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Kenkare Z, Murray T, Schramm C, Collins M. 342 Partnership in education–cystic fibrosis center patient education practices on home nebulizer care in relationship to published guidelines. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01032-3] [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: 11/06/2022]
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Pape S, Snijders RJALM, Gevers TJG, Chazouilleres O, Dalekos GN, Hirschfield GM, Lenzi M, Trauner M, Manns MP, Vierling JM, Montano-Loza AJ, Lohse AW, Schramm C, Drenth JPH, Heneghan MA, Alvarez F, Andrade R, Arikan C, Assis D, Bardou-Jacquet E, Biewenga M, Cancado E, Cazzagon N, Chazouillères O, Colloredo G, Cuarterolo M, Dalekos G, Debray D, Robles-Díaz M, Drenth J, Dyson J, Efe C, Engel B, Ferri S, Fontana R, Gatselis N, Gerussi A, Halilbasic E, Halliday N, Heneghan M, Hirschfield G, van Hoek B, Hørby Jørgensen M, Indolfini G, Iorio R, Jeong S, Jones D, Kelly D, Kerkar N, Lacaille F, Lammert C, Leggett B, Lenzi M, Levy C, Liberal R, Lleo A, Lohse A, Ines Lopez S, de Martin E, McLin V, Mieli-Vergani G, Milkiewicz P, Mohan N, Muratori L, Nebbia G, van Nieuwkerk C, Oo Y, Ortega A, Páres A, Pop T, Pratt D, Purnak T, Ranucci G, Rushbrook S, Schramm C, Stättermayer A, Swain M, Tanaka A, Taubert R, Terrabuio D, Terziroli B, Trauner M, Valentino P, van den Brand F, Villamil A, Wahlin S, Ytting H, Zachou K, Zeniya M. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group. J Hepatol 2022; 76:841-849. [PMID: 35066089 DOI: 10.1016/j.jhep.2021.12.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [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: 04/09/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment. METHODS A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis. RESULTS The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'. CONCLUSIONS These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints. LAY SUMMARY Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Romée J A L M Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6229HX, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Oliver Chazouilleres
- Hepatology Department, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital Assistance Publique-Hôpitaux de Paris, Paris, France; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa, Greece
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Marco Lenzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
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Moss H, Kolli S, Singh M, Yoon A, Schramm C, Restivo A. 113 Not Another Mass Casualty: Using Simulation to Increase Physician Comfort With the Unique Challenges of Protest Medicine. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.123] [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: 11/28/2022]
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Waldthaler A, Schramm C, Bergquist A. Present and future role of endoscopic retrograde cholangiography in primary sclerosing cholangitis. Eur J Med Genet 2021; 64:104231. [PMID: 33905896 DOI: 10.1016/j.ejmg.2021.104231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/06/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022]
Abstract
Primary sclerosing cholangitis (PSC) is a rare, inflammatory cholestatic liver disease that causes biliary strictures which can lead to secondary complications. About 30-50% of PSC patients develop dominant strictures (DS) in the biliary tree, which are both the cause of jaundice and bacterial cholangitis as well as predilection spots for development of neoplastic development. Cancer is the most common cause of death in PSC. A central concern is to distinguish malignant from benign strictures, which eventually is done by invasive methods to obtain a brush cytology or biopsy sample, in most cases via endoscopic retrograde cholangiography-pancreatography (ERCP). Since medical therapies, like ursodesoxycholic acid or immunosuppressive drugs have no proven effect, therapeutic ERCP has become the primary management strategy to improve symptoms and in some patients may slow down disease progression. This article aims at outlining the current and emerging methods in ERCP in PSC patients.
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Affiliation(s)
- A Waldthaler
- Department of Medicine Huddinge, Functional Unit Endoscopy, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; European Reference Network for Hepatological Diseases (ENR RARE-LIVER), Sweden.
| | - C Schramm
- Department of Medicine and Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network for Hepatological Diseases (ENR RARE-LIVER), Sweden
| | - A Bergquist
- Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; European Reference Network for Hepatological Diseases (ENR RARE-LIVER), Sweden
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Jungk C, Scherer M, DaoTrong H, Schramm C, Haehnel S, Herold-Mende C, Unterberg A. P01.106 Impact of intraoperative magnetic resonance imaging on the extent of resection and functional outcome in awake surgery for eloquent gliomas - a single center retrospective study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.148] [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: 11/12/2022] Open
Affiliation(s)
- C Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - M Scherer
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H DaoTrong
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C Schramm
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - S Haehnel
- Department of Neuroradiology, Clinic of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - C Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - A Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Keller S, Sedlacik J, Schuler T, Buchert R, Avanesov M, Zenouzi R, Lohse AW, Kooijman H, Fiehler J, Schramm C, Yamamura J. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol 2018; 29:818-828. [PMID: 30014204 DOI: 10.1007/s00330-018-5614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/09/2018] [Revised: 05/26/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference. MATERIAL AND METHODS Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure. RESULTS Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume. CONCLUSION DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI. KEY POINTS • Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01). • The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09). • DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).
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Affiliation(s)
- S Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany. .,Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany.
| | - J Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Schuler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A W Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - H Kooijman
- Philips Medical Systems, MR Clinical Science, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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Zenouzi R, Liwinski T, Yamamura J, Weiler-Normann C, Sebode M, Keller S, Lohse AW, Schramm C. Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret. Aliment Pharmacol Ther 2018; 48:169-178. [PMID: 29741240 DOI: 10.1111/apt.14797] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 02/05/2018] [Revised: 02/19/2018] [Accepted: 04/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. AIM To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. METHODS Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss' kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. RESULTS Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants' recommendations contrasted the real-life management and outcome. CONCLUSIONS In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.
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Affiliation(s)
- R Zenouzi
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - T Liwinski
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Weiler-Normann
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Sebode
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Schramm
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bartoletti M, Giannella M, Lewis R, Caraceni P, Tedeschi S, Paul M, Schramm C, Bruns T, Merli M, Cobos-Trigueros N, Seminari E, Retamar P, Muñoz P, Tumbarello M, Burra P, Torrani Cerenzia M, Barsic B, Calbo E, Maraolo A, Petrosillo N, Galan-Ladero M, D'Offizi G, Bar Sinai N, Rodríguez-Baño J, Verucchi G, Bernardi M, Viale P, Campoli C, Siccardi G, Ambretti S, Stallmach A, Venditti M, Lucidi C, Ludovisi S, De Cueto M, Navarro M, Lopez Cortes E, Bouza E, Valerio M, Eworo A, Losito R, Senzolo M, Nadal E, Ottobrelli A, Varguvic M, Badia C, Borgia G, Gentile I, Buonomo A, Boumis E, Beteta-Lopez A, Rianda A, Taliani G, Grieco S. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients. Clin Microbiol Infect 2018; 24:546.e1-546.e8. [DOI: 10.1016/j.cmi.2017.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
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Abstract
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology. Characteristic features are multifocal strictures and dilatations of the bile ducts. In 60-80 % of cases the PSC is strongly associated with chronic inflammatory bowel disease, mostly in the form of pancolitis. The diagnosis is established based on detection of typical cholangiographic lesions of the bile ducts and exclusion of secondary causes of sclerosing cholangitis. There is no approved medical treatment, but in Germany ursodeoxycholic acid is frequently used. Clinically relevant stenoses can be successfully treated by interventional endoscopy. Patients with PSC suffer from a greatly increased risk of hepatobiliary malignancies, especially with respect to cholangiocarcinoma and colorectal cancer and therefore require regular surveillance and screening. Liver transplantation is currently the only curative treatment option.
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Affiliation(s)
- T Liwinski
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Schramm
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Martin Zeitz Centrum für Seltene Erkrankungen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
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Keller S, Venkatesh SK, Avanesov M, Weinrich JM, Zenouzi R, Schramm C, Adam G, Yamamura J. Gadolinium-based relative contrast enhancement in primary sclerosing cholangitis: additional benefit for clinicians? Clin Radiol 2018; 73:677.e1-677.e6. [PMID: 29576223 DOI: 10.1016/j.crad.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/13/2018] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the benefit of extracellular gadolinium-based contrast agent (GBCA) enhanced magnetic resonance imaging (MRI) in addition to conventional non-enhanced T2-weighted imaging (WI) for quantification of inflammatory or fibrotic alterations in the liver parenchyma of patients with primary sclerosing cholangitis (PSC). MATERIAL AND METHODS MRI (3 T) examinations were reviewed retrospectively by two radiologists in 27 PSC patients (age 42.9±15.6 years), and 19 controls. Regions of interest (ROIs) were drawn onto T2 hyperintense and T2 isointense areas and copied to section position matched non-enhanced and delayed-phase contrast-enhanced T1WI. Signal intensities (SI) obtained from ROIs of the multiphase T1WI were used to calculate relative liver enhancement (RLE). The interobserver agreement of RLE and quantified T2 signal was calculated using Bland-Altman analysis. RLE assessed for both T2 hyperintense (RLEhyper) and T2 isointense (RLEiso) areas were compared in patients and controls (RLEhealthy). RESULTS The interobserver agreement of RLE in affected hyperintense areas (bias -0.77, limits of agreement -51.7 to 50.1) was superior to the quantification of T2 signal only in these areas (bias -3.35, limits of agreement -162.4 to 155.7). The RLEhyper (86.2±9.7%) was higher than the RLEiso (59.8±6.2%, p=0.03) and the RLEhealthy (53.2±2.7%, p=0.002). The mean RLEiso was not significantly different from the RLEhealthy (p=0.3). CONCLUSION The extracellular gadolinium-based RLE of T2 hyperintense areas could be a useful add-on for routine follow up MRI in the detection of early inflammatory changes, possibly preceding formation of fibrotic scarring in PSC patients, if validated in larger cohorts.
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Affiliation(s)
- S Keller
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - S K Venkatesh
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - M Avanesov
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - J M Weinrich
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - R Zenouzi
- University Medical Center Hamburg-Eppendorf (UKE), Department of Internal Medicine, Hamburg, Germany
| | - C Schramm
- University Medical Center Hamburg-Eppendorf (UKE), Department of Internal Medicine, Hamburg, Germany
| | - G Adam
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany
| | - J Yamamura
- University Medical Center Hamburg-Eppendorf (UKE), Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg, Germany.
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Schramm C, Scheller I, Franklin J, Demir M, Kuetting F, Nierhoff D, Goeser T, Toex U, Steffen HM. Predicting ADR from PDR and individual adenoma-to-polyp-detection-rate ratio for screening and surveillance colonoscopies: A new approach to quality assessment. United European Gastroenterol J 2016; 5:742-749. [PMID: 28815039 DOI: 10.1177/2050640616675220] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) has been established as a quality indicator for screening colonoscopy. Because ADR is cumbersome to obtain in routine practice, polyp detection rate (PDR), polypectomy rate (PR) and adenoma-to-polyp-detection-rate-ratio (APDRR) have been proposed to estimate ADR. This study aimed to evaluate APDRR in order to estimate ADR (ADRest) in different settings. METHODS Average risk screening and surveillance colonoscopies from a community-based private practice and a tertiary academic hospital setting were retrospectively evaluated. APDRR was calculated as averaged group APDRR for all study procedures (APDRR) and for the first half of study procedures of each gastroenterologist (APDRRag) or individually for each gastroenterologist on the basis of his or her first 25, 50 and 100 colonoscopies (APDRRind). ADRest was determined from PDR by using APDRR, APDRRag, and APDRRind, respectively. RESULTS A total of 2717 individuals were analyzed. Using APDRR, significant correlations between ADR and ADRest were observed for the entire (0.944, p < 0.001), proximal (0.854, p < 0.001), and distal (0.977, p < 0.001) colon. These correlations were lost when APDRRag was used to estimate each gastroenterologist's ADR for the second half of his or her included colonoscopies. However, ADR and ADRest correlated significantly with a root-mean-square-error of 6.8% and 5.8% when APDRRind on the basis of each gastroenterologist's first 50 and 100 colonoscopies was used for subsequent colonoscopies. CONCLUSIONS ADR for subsequent colonoscopies of an individual endoscopist can be reliably estimated from PDR by using an individually calculated APDRR. Prospective studies are needed to verify this promising approach in different practice settings.
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Affiliation(s)
- C Schramm
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - I Scheller
- Practice for Gastroenterology Remscheid, Remscheid, Germany
| | - J Franklin
- Institute for Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - M Demir
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - F Kuetting
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - D Nierhoff
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - T Goeser
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - U Toex
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
| | - H M Steffen
- Department for Gastroenterology and Hepatology, University Hospital of Cologne, Germany
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12
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Kocheva D, Stegmann R, Rainovski G, Jolie J, Pietralla N, Stahl C, Petkov P, Blazhev A, Hennig A, Bauer C, Braunroth T, Carpenter M, Cortes L, Dewald A, Djongolov M, Fransen C, Gladnishki K, Janssens R, Karayonchev V, Lettmann M, Lister C, Litzinger J, Möller T, Möller-Gatermann C, Scheck M, Scholz P, Schramm C, Thöle P, Werner V, Wölk D, Zhu S, Van Isacker P. Search for mixed-symmetry states of nuclei in the vicinity of the double-magic nucleus208Pb. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201610703004] [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: 11/14/2022] Open
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13
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Trauner M, Fickert P, Hirschfield G, Reiter F, Altorjay I, Marschall H, Färkkilä M, Schramm C, Spengler U, Chapman R, Bergquist A, Schrumpf E, Nevens F, Halilbasic E, Greinwald R, Proels M, Manns M. Norursodeoxycholic Acid Improves Cholestasis in Primary Sclerosing Cholangitis: Results of a Phase II Dose Finding Study. J Hepatol 2016. [DOI: 10.1016/s0168-8278(16)00171-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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14
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Roeb E, Steffen HM, Bantel H, Baumann U, Canbay A, Demir M, Drebber U, Geier A, Hampe J, Hellerbrand C, Pathil-Warth A, Schattenberg JM, Schramm C, Seitz HK, Stefan N, Tacke F, Tannapfel A, Lynen Jansen P, Bojunga J. [S2k Guideline non-alcoholic fatty liver disease]. Z Gastroenterol 2015; 53:668-723. [PMID: 26167698 DOI: 10.1055/s-0035-1553193] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- E Roeb
- Gastroenterologie, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | | | - H Bantel
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Germany
| | - U Baumann
- Pädiatrie, Medizinische Hochschule Hannover, Germany
| | - A Canbay
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Germany
| | - M Demir
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Germany
| | - U Drebber
- Institut für Pathologie, Universitätsklinikum Köln, Germany
| | - A Geier
- Gastroenterologie, Universitätsklinikum Würzburg, Germany
| | - J Hampe
- Gastroenterologie, Universitätsklinikum Dresden, Germany
| | - C Hellerbrand
- Innere Medizin I, Universitätsklinikum Regensburg, Germany
| | - A Pathil-Warth
- Medizinische Klinik IV, Universitätsklinikum Heidelberg, Germany
| | - J M Schattenberg
- I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - C Schramm
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - H K Seitz
- Department of Medicine, Salem Medical Center, Heidelberg, Germany
| | - N Stefan
- Innere Medizin IV, Universitätsklinikum Heidelberg, Germany
| | - F Tacke
- Medizinische Klinik III, Universitätsklinikum Aachen, Germany
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Germany
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin, Germany
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15
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Soussan M, Nicolas P, Schramm C, Katsahian S, Fain O, Mekinian A. THU0272 Diagnostic Performance and Disease Activity Assessment by FDG-PET in Large-Vessel Vasculitis: A Systematic Literature Review and Meta-Analysis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2610] [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: 11/03/2022]
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16
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Demir M, Nigemeier J, Kütting F, Bowe A, Schramm C, Hoffmann V, Waldschmidt D, Goeser T, Steffen HM. Clinical management of chronic hepatitis B infection: results from a registry at a German tertiary referral center. Infection 2015; 43:153-62. [PMID: 25701223 DOI: 10.1007/s15010-015-0751-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE We studied a cohort of adult patients with chronic hepatitis B (CHB) infection, followed at a tertiary referral liver center in Germany over 12.5 years to analyze the clinical features and impact of management on disease progression and survival of CHB patients in general and of those with CHB and HCC in particular. METHODS We retrospectively evaluated the medical records of 242 adult (age ≥ 18 years) patients. CHB was defined as positive hepatitis B surface antigen (HBsAg) and/or HBV-DNA levels >10 IU/mL for at least 6 months. Patient demographics, HBV markers, antiviral treatment, laboratory parameters, liver imaging and histology were recorded for each visit. HCC patients were divided into two groups and separately analyzed (group 1: n = 24, HCC at first visit and group 2: n = 11, HCC during surveillance). RESULTS The mean age was 44 years in CHB patients without HCC (63% male) and about 59 years in patients with HCC (77% male). Antiviral therapy was given to 59% of patients without HCC compared to only 25% in group 1 and 18% in group 2 with comparable median HBV DNA levels of approximately 36,000 IU/mL. There was no statistically significant difference concerning the HCC stages (Milan, UCSF, BCLC) at first diagnosis. Five-year survival was 19% in group 1 vs. 64% in group 2 (p = 0.019), with LTx performed in 12 vs. 45%, respectively. CONCLUSION Surveillance of CHB patients did not result in early stage detection of HCC but in a higher likelihood to receive potentially curative treatments.
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Affiliation(s)
- M Demir
- Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, 50924, Cologne, Germany,
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17
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Ernst TM, Raabe N, Schwinge D, Schramm C, Kaul MG, Adam G, Ittrich H. MRCP im Mausmodell bei 7 T - Vergleich von 2D und 3D Spin-Echo-Techniken. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346532] [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: 10/26/2022]
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18
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Kuhn A, Weiler-Normann C, Schramm C, Kluge S, Behne M, Lohse A, Benten D. Acute Liver Failure Following Minocycline Treatment – A Case Report and Review of the Literature. Z Gastroenterol 2012; 50:771-5. [DOI: 10.1055/s-0031-1299443] [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: 10/28/2022]
Abstract
AbstractWe present the case of a 23-year-old female patient with acute liver failure following intake of minocycline. This patient had severe hypereosinophilia and massively increased IgE levels. Experimental studies in this case revealed elevated IFN-γ-, as well as TNF-α-producing CD4+ and CD8+ T-cells after in vitro stimulation with minocycline, indicating a type I/IgE-mediated as well as type II/cytotoxic reaction in the pathogenesis of minocycline-induced liver failure. Although mild forms of liver involvement are well known side effects of minocycline, only 8 cases with acute liver failure have been reported, and we present a review of all cases.
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Affiliation(s)
- A. Kuhn
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Weiler-Normann
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Kluge
- Intensive Care Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M. Behne
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D. Benten
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Pannicke N, Schramm C, Lohse A. Autoimmunerkrankungen der Leber. Internist (Berl) 2012; 53:943-54; quiz 955-6. [DOI: 10.1007/s00108-012-3096-4] [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: 10/28/2022]
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20
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Löbner W, Schramm C, Regner J, Geringswald K, Leichsenring F, Schmidt P. Application of the tracer gas technology to investigate convective radon transport processes between mine workings and houses. KERNTECHNIK 2012. [DOI: 10.3139/124.110266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
In areas featuring air-filled mine workings the convective radon transport through the disturbed bedrock is a frequent cause of high radon concentrations in dwellings. The vertical transport distance of the radon propagation can be more than one hundred meters. The application of tracer gases that can be detected by gas chromatography at extreme low concentrations allows the clear detection of mine-originated radon in dwellings and provides knowledge on the complex processes of radon transport. The successful application of the method is demonstrated on the basis of investigations of the impact of former uranium mine sites on the radon situation in dwellings.
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Affiliation(s)
- W. Löbner
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
| | - C. Schramm
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
| | - J. Regner
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
| | - K. Geringswald
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
| | - F. Leichsenring
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
| | - P. Schmidt
- Wismut GmbH, Jagdschänkenstraße 29, D-09117 Chemnitz, Germany. E-mail:
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21
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Bartels E, Draaken M, Kazmierczak B, Spranger S, Schramm C, Baudisch F, Nöthen MM, Schmiedeke E, Ludwig M, Reutter H. De novo partial trisomy 18p and partial monosomy 18q in a patient with anorectal malformation. Cytogenet Genome Res 2011; 134:243-8. [PMID: 21709416 DOI: 10.1159/000328833] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2011] [Indexed: 01/24/2023] Open
Abstract
Anorectal malformations (ARM) encompass a broad clinical spectrum which ranges from mild anal stenosis to severe anorectal anomalies such as complex cloacal malformations. The overall incidence of ARM is around 1 in every 2,500 live births. Although causative genes for a few syndromic forms have been identified, the molecular genetic background of most ARM remains unknown. The present report describes a patient with a de novo 13.2-Mb deletion of chromosome 18q22.3-qter and a 2.2-Mb de novo duplication of chromosomal region 18pter-p11.32 located at the telomeric end of chromosome 18q. The patient presented with ARM and the typical features of 18q- syndrome (De-Grouchy syndrome). The combination of a partial duplication of the short arm and a partial deletion of the long arm of chromosome 18 has been described in 16 previous cases. However, this is the first report of an association between this complex chromosomal rearrangement and ARM.
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Affiliation(s)
- E Bartels
- Institute of Human Genetics, University of Bonn, Bonn, Germany
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22
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Wahl I, Weiler-Norman C, Schramm C, Löwe B, Rose M. Health attributions predict anxiety and depression in patients with autoimmune hepatitis. Psychother Psychosom Med Psychol 2011. [DOI: 10.1055/s-0031-1272447] [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: 10/18/2022]
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23
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Schramm C, Gotthardt D, Spengler U, Schirmacher P, Weismüller T. [Primary sclerosing cholangitis - challenges for all. The German Study Group PSC]. Z Gastroenterol 2011; 49:63-65. [PMID: 21225540 DOI: 10.1055/s-0029-1245890] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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24
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Naderi J, Lohse AW, Galle PR, Schramm C. [A rare cause of variceal bleeding]. Z Gastroenterol 2010; 48:1215-8. [PMID: 20886427 DOI: 10.1055/s-0029-1245465] [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: 10/19/2022]
Abstract
BACKGROUND Agnogenic myeloid metaplasia (AMM) is a clonal stem cell disease, which is characterized by myelofibrosis, osteosclerosis and pancytopenia. Affected patients frequently develop portal hypertension secondary to extramedullary hematopoiesis, which rarely becomes clinically relevant. CASE REPORT We here report on a 63-year-old patient with a first presentation of variceal bleeding. The patient was diagnosed with portal hypertension and due to marked splenomegaly, liver cirrhosis was suspected. Subsequently, an extramedullary hematopoiesis and AMM could be diagnosed. The variceal bleeding was initially treated endoscopically. The patient has received cytoreductive therapy and a splenorenal shunt, which has led to remission and long-term survival. CONCLUSION Agnogenic myeloid metaplasia is a rare cause of portal hypertension and may present with variceal bleeding. Clinicians should be aware of this rare cause of portal hypertension, as treatment of the underlying disease with cytoreductive therapy and appropriate management of portal hypertension may lead to long-term survival.
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Affiliation(s)
- J Naderi
- Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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25
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Schramm C, Schneider A, Marx A, Lohse AW. Adalimumab could suppress the activity of non alcoholic steatohepatitis (NASH). Z Gastroenterol 2008; 46:1369-71. [PMID: 19053005 DOI: 10.1055/s-2008-1027411] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of non-alcoholic steatohepatitis (NASH) is increasing. NASH confers an increased risk of liver-related morbidity and mortality with a substantial risk of developing liver cirrhosis. At present, there is no established medical treatment for NASH. The pathogenesis of NASH is incompletely understood. Several lines of evidence suggest that TNF-alpha may be involved in the pathogenesis of NASH by promoting liver inflammation, insulin resistance and hepatocyte apoptosis. Anti-TNF-alpha therapy has not been evaluated for the treatment of NASH. We report here on a patient with NASH who has experienced rapid normalization of liver biochemistry during treatment of an associated rheumatoid arthritis with the humanized anti-TNF-alpha antibody adalimumab. This observation suggests that pilot studies may be warranted to evaluate the role of adalimumab for the treatment of NASH.
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Affiliation(s)
- C Schramm
- III. Department of Medicine, University Medical Center Hamburg.
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Abstract
A 37-year old woman presented with a 9-year history of hepatitis of unknown origin and aminotransferases within a 3-fold upper limit of normal. Autoimmune hepatitis (AIH) was diagnosed on the basis of elevated aminotransferases, soluble liver antigen/liver pancreas (SLA/LP) autoantibodies and characteristic histology. Immunosuppressive therapy led to rapid normalization of aminotransferases. Two years later, the patient developed left sided hemisensory deficits under maintenance therapy of prednisolone and azathioprine (AZT). Later she developed right foot drop and paraesthesia in the ulnar innervation territory on both sides. Magnetic resonance imaging (MRI) and cerebral panangiography suggested cerebral vasculitis. Neurological investigation and electromyography disclosed multiplex neuritis (MN) probably due to vasculitis. Consistent with this diagnosis, autoantibodies to extractable nuclear antigens were detectable in serum. Immunosuppression was changed to oral 150 mg cyclophosphamide (CPM0) per day. Prednisolone was increased to 40 mg/d and then gradually tapered to 5 mg. Oral CPM was administered up to a total dose of 40 g and then substituted by 6 times of an intervall infusion therapy of CPM (600 mg/m2). Almost complete motoric remission was achieved after 3 mo of CPM. Sensibility remained reduced in the right peroneal innervation territory. Follow-up of cranial MRI provided stable findings without any new or progressive lesions. This is the first report of multiplex neuritis in a patient with autoimmune hepatitis.
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Affiliation(s)
- S Luth
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Abstract
BACKGROUND AND AIMS Leakage from pancreaticojejunostomy and development of pancreatic fistulas are the major postoperative complications in patients undergoing duodenopancreatectomy. The risk of developing these complications is higher when surgery is performed on a soft pancreas. A recent report suggests that octreotide hardens the pancreas when given intraoperatively. The present study aims at verifying this observation by measuring tissue hardness of the pancreas by a commercially available durometer in pigs with and without octreotide pretreatment. METHODS Three groups of pigs were investigated: Group 1 (n=6) received no treatment; group 2 (n=6) was treated with 3x100 microg octreotide for 1 day; group 3 (n=6) for 5 days. Thereafter, animals were killed and the pancreas was harvested for performing measurements: Tissue hardness was assessed by a commercially available durometer, and a suture holding test was performed using a Newton dynamometer. RESULTS There was a significant increase in tissue hardness between untreated control animals [26.3+/-2.5 S.U. (shore units)] and animals with 1 day octreotide pretreatment (29.8+/-2.6 S.U.; p=0.04) as well as between the groups treated for 1 and 5 days (34.8+/-2.8 S.U.; p=0.01). Suture holding capacity was higher in animals treated for 5 days. CONCLUSION The present study agrees with a recent report suggesting that octreotide hardens the pancreas. Octreotide pretreatment may therefore be an advantage when performing surgery on a soft pancreas, i.e., in patients scheduled for duodenopancreatectomy for ampullary carcinomas or circumscript pancreatic tumors not associated with chronic pancreatitis.
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Affiliation(s)
- T Foitzik
- Department of General, Vascular, Thoracic and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, D-18057 Rostock, Germany.
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Wegmann M, Fehrenbach H, Fehrenbach A, Held T, Schramm C, Garn H, Renz H. Involvement of distal airways in a chronic model of experimental asthma. Clin Exp Allergy 2006; 35:1263-71. [PMID: 16238784 DOI: 10.1111/j.1365-2222.2005.02306.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bronchial asthma is characterized by chronic airway inflammation and airway remodelling which occurs in both proximal and distal airways. These changes are associated with development of airway hyper-responsiveness and airflow limitation. OBJECTIVE This study was aimed to analyse whether chronic inhalative allergen challenges in mice lead to morphological and physiological changes comparable with this phenotype. METHODS For this purpose, BALB/c mice were systemically sensitized to ovalbumin (OVA) followed by aerosol allergen challenges on 2 consecutive days per week for 12 weeks. RESULTS In chronically challenged mice, tissue inflammation in proximal as well as distal airways was observed with a predominance of lymphocytes within the cellular infiltrate. In contrast, inflammation in the airway lumen decreased over time. These changes were associated by a shift in bronchoalveolar lavage-cytokine levels from IL-4, IL-5 and TNF-alpha production (during the acute phase) towards markedly increased levels of TGF-beta during the chronic phase. Goblet cell hyperplasia and subepithelial fibrosis occurred throughout the airway tree. In terms of lung function, chronically challenged mice developed persistent bronchial hyper-responsiveness and progressive airflow limitation. Six weeks after OVA aerosol discontinuation, airway inflammation still persisted although lung function was normalized. CONCLUSION These data indicate that our model of chronic aerosol allergen challenges leads to a phenotype of experimental asthma with participation of distal airways and persistence of inflammation thereby resembling many morphological and physiological aspects of human bronchial asthma.
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Affiliation(s)
- M Wegmann
- Department of Clinical Chemistry and Molecular Diagnostics, Hospital of the Philipps-University, Marburg, Germany
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Abstract
Primary sclerosing cholangitis is a chronic cholestatic liver disease of unknown aetiology. The course of the disease is usually progressive with the development of liver cirrhosis leading to death or liver transplantation within an average of 12 years. To date it is well known that the development of hepatobiliary malignancies and the rate of colonic mucosal dysplasia and carcinoma in patients with concomitant ulcerative colitis are greatly enhanced in patients with PSC. PSC can therefore be regarded as a premalignant condition. The following review will focus on the development of cholangiocellular carcinoma in patients with PSC and the associated diagnostic and therapeutic challenges.
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Affiliation(s)
- C Schramm
- Medizinische Klinik I, Universitätsklinikum Hamburg-Eppendorf
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31
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Abstract
Autoimmune Hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and overlap syndromes of these three disease entities are regarded as autoimmune liver diseases. These conditions are important differential diagnoses of elevated liver function tests as about 10 % of liver transplantations in Europe and North America are for these indications. The diagnosis is often difficult but can be facilitated by sequential measurement of relevant autoantibodies, exclusion of other liver disease, ultrasound, ERCP and liver histology. In AIH immunosuppressive therapy has been shown to prevent or stop the development of cirrhosis and improve the prognosis of the patients decisively. In other autoimmune liver diseases this evidence is missing making individual therapeutic decisions necessary. Ursodesoxycholic acid (UDCA) seems to slow disease progression in particular in early stages of PBC.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/therapy
- Azathioprine/administration & dosage
- Azathioprine/therapeutic use
- Biopsy
- Child
- Cholagogues and Choleretics/therapeutic use
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/diagnostic imaging
- Cholangitis, Sclerosing/immunology
- Cholangitis, Sclerosing/therapy
- Diagnosis, Differential
- Enzyme-Linked Immunosorbent Assay
- Female
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Hepatitis, Autoimmune/pathology
- Hepatitis, Autoimmune/therapy
- Humans
- Immunoassay
- Immunosuppression Therapy
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Liver/pathology
- Liver Cirrhosis, Biliary/diagnosis
- Liver Cirrhosis, Biliary/drug therapy
- Liver Cirrhosis, Biliary/immunology
- Liver Cirrhosis, Biliary/pathology
- Liver Diseases/diagnosis
- Liver Diseases/diagnostic imaging
- Liver Diseases/immunology
- Liver Diseases/pathology
- Liver Diseases/therapy
- Liver Function Tests
- Liver Transplantation
- Male
- Middle Aged
- Mycophenolic Acid/administration & dosage
- Mycophenolic Acid/analogs & derivatives
- Mycophenolic Acid/therapeutic use
- Prognosis
- Ultrasonography
- Ursodeoxycholic Acid/therapeutic use
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Affiliation(s)
- E M Bayer
- I. Medizinische Klinik und Poliklinik Johannes-Gutenberg-Universität Mainz, Germany
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Saloga J, Knop J, Rihs HP, Dumont B, Rozynek P, Lundberg M, Cremer R, Brüning T, Raulf-Heimsoth M, Yeang HY, Sander I, Arif SAM, Fleischer C, Brüning T, Pöppelmann M, Grobe K, Becker WM, Petersen A, Wicklein D, Lindner B, Lepp U, Altmann F, Hipler UC, Frank U, Schliemann-Willers S, Kaatz M, Eisner P, Kasche A, Krämer U, Klaus S, Buters J, Traidl-Hoffmann C, Ring J, Behrendt H, Huss-Marp J, Brockow K, Darsow U, Risse U, Böttcher I, Sellinghausen I, Brand P, Klostermann B, Mariant V, Jakob T, Hochrein H, Müller MJ, Wagner H, Baron JM, Schiffer R, Bostonci Ö, Merk HF, Zwadlo-Klarwasser G, Schäkel K, Kannagi R, Kniep B, Goto Y, Mitsuoka C, Zwirner J, Soruri A, von Kietzell M, Rieber P, Lisewski M, Mommert S, Kapp A, Zwirner J, Werfet T, Gutzmer R, Langer K, Werfel T, Soewarto D, Köllisch G, Howaldt M, Sandholzer N, Kreramer E, Hrabé deAngelis M, Balling R, Ollert M, Pfeffer K, Wolf E, Flaswinkel H, Ngoumou G, Schäfer D, Mattes J, Moseler M, Kühr J, Kopp MV, Gutzmer R, Wittmann M, Janssen S, Köther B, Alter M, Stünkel T, Hausdirjg M, Ho TC, Buerke M, Lehr AH, Lux C, Schipp M, Galle RP, Finotto S, Bünder R, Mittermann I, Herz U, Valenta R, Renz H, Seidel-Guvenot W, Goez R, Maurer M, Metz M, Blessing M, Schramm C, Steinbrink K, Köllisch GV, Mempel M, Bauer S, Völcker V, Kasche A, Fesq H, Feussner I, Schober W, Buters J, Hueltner L, Lippert U, Artuc M, Babina M, Blaschke V, Zachmann K, Neumann C, Henz BM, Stassen M, Müller C, Richter C, Neudörfl C, Hüttner L, Bhakdi S, Walev I, Schmitt E, Mageri M, Maurer M, Hartmann K, Artuc M, Hermes B, Mekori YA, Henz BM, Breit S, Schöpf P, Dugas M, Schiffl H, Ruëff F, Przybilla B, Forssmann U, Härtung I, Bälder R, Escher SE, Spodsberg N, Dulkys Y, Walden M, Heitland A, Braun A, Forssmann WG, Elsner J, Raap U, Deneka N, Bruder M, Wedi B, Feser A, Plötz SG, Kreyling W, Schober W, Weichenmeier I, Papo D, Eberlein-König B, Berresheim HW, Grimm V, Winneke G, Kleine-Tebbe J, Breuer K, Vieths S, Worm M, Kunkel G, Wahn U, Lau S, Errlmann SM, Sauer I, Termeer C, Salman S, Averbeck M, Simon JC, Heine G, Frotscher B, Anton K, Mahnke K, Qian Y, Enk A, Enk AH, Beinghausen I, Darcan Y, Seitzer U, Ahmed J, Sudowe S, Ludwig-Portugall I, Ross R, Reske-Kunz AB, Maurer T, Lipford G, Wagner H, Rueff F, Bauer C, Gosepath J, Mewes T, Ziegler E, Ziegler EA, Flagge A, Hipler UC, Baumbach H, Zintl F, Eisner P, Mainz J, Huber S, Protschka M, Burg J, Galle PR, Lohse AW, Podlech J, Köhler H, Wegmann M, Heimann S, Fehrenbach A, Wagner U, Alfke H, Fehrenbach H, Beier J, Semmler D, Beeh KM, Kornmann O, Buhl R, Quarcoo D, Ahrens B, Meeuw A, Reese G, Vieths S, Hameimann E, Heratizadeh A, Wulf A, Constien A, Tetau D, Lingelbach A, Rakoski J, Fiedler EM, Zuberbier T, Weidermiller M, Winterkamp S, Schwab D, Nabe A, Nägel A, Maiss J, Mühldorfer SDN, Hahn EG, Raithel M, Weidenhiller M, Abel R, Baenkler HW, Mühldorfer S, Funkt G, Klinik I, Scheibenzuber M, Meyer-Pittroff R, Reese I, Oppel T, Hartmann K, Pfützner W, Biedermann T, Sing A, Dechene M, Staubach P, Hanau A, Magerl M, Eckhardt-Henn A, Onnen K, Kromminga A, Lüdtke R, Tschentscher I, Lange J, Berkenheide S, Kuehr J, Simon D, von Gunten S, Borelli S, Braathen LR, Simon HU, Fokken N, Wittmann M, Mrabet-Dahbi S, Klotz M, Heeg K, Soost S, Lee H, Klinger R, Becker D, Bruchhausen S, Jaeger C, Hartschuh W, Jappe U. 15. Mainzer Allergie-Workshop 2003. Allergo J 2003. [DOI: 10.1007/bf03361093] [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: 11/24/2022]
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Timmermann W, Hamelmann WH, Meyer T, Timm S, Schramm C, Hoppe F, Thiede A. [Identification and surgical anatomy of the external branch of the superior laryngeal nerve]. Zentralbl Chir 2002; 127:425-8. [PMID: 12058302 DOI: 10.1055/s-2002-31971] [Citation(s) in RCA: 11] [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: 10/17/2022]
Abstract
Injury to the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery can cause serious consequences for patients who depend on control of pitch and a clear and forceful voice, like singers or professional speakers. We used the Neurosign 100(R) nerve monitor to identify 157 nerves in 108 patients undergoing thyroid surgery. The EBSLN was successfully identified in 98.7 % of cases. The recording electrode could be placed either into the cricothyroid muscle or the vocal cord. The latter position proved superior if the recurrent laryngeal nerve had to be identified as well. 16 percent of the nerves crossed the branches of the superior thyroid artery at or below the upper pole of the gland, posing a "high risk" for intraoperative lesions. Our data confirm the results of smaller studies reporting this type of nerve course in 12 % to 14 % of patients. The present findings show a significant number of EBSLN to be in danger of injury when the superior thyroid artery is ligated during thyroid surgery. Neuromonitoring proofed to be a reliable method to identify the nerve, which is an important element in concepts to prevent its injury.
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Affiliation(s)
- W Timmermann
- Chirurgische Universitätsklinik und Poliklinik Würzburg, Germany
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Affiliation(s)
- C Schramm
- Beatson Institute for Cancer Research, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, United Kingdom
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Schlaak JF, Schramm C, Radecke K, zum Büschenfelde KHM, Gerken G. Sustained suppression of HCV replication and inflammatory activity after interleukin-2 therapy in patients with HIV/hepatitis C virus coinfection. J Acquir Immune Defic Syndr 2002; 29:145-8. [PMID: 11832683 DOI: 10.1097/00042560-200202010-00006] [Citation(s) in RCA: 12] [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: 11/26/2022]
Abstract
OBJECTIVE There is increasing evidence that coinfection of hepatitis C (HCV) with HIV is associated with accelerated progression of liver cirrhosis. The aim of this pilot study was to investigate toxicity and efficacy of interleukin-2 (IL-2) for treatment of affected patients. DESIGN Because low-dose, daily IL-2 therapy is well tolerated and can elevate CD4 cell counts and improve immune functions, patients were treated with 1-2 million units (MU) IL-2 subcutaneously daily. METHODS This pilot trial included 7 HIV/HCV-coinfected individuals. During therapy, clinical, virologic, and laboratory parameters were closely monitored. RESULTS All patients responded to IL-2 therapy with either improvement of either CD4 cell counts or liver function test results. In 2 patients, HCV-RNA in serum became negative 2 and 4 months, respectively, after cessation of therapy. HCV-RNA has remained undetectable in these 2 patients for 18 and 24 months, respectively. Therapy was well tolerated and no grade III or IV toxicities were observed. CONCLUSIONS Low-dose, daily IL-2 therapy can improve both CD4 cell counts and liver function test results in patients with HIV/HCV coinfection and may in some cases lead to sustained suppression of viremia of HCV.
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Affiliation(s)
- Jörg F Schlaak
- Department of Medicine A, Imperial College, School of Medicine, St. Mary's Hospital, London, UK.
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Abstract
We present a 17-year-old Caucasian male with congenital pulmonary lymphangiectasia and an absent thoracic duct. This patient is unique as he did not present with the disorder until age 9.5 years. Since his initial presentation he has had recurrent chylothoraces and has been treated symptomatically. We discuss the possible implications of his disorder as well as some of the limited treatment that is available.
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Affiliation(s)
- M Antonetti
- Department of Pediatric Surgery and Urology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, Connecticut 06106, USA
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Abstract
OBJECTIVES Autoimmune hepatitis (AIH) is widely believed to be a disease of young women and menopause. Little is known about the frequency and clinical characteristics in patients aged > or =65 yr. METHODS We reviewed charts of 120 consecutive outpatients with known AIH to identify patients who were diagnosed at the age of 65 or older. These 20 patients (median age, 69 yr) were compared to the same number of younger patients (median age, 24 yr) with well-documented AIH from the same cohort. RESULTS Seventeen percent (20/120) of our patients were > or =65 yr at the time of diagnosis. In the older patients median time to diagnosis was significantly longer than in the younger patients (8.5 vs 3.5 months). Patients most commonly presented with an acute icteric hepatitis. Complete remission was achieved to a similar extent (18/20 and 17/20 patients). Fewer older patients expressed human leukocyte antigen A1-B8 (p = 0.005). CONCLUSIONS Diagnosis of AIH often seems to be delayed in the elderly, presumably because AIH is erroneously considered to be a disease of young age. Presentation with acute icteric hepatitis is similar to that of younger patients, supporting the assumption that beneficial effects of hormonal changes associated with menopause are not as pronounced in AIH as in other autoimmune diseases. Human leukocyte antigen type seems to have an influence on the age of onset of AIH. Prognosis is excellent, and AIH should be considered in the older patient to avoid delayed initiation of immunosuppressive therapy.
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Affiliation(s)
- C Schramm
- I. Department of Medicine, Johannes Gutenberg-University, Mainz, Germany
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Schramm C, Rinderer B. Determination of cotton-bound glyoxal via an internal cannizzaro reaction by means of high-performance liquid chromatography. Anal Chem 2000; 72:5829-33. [PMID: 11128943 DOI: 10.1021/ac000704r] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Glyoxal, a non-formaldehyde cross-linking agent, was applied in combination with aluminum sulfate hexadecahydrate to impart durable-press properties to cellulosic materials. The cotton fabric was impregnated with a pad bath formulation containing 6% (w/w) glyoxal and 4.5% (w/w) aluminum sulfate hexadecahydrate. The curing process was conducted at 140 degrees C for 3 min, thus affecting a cross-linkage between the cellulose chains. For the first time, a chromatographic method is presented that enables both qualitative and quantitative analysis of the portion of glyoxal that has reacted with the cellulosic material. For this purpose, the glyoxal-treated fabric was treated with an NaOH solution (c = 4 mol L(-1)) at 100 degrees C for 20 min. As a result, glyoxal was extracted from the cellulosic sample and converted into glycolate via an internal Cannizzaro reaction. Subsequently, the glycolate was analyzed chromatographically using the strong cation-exchange column Aminex HPX-87H as the stationary phase and sulfuric acid as the mobile phase. The detection limit was 1.87 mg L(-1) (UV detection). The recovery was 85%. Dry crease wrinkle recovery measurements gave evidence that the cross-linkage was removed completely. The application of the analytical technique developed in the present study demonstrated that the amount of glyoxal that had reacted with the cellulose was 15.7 +/- 0.72 mg/g of fabric. In addition, glycolate thus formed was well separated from non-formaldehyde durable-press finishing agents based on polycarboxylic acids such as 1,2,3,4-butanetetracarboxylic acid or citric acid.
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Affiliation(s)
- C Schramm
- Institute for Textile Chemistry and Textile Physics, Leopold-Franzens-University Innsbruck, Dornbirn, Austria
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Schramm C, Schlaak JF, Galle PR. Rapid development of Epstein-Barr virus-associated Hodgkin's disease after cessation of foscarnet therapy in an HIV-infected patient. Int J STD AIDS 2000; 11:609-10. [PMID: 10997507 DOI: 10.1258/0956462001916489] [Citation(s) in RCA: 3] [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: 11/18/2022]
Abstract
Epidemiological features suggest a link between Hodgkin's disease (HD) and Epstein-Barr virus (EBV) infection. Indeed, EBV genome and expression of latent antigens can be found in Reed-Sternberg cells. In the majority of cases HD in HIV patients seems to be EBV-associated. We report on a 51-year-old HIV-infected patient in whom EBV-positive HD of mixed cellularity rapidly developed within one month after cessation of treatment with intravenous foscarnet.
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Affiliation(s)
- C Schramm
- 1st Department of Medicine, Johannes Gutenberg University, Mainz, Germany.
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Abstract
In budding yeast, microtubules are organized by the spindle pole body (SPB), which is embedded in the nuclear envelope via its central plaque structure. Here, we describe the identification of BBP1 in a suppressor screen with a conditional lethal allele of SPC29. Bbp1p was detected at the central plaque periphery of the SPB and bbp1-1 cells were found to be defective in SPB duplication. bbp1-1 cells extend their satellite into a duplication plaque like wild-type cells; however, this duplication plaque then fails to insert properly into the nuclear envelope and does not assemble a functional inner plaque. This function in SPB duplication is probably fulfilled by a stable complex of Bbp1p and Mps2p, a nuclear envelope protein that is also essential for duplication plaque insertion. In addition, we found that Bbp1p interacts with Spc29p and the half-bridge component Kar1p. These interactions are likely to play a role in connecting the SPB with the nuclear envelope and the central plaque with the half-bridge.
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Affiliation(s)
- C Schramm
- The Beatson Institute for Cancer Research, CRC Beatson Laboratories, Glasgow G61 1BD, UK
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Schramm C, Schirmacher P, Helmreich-Becker I, Gerken G, zum Büschenfelde KH, Lohse AW. Combined therapy with azathioprine, prednisolone, and ursodiol in patients with primary sclerosing cholangitis. A case series. Ann Intern Med 1999; 131:943-6. [PMID: 10610645 DOI: 10.7326/0003-4819-131-12-199912210-00006] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND No established medical therapy alters the progressive course of primary sclerosing cholangitis. OBJECTIVE To explore the potential usefulness of combined therapy with azathioprine, steroids and ursodeoxycholic acid (UDCA) in primary sclerosing cholangitis. DESIGN Case series. SETTING University hospital in Mainz, Germany. PATIENTS 15 patients with primary sclerosing cholangitis. INTERVENTION Azathioprine (1 to 1.5 mg/kg of body weight per day), prednisolone (1 mg/kg per day initially, tapering to 5 to 10 mg per day) and UDCA (500 to 750 mg per day). MEASUREMENTS Clinical and laboratory evaluation, liver biopsy, and endoscopic retrograde cholangiography (a >30% change in stenosis was considered significant). RESULTS After a median observation period of 41 months (range, 3 to 81 months), liver enzyme levels declined significantly in all patients. Six of 10 patients with follow-up liver biopsies showed histologic improvement. Significant radiographic deterioration was seen in only 1 of 10 patients who had endoscopic retrograde cholangiography. In 7 patients previously treated with UDCA alone, liver enzyme levels declined significantly only after immunosuppressive therapy was added. Adverse drug reactions led to the withdrawal of study medications in 2 patients. CONCLUSIONS Combined immunosuppressive therapy may alter the progression of primary sclerosing cholangitis. Our observations suggest a benefit from adding immunosuppressive drugs to UDCA therapy. A randomized trial is warranted.
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Affiliation(s)
- C Schramm
- Johannes Gutenberg University, Mainz, Germany
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Abstract
Nucleoside analogue-induced lactic acidosis is an often fatal condition in patients with HIV. There is only one report of successful treatment with riboflavin. We describe a 30-year-old female with AIDS and nucleoside analogue-induced lactic acidosis that exacerbated shortly after introducing total parenteral nutrition and reversed within hours after the addition of thiamine. Successful treatment of nucleoside analogue-induced lactic acidosis with a high dose of thiamine supports the hypothesis that vitamin deficiency is an important cofactor in the development of this rare and unpredictable condition in patients with HIV. We suggest that high dose B-vitamins should be given to any patient presenting with lactic acidosis under nucleoside analogue treatment.
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Affiliation(s)
- C Schramm
- Department of Medicine, Johannes Gutenberg-University, Mainz, Germany
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Abstract
The expression of major histocompatibility complex (MHC) class II molecules in murine T cells has been controversial. We therefore reexamined the transcription, synthesis and surface expression of MHC class II determinants in rat T cells both in vivo and in vitro. In naive rats, a large proportion of small CD4+8+ and mature CD4+8-/CD4-8+ thymocytes was found to be MHC class II positive. At least some of the MHC class II molecules found on thymocytes were actively synthesized. The synthesis of MHC class II proteins was detected in peripheral T cells activated in vivo during induction of experimental allergic encephalomyelitis (EAE). A proportion of T cells from the inflammatory lesion of EAE exhibited MHC class II on the surface. A panel of helper T cell lines and clones was shown to synthesize MHC class II proteins. In a prototypic clone, a weak constitutive expression of MHC class II was observed. During activation, the rate of endogenous MHC class II synthesis increased and passive absorption of surface MHC class II from other cells occurred. Our data demonstrate the expression of MHC class II molecules in rat T cells in both the thymus and periphery. Since the primary function of MHC class II molecules is the presentation of peptide epitopes to T cells, these results call attention to the possible role of MHC class II molecules in T-T interactions during T cell maturation and activation.
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Affiliation(s)
- B Reizis
- Department of Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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Ruchti B, Schramm C, Kubitschko S, Neidhart B. A new screening procedure for the estimation of oxidizable organic compounds in water samples. Anal Bioanal Chem 1992. [DOI: 10.1007/bf00322142] [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: 10/26/2022]
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Gessert CE, Katcher ML, Cohen R, Kindig DA, Kritek PB, Lobeck CC, Moskol F, Schramm C. The Wisconsin Area Health Education Center System. Wis Med J 1991; 90:473-8. [PMID: 1926888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
The skeletal musculature of chick limb buds is derived from somitic cells that migrate into the somatopleure of the future limb regions. These cells become organized into the earliest muscle primordia, the dorsal and ventral premuscle masses, prior to myogenic differentiation. Therefore, skeletal-muscle specific markers cannot be used to observe myogenic cells during the process of premuscle mass formation. In this study, an alternative marking method was used to determine the specific stages during which this process occurs. Quail somite strips were fluorescently labeled and implanted into chick hosts. Paraffin sections of the resulting chimeric wing buds were stained with the monoclonal antibody QH1 in order to identify graft-derived endothelium. Non-endothelial graft-derived cells present in the wing mesenchyme were assumed to be myogenic. At Hamburger and Hamilton stage 20, myogenic cells were distributed throughout the central region of the limb, including the future dorsal and ventral premuscle mass regions and the prechondrogenic core region. By stage 21, the myogenic cells were present at greater density in dorsal and ventral regions than in the core. By stage 23, nearly all myogenic cells were located in the dorsal and ventral premuscle masses. Therefore, the two premuscle masses become established by stage 21 and premuscle mass formation is not complete until stage 23 or later. Premuscle mass formation occurs concurrently with early chondrogenic events, as observed with the marker peanut agglutinin. To facilitate the investigation of possible underlying mechanisms of premuscle mass formation, the micromass culture system was evaluated, to determine whether or not it can serve as an accurate in vitro model system. The initially randomly distributed myogenic cells were observed to segregate from prechondrogenic regions prior to myogenic differentiation. This is similar to myogenic patterning in vivo.
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Affiliation(s)
- C Schramm
- Department of Biology, University of Iowa, Iowa City 52242
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Schramm C. Insuring health in today's health care environment. Interview by Janice C. Simmons. Internist 1990; 31:16-9. [PMID: 10113277] [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] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- C Schramm
- Health Insurance Association of America
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Hufert FT, von Laer D, Schramm C, Tárnok A, Schmitz H. Detection of HIV-1 DNA in different subsets of human peripheral blood mononuclear cells using the polymerase chain reaction. Rapid communication. Arch Virol 1989; 106:341-5. [PMID: 2570562 DOI: 10.1007/bf01313963] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [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: 01/01/2023]
Abstract
The presence of HIV-1 proviral DNA was determined in CD4 cells, CD8 cells and macrophages/monocytes obtained from peripheral blood of 8 HIV-1 infected persons. Using the polymerase chain reaction (PCR) we were able to detect proviral DNA in the extracts of only 10(2)-10(3) CD4 (T4) cells. In contrast, 10(5) CD8 cells did not contain detectable amounts of proviral DNA. Surprisingly, in four of our eight patients studied no HIV-1 DNA was found in macrophages. In peripheral blood, every hundred T4 cell may be infected with HIV-1.
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Affiliation(s)
- F T Hufert
- Virological Department, Bernhard-Nocht Institute of Tropical Medicine, Hamburg, Federal Republic of Germany
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Abstract
Multimedia radiological reports tie together radiographic images and operations on these images with textual, vocal, or graphic annotation. The result is an animated presentation of the radiological examination report. A temporal representation for a multimedia radiological report that describes the temporal behavior of the animated report is introduced. The temporal behavior specifies the synchronization requirements for the coordinated presentation of the multimedia report components. The temporal behavior is encoded in a temporal semantic network that is a network of temporally ordered nodes, where each node represents some primitive behavior. Automatic creation of the multimedia radiological report consists of the capture, interpretation, and storage of the temporal semantics of the radiologist's reporting session in terms of a set of primitive behaviors. Automatic playback of the multimedia radiological report is the orderly traversal of the temporal semantic network, invoking the behavior associated with each of the nodes in the temporal order described by the interconnecting arcs.
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Affiliation(s)
- C Schramm
- Telecommunications Research Institute of Ontario, University of Ottawa Medical Communications, Canada
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