Gunnar Alm Rosland. Tidsskriftet 2021. [DOI: 10.4045/tidsskr.21.0561] [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: 11/02/2022] Open
|
2
|
Klausen SH, Buys R, Andersen LL, Hirth A, McCrindle BW, Kjaergaard H, Wetterslev J. Interventions to increase physical activity for people with congenital heart disease. Hippokratia 2018. [DOI: 10.1002/14651858.cd011030.pub2] [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: 11/05/2022]
Affiliation(s)
- Susanne H Klausen
- Copenhagen University Hospital, Rigshospitalet; The Research Unit Women and Children's Health, The Juliane Marie Centre; Section 7821 Blegdamsvej 9 Copenhagen Denmark DK 2100
| | - Roselien Buys
- Catholic University of Leuven; Research Center for Cardiovascular and Respiratory Rehabilitation; Tervuursevest 101 Heverlee Belgium 3001
| | - Lars Louis Andersen
- National Research Centre for the Working Environment; Department of Musculoskeletal Disorders; Lersø Parkalle 105 Copenhagen Denmark DK-2100
| | - Asle Hirth
- Haukeland University Hospital; Children's Department; Jonas Lies vei 1 Bergen Norway N-5021
| | - Brian W McCrindle
- The Hospital for Sick Children; University of Toronto; 555 University Avenue Toronto ON Canada M5G 1X8
| | | | - Jørn Wetterslev
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark DK-2100
| |
Collapse
|
3
|
Jortveit J, Eskedal L, Hirth A, Fomina T, Døhlen G, Hagemo P, Tell GS, Birkeland S, Øyen N, Holmstrøm H. Sudden unexpected death in children with congenital heart defects. Eur Heart J 2015; 37:621-6. [PMID: 26341891 DOI: 10.1093/eurheartj/ehv478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Congenital heart defects (CHDs) are the most common birth defects and are an important cause of death in children. The fear of sudden unexpected death has led to restrictions of physical activity and competitive sports. The aim of the present study was to investigate the rate of sudden unexpected deaths unrelated to surgery in children 2-18 years old with CHDs and, secondarily, to determine whether these deaths were related to cardiac disease, comorbidity, or physical activity. METHODS AND RESULTS To identify children with CHDs and to determine the number of deaths, data concerning all 9 43 871 live births in Norway in 1994-2009 were retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital's Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and information for the deceased children was retrieved from medical records at Norwegian hospitals. Among 11 272 children with CHDs, we identified 19 (0.2%) children 2-18 years old who experienced sudden unexpected deaths unrelated to cardiac surgery. A cardiac cause of death was identified in seven of these cases. None of the children died during physical activity, whereas two children survived cardiac arrest during sports. CONCLUSION Sudden unexpected death was infrequent among children with CHDs who survived 2 years of age. Comorbidity was common among the children who died. This study indicates that sudden unexpected death in children with CHDs rarely occurs during physical activity.
Collapse
Affiliation(s)
- Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital, PO Box 783, Stoa, 4809 Arendal, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leif Eskedal
- Research Department, Sørlandet Hospital, Kristiansand, Norway
| | - Asle Hirth
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gaute Døhlen
- Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| | - Petter Hagemo
- Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Henrik Holmstrøm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
4
|
Midtbø H, Gerdts E, Kvien TK, Olsen IC, Hirth A, Davidsen ES, Semb AG. Disease activity and left ventricular structure in patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 54:511-9. [PMID: 25224414 DOI: 10.1093/rheumatology/keu368] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Increased left ventricular (LV) wall thickness/internal diameter ratio (relative wall thickness) was recently reported in RA patients. The aim of this study was to assess the association between LV relative wall thickness and RA disease activity. METHODS Clinical and echocardiographic data from 129 RA patients without established cardiovascular disease and 102 controls were used. RA disease activity was assessed by different composite scores and active RA defined by the Simplified Disease Activity Index (SDAI) level exceeding the cut-off for remission (SDAI >3.3). RESULTS The RA patients were on average 61.3 years old, 77% were women and 67% had active RA (SDAI >3.3). Patients with active RA had greater LV relative wall thickness and included more patients with treated hypertension (all P < 0.05), but had LV mass index and blood pressure comparable to patients in remission. Having active RA by the SDAI score (β = 0.20, P = 0.008) was also independently associated with greater LV relative wall thickness after adjusting for systolic blood pressure, wall stress, age and sex in a multivariate model. This association was robust also in secondary models including other disease activity composite scores such as the Clinical Disease Activity Index and 28-joint DAS. CONCLUSION Among RA patients, higher disease activity was independently associated with greater LV relative wall thickness, reflecting subclinical heart disease. The findings point to the importance of disease activity control in RA patients to prevent progression to clinical heart disease.
Collapse
Affiliation(s)
- Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway. Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
| | - Eva Gerdts
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| | - Tore K Kvien
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| | - Inge C Olsen
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| | - Asle Hirth
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| | - Einar Skulstad Davidsen
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| | - Anne Grete Semb
- Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
5
|
Berg A, Bråtane E, Odland HH, Brudvik C, Rosland B, Hirth A. [Cardiovascular risk assessment for the use of ADHD drugs in children]. Tidsskr Nor Laegeforen 2014; 134:710-4. [PMID: 24721858 DOI: 10.4045/tidsskr.13.0565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations. METHOD The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments. RESULTS The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes. INTERPRETATION Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.
Collapse
Affiliation(s)
- Ansgar Berg
- Barneklinikken Haukeland universitetssykehus og Klinisk institutt 2 Universitetet i Bergen
| | | | | | | | | | - Asle Hirth
- Barneklinikken Haukeland universitetssykehus
| |
Collapse
|
6
|
Klausen SH, Buys R, Andersen LL, Hirth A, McCrindle BW, Kjaergaard H, Wetterslev J. Interventions to increase physical activity for people with congenital heart disease. Hippokratia 2014. [DOI: 10.1002/14651858.cd011030] [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: 11/11/2022]
Affiliation(s)
- Susanne H Klausen
- Copenhagen University Hospital, Rigshospitalet; The Research Unit Women and Children's Health, The Juliane Marie Centre; Section 7821 Blegdamsvej 9 Copenhagen Denmark DK 2100
| | - Roselien Buys
- Catholic University of Leuven; Research Center for Cardiovascular and Respiratory Rehabilitation; Tervuursevest 101 Heverlee Belgium 3001
| | - Lars Louis Andersen
- National Research Centre for the Working Environment; Department of Musculoskeletal Disorders; Lersø Parkalle 105 Copenhagen Denmark DK-2100
| | - Asle Hirth
- Haukeland University Hospital; Children's Department; Jonas Lies vei 1 Bergen Norway N-5021
| | - Brian W McCrindle
- The Hospital for Sick Children; University of Toronto; 555 University Avenue Toronto Ontario Canada M5G 1X8
| | | | - Jørn Wetterslev
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812; Blegdamsvej 9 Copenhagen Denmark DK-2100
| |
Collapse
|
7
|
Tøndel C, Bostad L, Larsen KK, Hirth A, Vikse BE, Houge G, Svarstad E. Agalsidase benefits renal histology in young patients with Fabry disease. J Am Soc Nephrol 2013; 24:137-48. [PMID: 23274955 DOI: 10.1681/asn.2012030316] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The effect of early-onset enzyme replacement therapy on renal morphologic features in Fabry disease is largely unknown. Here, we evaluated the effect of 5 years of treatment with agalsidase alfa or agalsidase beta in 12 consecutive patients age 7-33 years (median age, 16.5 years). We performed renal biopsies at baseline and after 5 years of enzyme replacement therapy; 7 patients had additional biopsies after 1 and 3 years. After a median of 65 months, biopsy findings from all patients showed total clearance of glomerular endothelial and mesangial cell inclusions, and findings from 2 patients showed complete clearance of inclusions from epithelial cells of the distal tubule. The 4 patients who received the highest dose of agalsidase exhibited substantial clearance of podocyte inclusions, and the youngest patient had nearly complete clearance of these inclusions. Linear regression analysis showed a highly significant correlation between podocyte globotriaocylceramide clearance and cumulative agalsidase dose (r=0.804; P=0.002). Microalbuminuria normalized in five patients. In summary, long-term enzyme replacement therapy in young patients can result in complete globotriaocylceramide clearance of mesangial and glomerular endothelial cells across all dosage regimens, and clearance of podocyte inclusions is dose-dependent.
Collapse
Affiliation(s)
- Camilla Tøndel
- Renal Research Group, Institute of Medicine, University of Bergen, Haukeland University Hospital, N-5021 Bergen, Norway.
| | | | | | | | | | | | | |
Collapse
|
8
|
Hirth A, Edwards NC, Greve G, Tangeraas T, Gerdts E, Lenes K, Norgård G. Left ventricular function in children and adults after renal transplantation in childhood. Pediatr Nephrol 2012; 27:1565-74. [PMID: 22527532 DOI: 10.1007/s00467-012-2167-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 09/01/2011] [Revised: 03/07/2012] [Accepted: 03/12/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Renal transplantation improves left ventricular (LV) function, but cardiovascular mortality remains elevated. The aim of this cross-sectional study was to determine whether subclinical abnormalities of LV longitudinal function also persist in patients who underwent renal transplant in childhood. METHODS Conventional and speckle tracking echocardiography was performed in 68 renal transplant recipients (34 children and 34 adults, median 9.8 years (range 2.0-28.4 years) after first transplantation and 68 age- and sex-matched healthy controls. RESULTS Mean age at first transplantation was 8.8 ± 4.8 years. Forty-three percent had a pre-emptive transplant. Of the remaining, 70% received haemodialysis and 30% peritoneal dialysis on average for 6.9 months. Thirty-one percent of paediatric and 35% of adult patients had hypertension. LV mass index was increased in adult patients (92 ± 24 vs 75 ± 11 g/m(2), P< 0.01). LV diastolic function and exercise capacity were impaired in both paediatric and adult patients. LV longitudinal peak systolic strain and strain rate were comparable in patients and controls. In multivariate analysis, systolic blood pressure and LV diastolic relaxation were the main covariates of LV peak systolic strain and strain rate (all P < 0.01). CONCLUSIONS Patients who underwent renal transplantation in childhood have abnormal LV diastolic function and impaired exercise capacity, despite preserved LV longitudinal systolic deformation.
Collapse
Affiliation(s)
- Asle Hirth
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | | | | | | | | | | |
Collapse
|
9
|
Klausen SH, Mikkelsen UR, Hirth A, Wetterslev J, Kjærgaard H, Søndergaard L, Andersen LL. Design and rationale for the PREVAIL study: effect of e-Health individually tailored encouragements to physical exercise on aerobic fitness among adolescents with congenital heart disease--a randomized clinical trial. Am Heart J 2012; 163:549-56. [PMID: 22520519 DOI: 10.1016/j.ahj.2012.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
Abstract
Intensive exercise may be an important part of rehabilitation in patients with congenital heart disease (CHD). However, performing regular physical exercise is challenging for many adolescent patients. Consequently, effective exercise encouragements may be needed. Little is known on the effect of e-Health encouragements on physical fitness, physical activity, and health-related quality of life in adolescents. This trial is a nationwide interactive e-Health rehabilitation study lasting 1 year, centered on interactive use of mobile phone and Internet technology. We hypothesize that e-Health encouragements and interactive monitoring of intensive exercise for 1 year can improve physical fitness, physical activity, and health-related quality of life. Two hundred sixteen adolescents (age, 13-16 years) with surgically corrected complex CHD but without significant hemodynamic residual defects and no restrictions to participate in physical activity are in the process of being enrolled by invitation after informed consent. Physical fitness is measured as the maximal oxygen uptake (Vo(2)) at baseline and after 12 months by an assessor blinded to the randomization group. After baseline testing, the patients are 1:1 randomized to an intervention group or a control group. Individually fully automated tailored e-Health encouragements--SMS, Internet, and mobile applications--aimed at increasing physical activity are delivered to the participants in the intervention group once a week. The Bandura's Social Cognitive Theory inspires the behavioral theoretical background. The e-Health intervention and the Godfrey cycle ergometer protocol have been feasibility tested and seem applicable to adolescents with CHD. The trial is expected to contribute with new knowledge regarding how physical activity in adolescents with CHD can be increased and, possibly, comorbidity be reduced.
Collapse
|
10
|
Hirth A, Disney P, Thorne S. Brain abscess associated with an unusual cause of right to left shunt. Case Reports 2009; 2009:bcr2006093773. [DOI: 10.1136/bcr.2006.093773] [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: 11/03/2022] Open
|
11
|
Kieleck C, Eichhorn M, Hirth A, Faye D, Lallier E. High-efficiency 20-50 kHz mid-infrared orientation-patterned GaAs optical parametric oscillator pumped by a 2 microm holmium laser. Opt Lett 2009; 34:262-264. [PMID: 19183625 DOI: 10.1364/ol.34.000262] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report on what are, to our knowledge, the best results obtained with an orientation-patterned GaAs optical parametric oscillator (OPO) pumped by a Q-switched 2 microm Ho:YAG laser. Up to 2.85 W are obtained for 6.1 W of pump power, corresponding to an optical-to-optical conversion efficiency of 46.5% with a threshold of 1 W. Optical damage occurred at a fluence of about 2 J/cm2. The thickness of the crystal limited the pump power. Slope efficiencies are of the same order as those obtained with ZnGeP2 OPOs pumped with the same Ho:YAG laser.
Collapse
Affiliation(s)
- C Kieleck
- French-German Research Institute of Saint-Louis ISL, Saint Louis, France.
| | | | | | | | | |
Collapse
|
12
|
Edwards NC, Hirth A, Ferro CJ, Townend JN, Steeds RP. Subclinical Abnormalities of Left Ventricular Myocardial Deformation in Early-Stage Chronic Kidney Disease: The Precursor of Uremic Cardiomyopathy? J Am Soc Echocardiogr 2008; 21:1293-8. [DOI: 10.1016/j.echo.2008.09.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Indexed: 10/21/2022]
|
13
|
Downham E, Winterthun S, Nakkestad HL, Hirth A, Halvorsen T, Taylor RW, Bindoff LA. A novel mitochondrial ND5 (MTND5) gene mutation giving isolated exercise intolerance. Neuromuscul Disord 2008; 18:310-4. [PMID: 18396045 DOI: 10.1016/j.nmd.2008.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/18/2007] [Accepted: 01/03/2008] [Indexed: 11/15/2022]
Abstract
We describe a patient with isolated exercise intolerance caused by a new, maternally inherited mutation in mitochondrial DNA. The heteroplasmic T>C transition at position 13271 in MTND5 affects a highly conserved base and segregates with the disease, being present at highest levels in skeletal muscle fibres showing abnormal mitochondrial accumulation. This is the 15th mutation affecting the MTND5 subunit of respiratory chain complex I and confirms this protein as an important site for disease with phenotypes ranging from MELAS and infantile encephalopathies to isolated syndromes affecting a single tissue such as Leber hereditary optic neuropathy and now skeletal muscle.
Collapse
Affiliation(s)
- Esther Downham
- Department of Clinical Medicine, University of Bergen, Heukeland University Hospital, 5021 Bergen, Norway
| | | | | | | | | | | | | |
Collapse
|
14
|
Tøndel C, Bostad L, Hirth A, Svarstad E. Renal biopsy findings in children and adolescents with Fabry disease and minimal albuminuria. Am J Kidney Dis 2008; 51:767-76. [PMID: 18436087 DOI: 10.1053/j.ajkd.2007.12.032] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 12/11/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Information concerning renal pathological characteristics in Fabry disease in childhood is limited. Our objective is to define renal morphological abnormalities in children and adolescents with Fabry disease and minimal proteinuria. STUDY DESIGN Case series. SETTING & PARTICIPANTS 9 symptomatic patients (7 males, 2 females; age range, 7 to 18 years); 2 patients had received enzyme replacement therapy for 2 years. OUTCOMES & MEASUREMENTS Renal morphological changes assessed by using light and electron microscopy. RESULTS All patients had acroparesthesia and typical eye changes, 7 showed hypohidrosis, 7 had gastrointestinal problems, and 2 had typical angiokeratomas. Mean albumin-creatinine ratio was 38 mg/g [corrected] (range, 5.3 to 104.3 mg/g). [corrected] Measured glomerular filtration rate was normal in all patients. Light microscopy showed changes in glomerular, tubulointerstitial, or vascular compartments alone or in combination in 7 patients. Electron microscopy showed lesions in all patients. LIMITATIONS Small sample size. CONCLUSIONS Glomerular and vascular changes are present before progression to overt proteinuria and decreased glomerular filtration rate. The combination of acroparesthesia and mild albuminuria, glomerular endothelial cell deposits, and arteriopathy may constitute a clinical and morphological combination heralding a potentially progressive renal disease.
Collapse
Affiliation(s)
- Camilla Tøndel
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | | | | | | |
Collapse
|
15
|
|
16
|
Hirth A, Berg A, Greve G. Successful treatment of severe heart failure in an infant with Hurler syndrome. J Inherit Metab Dis 2007; 30:820. [PMID: 17768668 DOI: 10.1007/s10545-007-0613-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 06/25/2007] [Accepted: 06/26/2007] [Indexed: 11/30/2022]
Abstract
Hurler syndrome (MPS IH) is the most severe form of mucopolysaccharidosis type I. It is caused by deficiency or absence of the enzyme alpha-L-iduronidase. Cardiac involvement includes cardiomyopathy and valve and coronary pathology. Cardiomyopathy causing symptoms in an infant with MPS IH carries a very poor prognosis. We describe a previously healthy 10-week-old boy who was admitted to hospital critically ill with severe heart failure. Echocardiography on admission showed severe dilatation of the left ventricle and moderate insufficiency of the left-sided cardiac valves. Accumulation of heparan sulfate and dermatan sulfate substrates in the urine and leukocyte analysis confirmed the diagnosis of MPS IH. Enzyme replacement therapy (ERT) with intravenous laronidase at a standard dosage of 100 U/kg weekly was started soon after. This improved the child's general clinical wellbeing dramatically. His cardiac function improved steadily over a period of months. Stem cell transplantation from cord blood is not available in Norway and he underwent successful transplantation from an unrelated bone marrow donor at the age of 11 months. ERT was stopped four months later. At the age of 26 months his heart function is close to normal and he is currently on no medication. This report highlights three important clinical issues: (1) MPS IH must be considered in infants with cardiomyopathy; (2) early ERT may have a significant impact on short-term outcome in children less than 18 months old with severe cardiomyopathy; (3) our report confirms that patients in poor condition benefit from ERT before stem cell transplantation.
Collapse
Affiliation(s)
- A Hirth
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | | |
Collapse
|
17
|
Vedder AC, Linthorst GE, Houge G, Groener JE, Ormel EE, Bouma BJ, Aerts JM, Hirth A, Hollak CE. Treatment of Fabry disease: outcome of a comparative trial with agalsidase alfa or beta at a dose of 0.2 mg/kg. PLoS One 2007; 2:e598. [PMID: 17622343 PMCID: PMC1913555 DOI: 10.1371/journal.pone.0000598] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 05/25/2007] [Indexed: 11/18/2022] Open
Abstract
Background Two different enzyme preparations, agalsidase alfa (ReplagalTM, Shire) and beta (FabrazymeTM, Genzyme), are registered for treatment of Fabry disease. We compared the efficacy of and tolerability towards the two agalsidase preparations administered at identical protein dose in a randomized controlled open label trial. Methodology/Principal Findings Thirty-four Fabry disease patients were treated with either agalsidase alfa or agalsidase beta at equal dose of 0.2 mg/kg biweekly. Primary endpoint was reduction in left ventricular mass after 12 and 24 months of treatment. Other endpoints included occurrence of treatment failure (defined as progression of cardiac, renal or cerebral disease), glomerular filtration rate, pain, anti-agalsidase antibodies, and globotriaosylceramide levels in plasma and urine. After 12 and 24 months of treatment no reduction in left ventricular mass was seen, which was not different between the two treatment groups. Also, no differences in glomerular filtration rate, pain and decline in globotriaosylceramide levels were found. Antibodies developed only in males (4/8 in the agalsidase alfa group and 6/8 in the agalsidase beta group). Treatment failure within 24 months of therapy was seen in 8/34 patients: 6 male patients (3 in each treatment group) and 2 female patients (both agalsidase alfa). The occurrence of treatment failures did not differ between the two treatment groups; χ2 = 0.38 p = 0.54. Conclusion Our study revealed no difference in reduction of left ventricular mass or other disease parameters after 12 and 24 months of treatment with either agalsidase alfa or beta at a dose of 0.2 mg/kg biweekly. Treatment failure occurred frequently in both groups and seems related to age and severe pre-treatment disease. Trial Registration International Standard Randomized Clinical Trial ISRCTN45178534
Collapse
Affiliation(s)
- Anouk C. Vedder
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Gabor E. Linthorst
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Gunnar Houge
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Johannna E.M. Groener
- Department of Medical Biochemistry, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Els E. Ormel
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Berto J. Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johannes M.F.G. Aerts
- Department of Medical Biochemistry, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Asle Hirth
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Carla E.M. Hollak
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
- * To whom correspondence should be addressed. E-mail:
| |
Collapse
|
18
|
|
19
|
Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffmann A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. ACTA ACUST UNITED AC 2006; 13:293-9. [PMID: 16926656 DOI: 10.1097/01.hjr.0000220574.22195.d6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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
BACKGROUND Physical activity is important for patients with congenital heart disease. The aim of this paper is to provide a consensus document for participation in competitive or leisure sport activity in children and adults with congenital heart disease. METHODS The recommendations are based on expert consensus meetings, personal experience of the contributing authors and an updated review of the literature regarding exercise performance and risk stratification in patients with congenital heart disease. RESULTS Physical performance and exercise tolerance is close to normal in patients with simple lesions with successful repair or no need for therapy. Most patients with complex lesions have some degree of residual disease, making them less suitable for participation in competitive sport. CONCLUSION Regular exercise at recommended levels can be performed and should be encouraged in all patients with congenital heart disease. Many can attend sports with no restrictions. Special concern should be given to those patients with a significant ventricular dysfunction or recent history or risk of arrhythmia.
Collapse
Affiliation(s)
- Asle Hirth
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | |
Collapse
|
20
|
Midtbø H, Hirth A, Norgård G, Greve G. [Do patients with ventricular septal defect need endocarditis prophylaxis?]. Tidsskr Nor Laegeforen 2005; 125:3256-8. [PMID: 16327848] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Patients with ventricle septal defect are considered at higher risk of infectious endocarditis than the population in general. According to guidelines, these patients should receive prophylactic antibiotics prior to invasive procedures. Recently, several studies have been published that challenge this view. MATERIAL AND METHODS Based on searches in Medline, we discuss the risk of endocarditis and indication for antibiotic prophylaxis in patients with this defect. RESULTS Patients with perimembranous and subvalvular defects have higher risk of endocarditis than the population in general. The proportion of patients developing endocarditis in relation to invasive procedures is low. Prophylactic antibiotics are only partially effective. INTERPRETATION The proportion of preventable cases of endocarditis is low, and the prophylaxis does not give sufficient protection. Studies suggest that only patients at the highest risk should receive prophylactics.
Collapse
Affiliation(s)
- Helga Midtbø
- Seksjon for pediatri, Institutt for klinisk medisin, Haukeland Universitetssjukehus, 5021 Bergen.
| | | | | | | |
Collapse
|
21
|
Berg A, Søvik O, Hirth A. [Fluid management and the risk of cerebral oedema in children with diabetic ketoacidosis]. Tidsskr Nor Laegeforen 2005; 125:2932-5. [PMID: 16276374] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Cerebral oedema is a rare but life-threatening complication of diabetic ketoacidosis in children. MATERIAL AND METHODS This paper presents a case report on an infant with diabetic ketoacidosis and in an extreme hyperosmolar and hypernatremic state. Considerations regarding appropriate fluid management and the osmotic role of serum sodium are discussed. Recommendations for treatment are given based on available guidelines and published evidence. INTERPRETATION Intracellular swelling of the brain seems to be caused by water moving along osmotic gradients. In diabetic ketoacidosis, sodium and glucose are the dominant osmotic forces. It is important to understand the relation between serum osmolarity, sodium and glucose, as appropriate fluid treatment might prevent this potentially fatal complication.
Collapse
Affiliation(s)
- Ansgar Berg
- Barneklinikken, Haukeland Universitetssjukehus, 5021 Bergen.
| | | | | |
Collapse
|
22
|
Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carrè F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G. Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26:1422-45. [PMID: 15923204 DOI: 10.1093/eurheartj/ehi325] [Citation(s) in RCA: 523] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, 00197 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Berg A, Greve G, Hirth A, Rosland GA, Norgård G. [Evaluation of cardiac murmurs in children]. Tidsskr Nor Laegeforen 2005; 125:1000-3. [PMID: 15852070] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Many normal children have heart murmurs, but most children do not have heart disease. Differentiation of innocent murmurs from those due to structural heart disease, pathological murmurs, is largely clinical. MATERIAL AND METHODS This review is based upon the authors' own studies and PubMed searches. RESULTS An appropriate history and a properly conducted physical examination can identify children at risk of significant heart disease. INTERPRETATION If a murmur cannot clearly be labelled as innocent based on characteristics like sound quality, intensity, location and response to posture, then referral to a paediatric cardiologist is indicated. Other indications for referral are any sign or symptom of cardiovascular disease such as shortness of breath, cyanosis or decreased exercise tolerance. In addition, children with syndromes should, because of their high risk of congenital heart disease, be referred to a paediatric cardiologist for further evaluation.
Collapse
Affiliation(s)
- Ansgar Berg
- Barneklinikken, Haukeland Universitetssjukehus, 5021 Bergen
| | | | | | | | | |
Collapse
|
24
|
Sack U, Hirth A, Funke B, Wiedemeyer K, Lange F, Tröltzsch M, Tannapfel A, Gebhardt R, Emmrich F, Lehmann J. A novel model of fibroblast-mediated cartilage destruction. Scand J Immunol 2005; 61:18-28. [PMID: 15644119 DOI: 10.1111/j.0300-9475.2005.01536.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/27/2022]
Abstract
In rheumatoid arthritis (RA), fibroblasts have been shown to be crucial for disease progression as well as joint destruction. In the model of human/murine SCID arthritis, synovial explants as well as fibroblasts from human rheumatoid synovial membrane induce destructive arthritis in immunodeficient mice. Hereby, the underlying cartilage destruction is accomplished by murine fibroblasts. Therefore, murine destructive fibroblasts represent a promising tool to investigate destruction of articular cartilage and bone. In this context, a novel destructive murine fibroblast line (LS48) was examined for morphological, ultrastructural, immunological and functional cellular parameters. These cells were injected into knees of SCID mice. Subsequently, the animals were monitored for joint swelling and serological parameters of arthritis by radiological methods. Finally, cartilage destruction was assessed morphologically. Cultured LS48 cells exhibit characteristic features that resemble those of activated synovial fibroblasts in human RA. Expression levels of inducible nitric oxide synthase, interleukin-6, tumour necrosis factor-alpha and matrix metalloproteinases were comparable to those detected in invasive human fibroblasts. The instillation of 5 x 10(5) LS48 cells into the knee joints of SCID mice initiated a rapid progressive process, that caused cartilage destruction within 10 days, and morphological examinations revealed that articular cartilage was infiltrated by the fibroblasts injected previously. In summary, the intra-articular application of LS48 cells represents a rapid and highly reproducible model to investigate the initiation and progression of cartilage destruction in connection with RA therapy and represents an easy-to-handle animal model.
Collapse
Affiliation(s)
- U Sack
- Institute of Clinical Immunology and Transfusion Medicine, University of Leipzig, Leipzig, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Tøndel C, Laegreid LM, Hirth A, Houge G, Månsson JE, Søvik O. [Intravenous enzyme substitution therapy in children with Fabry's disease]. Tidsskr Nor Laegeforen 2003; 123:3388-90. [PMID: 14713976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Fabry's disease is a X-linked lysosomal storage disorder with accumulation of globotriaosylceramide primarily in vascular endothelial cells, affecting mainly skin, kidney, heart and brain. Symptoms may appear in 7-8-year-old children as burning pain in hands and feet; organ damage usually becomes evident in adult age. Intravenous enzyme replacement therapy has recently become available. PATIENTS Two brothers, 13.5 and 15 years old, had typical symptoms with acroparesthesia, fever, abdominal pain and diarrhoea. There were high levels of urinary globotriaosylceramide, low levels of alfagalactosidase A in leukocytes, and a single-nucleotide deletion in position 10671 of the alfagalactosidase gene (GLA). Both brothers showed slightly abnormal echocardiography and one had typical changes on cerebral MRI. Enzyme replacement therapy with alfagalactosidase A (Replagal) was started in November 2001. After one year of therapy there was clearly clinical improvement with no fever and diarrhoea and less pain. The urinary excretion of globotriaosylceramide was reduced. No adverse effects were recorded. INTERPRETATION During 12 months of intravenous enzyme replacement therapy in two adolescent subjects with Fabry's disease we observed clinical improvement and no adverse effects. We recommend greater awareness of Fabry's disease in paediatrics as well as in adult medicine.
Collapse
Affiliation(s)
- Camilla Tøndel
- Senter for medisinsk genetikk og molekylaemedisin, Haukeland Universitettssykehus, Bergen.
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
We report a compact Ho:YAG laser that is intracavity pumped by a diode-pumped Tm:YLF laser. Both lasers exhibit pulse mode behavior. Operating both crystals at room temperature (25 degrees C), we obtained 1.6 W of average output at 2.09 microm from the Ho:YAG laser for 15.4 W of diode power incident upon the Tm:YLF rod and a slope efficiency of 21%.
Collapse
Affiliation(s)
- M Schellhorn
- French-German Research Institute of Saint-Louis, 5 Rue du Général Cassagnou, F-68301 Saint-Louis, France.
| | | | | |
Collapse
|
27
|
Distler JHW, Hirth A, Kurowska-Stolarska M, Gay RE, Gay S, Distler O. Angiogenic and angiostatic factors in the molecular control of angiogenesis. Q J Nucl Med 2003; 47:149-61. [PMID: 12897707] [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] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
The vascular system that ensures an adequate blood flow is required to provide the cells with sufficient supply of nutrients and oxygen. Two different mechanisms of the formation of new vessels can be distinguished: vasculogenesis, the formation of the first primitive vascular plexus de novo and angiogenesis, the formation of new vessels from preexisting ones. Both processes are regulated by a delicate balance of pro- and anti-angiogenic factors. Physiologically, angiostatic mediators outweigh the angiogenic molecules and angiogenesis does not occur. Under certain conditions such as tumor formation or wound healing, the positive regulators of angiogenesis predominate and the endothelium becomes activated. Angiogenesis is initiated by vasodilatation and an increased permeability. After destabilization of the vessel wall, endothelial cells proliferate, migrate and form a tube, which is finally stabilized by pericytes and smooth muscle cells. Numerous soluble growth factors and inhibitors, cytokines and proteases as well as extracellular matrix proteins and adhesion molecules strictly control this multi-step process. The properties and interactions of angiogenic molecules such as VEGFs, FGFs, angiopoietins, PDGF, angiogenin, angiotropin, HGF, CXC chemokines with ELR motif, PECAM-1, integrins and VE-cadherin as well as angiostatic key players such as angiostatin, endostatin, thrombospondin, CXC chemokines without ELR motif, PEDF are discussed in this review with respect to their molecular impact on angiogenesis.
Collapse
Affiliation(s)
- J H W Distler
- WHO Collaborating Center for Molecular Biology and Novel Therapeutic Strategies for Rheumatic Diseases, University Hospital, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
28
|
Hirth A, Pedersen PH, Wester K, Mörk S, Helgestad J. Cerebral atypical teratoid/rhabdoid tumor of infancy: long-term survival after multimodal treatment, also including triple intrathecal chemotherapy and gamma knife radiosurgery--case report. Pediatr Hematol Oncol 2003; 20:327-32. [PMID: 12746165] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Cerebral atypical teratoid/rhabdoid tumors (AT/RT) of infancy are highly malignant and have a poor prognosis. The authors report on one case with long-term survival. The patient was a 1 year-old boy presenting with a large AT/RT in the right temporal lobe. He was treated with complete surgery, followed by multiagent chemotherapy. Later he had a second resection and intrathecal chemotherapy and Gamma knife radiosurgery was added to the treatment. Except for a well-controlled temporal epilepsy, the boy is doing well after 6 years follow-up. AT/RT should be treated in a multimodal way. Intrathecal chemotherapy and Gamma knife radiosurgery of single recurrent or residual tumors might increase survival.
Collapse
Affiliation(s)
- Asle Hirth
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | |
Collapse
|
29
|
Thomassen L, Waje-Andreassen U, Naess H, Hirth A, Russell D. [Transcranial Doppler sonography, paradoxical embolism and right-to-left shunt]. Tidsskr Nor Laegeforen 2003; 123:789-90. [PMID: 12693116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Lars Thomassen
- Nevrologisk avdeling, Haukeland Universitetssykehus 5021 Bergen.
| | | | | | | | | |
Collapse
|
30
|
Hirth A, Greve G, Rosland GA, Thomassen L, Norgård G. [Transcatheter closure of patent foramen ovale in young stroke patients]. Tidsskr Nor Laegeforen 2003; 123:785-8. [PMID: 12693115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Asle Hirth
- Hjerteavdelingen Haukeland Universitetssykehus 5021 Bergen.
| | | | | | | | | |
Collapse
|
31
|
Hirth A, Pedersen PH, Baardsen R, Larsen JL, Krossnes BK, Helgestad J. Gamma-knife radiosurgery in pediatric cerebral and skull base tumors. Med Pediatr Oncol 2003; 40:99-103. [PMID: 12461793 DOI: 10.1002/mpo.10218] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This retrospective study of 12 children with cerebral or skull base tumors was undertaken to evaluate morbidity and outcome after gamma-knife surgery. PROCEDURE Twelve consecutive children treated with stereotactic radiosurgery in a curative intent were reviewed. There were five girls and seven boys. The mean age at diagnosis was 5.8 years and at radiosurgical treatment 8.4 years. There were four pilocytic astrocytomas, two craniopharyngeomas, two pineoblastomas, two ependymomas, and two other tumors of high malignancy. We used a 201-source Co60 Leksell gamma knife and all children were treated in general anesthesia. RESULTS The mean tumor volume was 3.7 cm(3) and the mean tumor margin dose was 13.8 Gy. Seven patients remained stable after gamma-knife treatment with a mean follow- up of 78.6 months. One patient died during follow-up. The remaining four patients had progressive disease, two within and two outside the irradiated field, and have received further treatment. They are still alive with and without disease with a mean follow-up of 96.8 months. CONCLUSION Gamma-knife surgery is an effective treatment in some non-resectable cerebral and skull base pediatric tumors. In most cases, it is used in combination with other therapeutic modalities. It is safe and well tolerated.
Collapse
Affiliation(s)
- Asle Hirth
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | | | |
Collapse
|
32
|
Sack U, Hirth A, Moessner A, Grapenthin M, Kahlenberg F, Lehmann J, Anderegg U, Ueberla K, Emmrich F. Arthritis Res Ther 2003; 5:76. [DOI: 10.1186/ar706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
33
|
Sack U, Hirth A, Funke B, Wiedemeyer K, Konrad S, Lehmann J, Emmrich F. Induction of a rapid progessive cartilage destruction in SCID mice by intraarticular application of a murine fibroblast like cell line. Arthritis Res Ther 2001. [PMCID: PMC3273268 DOI: 10.1186/ar264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
34
|
Abstract
BACKGROUND/RATIONALE Support groups of peers were designed to convey support specific to stressful situations encountered by persons with a first-time myocardial infarction and by their spouse or partners. There were no previous published support intervention studies focused on the couple. Survivors and spouses (n=28) participated in a pilot study which tested the effect of a 12-week support group intervention. DESIGN The support groups for couples were cofacilitated by a peer and professional. The facilitators recorded field notes, while participants completed weekly diaries about the intervention activities. Following the intervention, participants were interviewed individually and facilitators were interviewed jointly about the perceived effect of the intervention and influencing factors. This article focuses on the facilitators' and participants' perceptions of intervention processes and outcomes. FINDINGS Support processes in the group included social comparison, social learning, and social exchange. Three types of support--emotional, information, and affirmation--were provided. All participants were satisfied with the support intervention and referred to the positive effect on their coping, confidence, outlook, and spousal relationship. Factors that influenced the intervention effect were participant input, cofacilitation, similarity of group members, and the provision of information and support. CONCLUSIONS Future interventions could consider similarity of peers, leadership, and optimum timing and duration.
Collapse
Affiliation(s)
- M Stewart
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | |
Collapse
|
35
|
Abstract
Despite evidence that spouses play an important role in the recovery of MI survivors, there have been few studies of pertinent psychosocial factors from the perspectives of both survivors and spouses. Accordingly, the aim of this study was to describe stress, coping strategies and social support experienced by survivors and spouses. This study was limited to first-time MI to focus on a time of uncertainty and transition. Twenty-eight persons (14 couples) participated. Both survivors and their spouses reported similar post-MI stresses: emotional impact, lifestyle changes, encounters with health professionals, and their partners' reactions. Spouses and survivors used diverse strategies to cope with the stresses of MI. Seeking informational support was prevalent. Both spouses and survivors engaged in 'protective buffering' of their partners. Couples described deficient support, conflict and miscarried helping efforts within their relationships. Spouses and survivors referred to inadequate informational support from health professionals.
Collapse
Affiliation(s)
- M Stewart
- Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | |
Collapse
|
36
|
Nazeeruddin MDK, Humphry‐Baker R, Grätzel M, Wöhrle D, Schnurpfeil G, Schneider G, Hirth A, Trombach N. Efficient near‐IR sensitization of nanocrystalline TiO2 films by zinc and aluminum phthalocyanines. J PORPHYR PHTHALOCYA 1999. [DOI: 10.1002/(sici)1099-1409(199903)3:3<230::aid-jpp127>3.3.co;2-c] [Citation(s) in RCA: 2] [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: 11/07/2022]
|
37
|
Lutz Y, Musset O, Boquillon JP, Hirth A. Efficient pulsed 946-nm laser emission from Nd:YAG pumped by a titanium-doped sapphire laser. Appl Opt 1998; 37:3286-3289. [PMID: 18273284 DOI: 10.1364/ao.37.003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Efficient pulsed room-temperature laser emission at 946 nm is obtained from a Nd:YAG rod pumped by a Ti-doped sapphire laser in the free-running mode. Three bonded YAG rods of 3-mm diameter with different Nd concentrations and active lengths were tested. A maximum output energy of 83.5 mJ at 3 Hz was obtained with a slope efficiency of 32.3% in an end-pumping configuration.
Collapse
Affiliation(s)
- Y Lutz
- Institut Franco-Allemand de Recherches de Saint-Louis, 5 rue du Général Cassagnou, B.P. 34, 68301 Saint-Louis Cedex, France
| | | | | | | |
Collapse
|
38
|
Wöhrle D, Hirth A, Bogdahn-Rai T, Schnurpfeil G, Shopova M. Photodynamic therapy of cancer: Second and third generations of photosensitizers. Russ Chem Bull 1998. [DOI: 10.1007/bf02498146] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
39
|
Stewart MJ, Ellerton ML, Hart G, Hirth A, Mann K, Meagher-Stewart D, Ritchie J, Tomblin-Murphy G. Insights from a nursing research program on social support. Can J Nurs Res 1998; 29:93-110. [PMID: 9505586] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This paper highlights the conceptual and practical implications of a nursing research program that focuses on social support. The diverse dimensions of the construct of social support; its relationship to stress and coping; and its impact on health, health behaviour, and use of health services are explicated in the conceptual framework underpinning the program. These associations will be elucidated by citing examples from eight assessment studies and four intervention studies. The research program yielded new insights and reinforced reported findings of other social-support research.
Collapse
Affiliation(s)
- M J Stewart
- Dalhousie University School of Nursing, Halifax
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Jelstad A, Hirth A. [Accidental atropine poisoning. Anticholinergic syndrome in a child after intranasal overdose]. Tidsskr Nor Laegeforen 1995; 115:3030-1. [PMID: 7570533] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
As paediatricians we are often reminded of the importance of correct marking and storage of drugs to prevent accidental intoxication. We report on a patient who developed typical signs of central and peripheral anticholinergic syndrome within a few hours after intake of atropine through her nose. Clinical presentation and treatment are described. Children with fever, Down's syndrome or convulsive disorders seem to be particularly sensitive to atropine.
Collapse
Affiliation(s)
- A Jelstad
- Barneavdelinga, Sentralsjukehuset i Sogn og Fjordane, Førde
| | | |
Collapse
|
41
|
Lutz Y, Rytz D, Hirth A. Characterization of KNbO(3) crystal for frequency doubling of a tunable pulsed near-infrared laser. Opt Lett 1995; 20:1946-1948. [PMID: 19862212 DOI: 10.1364/ol.20.001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Using KNbO(3) crystals for second-harmonic generation in the blue spectral range, we have obtained conversion efficiencies as high as 53.7%. To our knowledge this value is the highest reported for a pulsed laser. A gainswitched nanosecond Ti:sapphire oscillator, amplified by a Cr:LiSrAlF(6) multipass amplifier, was used as the fundamental light source. The maximum energy obtained at the harmonic wavelength of 430 nm was 38 mJ for a bandwidth of 230 MHz.
Collapse
|
42
|
Abstract
Among other things, the fragmentation efficiency of laser lithotripsy using a dye laser depends upon the physical properties of the surface of the calculus, especially optical absorption. In this in vitro study we were able to increase the fragmentation efficiency on white, nonabsorbing calculi by introducing an absorbing liquid between the distal end of the fiber and the stone surface. This absorbing liquid (in our case potassium dichromate) provides a reliable plasma ignition and thus makes the fragmentation independent of the properties of the stone surface. Furthermore, we examined and documented the existence of liquid jets that were produced by the collapse of a cavitation bubble near a stone. We observed considerable fragmentation effects on artificial stones that were, however, inferior to those achieved with the fiber in contact with the stone. This work suggests that the effects of a liquid jet should be taken into consideration when using a holmium:YAG laser for lithotripsy.
Collapse
Affiliation(s)
- M Rudhart
- Institut Franco-Allemand de Recherche de Saint-Louis (ISL), France
| | | |
Collapse
|
43
|
Eades-Perner AM, van der Putten H, Hirth A, Thompson J, Neumaier M, von Kleist S, Zimmermann W. Mice transgenic for the human carcinoembryonic antigen gene maintain its spatiotemporal expression pattern. Cancer Res 1994; 54:4169-76. [PMID: 8033149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The tumor marker carcinoembryonic antigen (CEA) is predominantly expressed in epithelial cells along the gastrointestinal tract and in a variety of adenocarcinomas. As a basis for investigating its in vivo regulation and for establishing an animal model for tumor immunotherapy, transgenic mice were generated with a 33-kilobase cosmid clone insert containing the complete human CEA gene and flanking sequences. CEA was found in the tongue, esophagus, stomach, small intestine, cecum, colon, and trachea and at low levels in the lung, testis, and uterus of adult mice of independent transgenic strains. CEA was first detected at day 10.5 of embryonic development (embryonic day 10.5) in primary trophoblast giant cells and was found in the developing gut, urethra, trachea, lung, and nucleus pulposus of the vertebral column from embryonic day 14.5 onwards. From embryonic day 16.5 CEA was also visible in the nasal mucosa and tongue. Because this spatiotemporal expression pattern correlates well with that known for humans, it follows that the transferred genomic region contains all of the regulatory elements required for the correct expression of CEA. Furthermore, although mice apparently lack an endogenous CEA gene, the entire repertoire of transcription factors necessary for correct expression of the CEA transgene is conserved between mice and humans. After tumor induction, these immunocompetent mice will serve as a model for optimizing various forms of immunotherapy, using CEA as a target antigen.
Collapse
|
44
|
Hirth A, Lauzon L. Development of a quality assurance tool for critical care. Can J Nurs Adm 1989; 2:15-8. [PMID: 2486686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Current conditions in the health care arena demand that nurses be held accountable for the quality of nursing care delivered. Nursing administrators today face multiple challenges which include incorporating the expanding role of the nurse, dealing with financial constraints, and meeting the demands of an increasingly informed public. These factors combine to emphasize the need to examine the quality of care delivered and to identify and promote effective nursing care behaviours. The use of a quality assurance tool can be invaluable in revealing areas of both excellence and weakness in the care of clients, as well as providing a solid foundation for change. This paper will follow the authors through the development and implementation of a unit-specific quality assurance tool for a critical care area. We begin with a brief review of the literature and explore the factors relevant to our decision to choose a concurrent chart audit as our tool. We then describe the discovery of standards, the design of the tool itself, and follow the process of testing, approval and implementation of the tool for use in our institution. Finally, we explain the methods used to introduce the tool to staff and elicit their support to monitor and thus improve the quality of nursing care delivered.
Collapse
|
45
|
Ball F, Stöver B, Vettermann H, Mölter N, Hirth A. [An analysis of the plain chest films of 109 children with atrial septal defect. The correlation between different radiological criteria and shunt size (author's transl)]. Radiologe 1976; 16:353-60. [PMID: 968041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiograms of the chest (p.a.--and lateral projection) of 109 children with atrial septal defect taken before cardiac catheterisation have been evaluated under standardized principles; correlation between size of the left-to-right shunt and the radiographic changes has been performed. The examiner evaluated at random radiographs of 213 subjects, of whom 104 had no cardiac disease. Besides the determination of several radiographic criteria the examiner had to decide whether the subject in question had cardiac abnormalities or not. There has been a statistically significant correlation between the size of shunt-volume and the amount of radiographic changes as: 1. pulmonary vascular markings, 2. size of the right ventricle in the lateral projection, 3. cardiac configuration in the p.a.-projection, 4. relative cardiac volume, 5. size and shape of the pulmonary artery segment, 6. size of the aortic arch. The highest diagnostic value is represented by pulmonary vascular markings; this is of great importance. Because pulmonary vascular markings can be in any age group evaluated on technically good radiographs. 78% of the atrial septal defects could be detected by radiographic criteria. In 5% of the children with no cardiac disease a vitium cordis had been diagnosed erroneously.
Collapse
|
46
|
Hugenschmidt M, Vollrath K, Hirth A. Schlieren-cinematographic and holographic diagnostic of a laser-produced plasma in xenon. Appl Opt 1972; 11:339-344. [PMID: 20111505 DOI: 10.1364/ao.11.000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We have studied extensively a gas breakdown in xenon produced by a giant pulse ruby laser with a power <100 MW. Detailed information concerning the structure of the laser plasma formation and of the following expansion has been obtained by different optical methods, including schlieren techniques (single frames and ultra high speed cinematography) and holography. The high quality of the holographic pictures was achieved by the use of a monomode laser. With this we were able to visualize the plasma history and to determine the velocities of the boundary layer and of the blast wave with utmost accuracy. Investigations of the electron density and electron temperature showed that a relaxation time of about 10 nsec is necessary to establish local thermodynamic equilibrium states. After this relaxation time it is then possible to carry out thermodynamic calculations, applying the shock-wave theory, to relate the optically measured expansion velocity with the plasma parameters involved. The mean specific internal energy epsilon , for instance, attained values in excess of 10(12) erg/g which decayed rapidly during the first 100 nsec to about 5. 10(10) erg/g. By comparing the results to theoretical calculations of we obtained a first estimate of the temperature, taking into consideration the partial densities n(j) as well as the partition functions Z(j)((i)) of the xenon atoms, the single-charged ions, and the double-charged ones. Furthermore, a two-step iteration computer program was used to give more detailed and more accurate results on the variations of the pressure, temperature, partial densities, and enthalpy as a function of time.
Collapse
|