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Clerc O, Datar Y, Cuddy SAM, Bianchi G, Taylor A, Benz D, Robertson M, Kijewski MF, Jerosh-Herold M, Kwong RY, Ruberg FL, Liao R, Di Carli MF, Falk RH, Dorbala S. Cardiomyocyte stretch mediates the relation between left ventricular amyloid burden and adverse outcomes in light chain amyloidosis: a 18F-florbetapir positron emission tomography study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.319] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with light chain (AL) amyloidosis and cardiac involvement have poor prognosis. Mayo stage accounts for severity of plasma cell dyscrasia and cardiac biomarker release, and provides powerful risk stratification. Myocardial amyloid burden can be quantified by 18F-florbetapir positron emission tomography (PET), but its prognostic value is not known.
Purpose
To test our hypothesis that (1) myocardial amyloid burden predicts adverse outcomes and (2) the relationship between amyloid burden and adverse outcomes is mediated by cardiomyocyte stretch and injury. Amyloid burden was estimated by left ventricular 18F-florbetapir retention index (RI) and cardiomyocyte stretch and injury by NT proBNP and troponin T respectively.
Methods
We performed 18F-florbetapir PET (median dose 9.05 mCi) in prospectively enrolled subjects with newly diagnosed AL amyloidosis with abnormal cardiac biomarkers or with normal cardiac biomarkers and normal left ventricular wall thickness (NCT02641145). Left ventricular RI was calculated as the activity concentration between 10 and 30 min. after injection divided by the integral of the left atrial blood time-activity curve from 0 to 20 min. RI was categorized as normal (<0.06/min, based on controls), increased (0.06–0.12/min), or high risk (>0.12/min, based on log-rank statistic maximization). Mayo stages I–IV were based on elevated serum cardiac biomarkers: NT-proBNP ≥1800 pg/ml, troponin T ≥0.025 ng/ml, and difference in free light chains ≥180 mg/l. Adverse outcomes of all-cause death or heart failure hospitalization were evaluated. Survival analysis was performed using Kaplan-Meier and Cox regression including Mayo stage and RI. Mediation analysis was used to elucidate the role of cardiomyocyte stretch (as NT-proBNP) and injury (as troponin T) in the association between amyloid burden estimated by RI and adverse outcomes.
Results
We studied 80 subjects with median age 62 years (IQR 57–67), 46 men (57%), 60 with abnormal cardiac biomarkers (75%), and median RI of 0.10/min (IQR 0.06–0.16). At follow-up (median 15 months), adverse outcomes occurred in 34 subjects (42%), with 17 deaths (21%) and 23 heart failure hospitalizations (29%). The incidence of adverse outcomes increased across Mayo stages from 9% to 44% (log-rank p<0.001), and across RI levels from 29% to 57% (log-rank p=0.037, Figure 1). In multivariable Cox regression, only Mayo stage independently predicted adverse outcomes (HR 2.0 [95% CI 1.4–3.0], p<0.001). Multivariable mediation analysis showed that 83% of the association between RI and adverse outcomes was mediated by NT-proBNP (p<0.001, Figure 2), without contribution from troponin T.
Conclusion
Myocardial amyloid burden estimated by F-18 florbetapir RI predicts adverse outcomes in AL amyloidosis, but not independently of Mayo stage. Cardiomyocyte stretch mediates the relationship between myocardial amyloid burden and adverse outcomes in AL amyloidosis.
Funding Acknowledgement
Type of funding sources: Private company.
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Affiliation(s)
- O Clerc
- Brigham and Women's Hospital , Boston , United States of America
| | - Y Datar
- Boston University School of Medicine , Boston , United States of America
| | - S A M Cuddy
- Brigham and Women's Hospital , Boston , United States of America
| | - G Bianchi
- Brigham and Women's Hospital , Boston , United States of America
| | - A Taylor
- Brigham and Women's Hospital , Boston , United States of America
| | - D Benz
- Brigham and Women's Hospital , Boston , United States of America
| | - M Robertson
- Brigham and Women's Hospital , Boston , United States of America
| | - M F Kijewski
- Brigham and Women's Hospital , Boston , United States of America
| | - M Jerosh-Herold
- Brigham and Women's Hospital , Boston , United States of America
| | - R Y Kwong
- Brigham and Women's Hospital , Boston , United States of America
| | - F L Ruberg
- Boston University School of Medicine , Boston , United States of America
| | - R Liao
- Stanford University Medical Center , Stanford , United States of America
| | - M F Di Carli
- Brigham and Women's Hospital , Boston , United States of America
| | - R H Falk
- Brigham and Women's Hospital , Boston , United States of America
| | - S Dorbala
- Brigham and Women's Hospital , Boston , United States of America
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Giannopoulos A, Bolt B, Benz D, Messerli M, Schwyzer M, Von Felten E, Kamani C, Patriki D, Gebhard C, Pazhenkottil A, Graeni C, Kaufmann P, Buechel R, Gaemperli O. Coronary computed tomography angiography-derived endothelial shear stress in myocardial bridging. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benetos G, Goncalves M, Von Felten E, Rampidis G, Clerc O, Benz D, Gebhard K, Fuchs T, Pazhenkottil A, Kaufmann P, Buechel R, Graeni C. P6157Indexed coronary volume - A potential novel low-dose CCTA derived predictor for cardiovascular events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0763] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary computed tomography angiography (CCTA) provides incremental prognostic information over traditional risk factors in patients with suspected coronary artery disease. However, little is known about the long-term predictive performance of CCTA-derived coronary volumes and mid-diastolic left ventricular (LV) mass.
Purpose
To assess long-term prognostic value of coronary volumes and mid-diastolic LV mass as novel potential imaging predictors derived from low-dose prospectively ECG-triggered CCTA.
Methods
Consecutive patients with suspected or known coronary artery disease, referred for low-dose CCTA, were included. Patients with previous revascularization were excluded. The following parameters were evaluated: calcium score, segment involvement score (SIS: 1 point for each coronary segment with presence of plaque), coronary volume, mid-diastolic LV mass and coronary volume indexed to LV mass. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fatal myocardial infarction and revascularization (PCI or CABG). The association between CCTA measures and the occurrence of events was quantified using cox regression hazard and Kaplan Meier analysis.
Results
A total of 147 consecutive patients were included in the study. Of them, 93 (63.3%) were male and 79 (53.7%) hat one or more traditional cardiovascular risk factors. There was a weak but statistical significant inverse correlation between indexed coronary volume and both calcium score (R=-0.3, p=0.01) and SIS (R=-0.24, p=0.005). After a median follow-up of 5.8 years 30 MACE occurred in 25 patients, including 3 deaths, 26 revascularizations and 1 non-fatal myocardial infarction. In univariate cox regression hazard analysis calcium score (HR=12.69, 95% CI 2.99–53.83, p<0.001), SIS (HR=1.66, 95% CI 1.43–1.94, p<0.001), LV mass (HR=1.02, 95% CI 1.01–1.03, p=0.007) and indexed coronary volume (HR=0.89, 95% 0.82–0.96, p=0.004) were associated with outcome. In multivariate analysis, indexed coronary volume, remained an independent predictor for MACE when adjusted for traditional risk factors and SIS (HR=0.93, 95% CI 0.87–1.00, p=0.05), while LV mass did not reach statistical significance (p=0.46). By ROC curve analysis, a value of 21.85 mm3/gr was defined as optimal cutoff for indexed coronary volume. In Kaplan Meier plots, patients with low indexed coronary volume (<21.85 mm3/gr) showed higher event rates (log rank p<0.001) compared to high indexed coronary volume (≥21.85 mm3/gr).
Conclusions
Indexed coronary volume, derived from low-dose CCTA, independently predicts cardiovascular events. Larger studies are mandated to confirm the predictive value of this potential new biomarker.
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Affiliation(s)
- G Benetos
- University Hospital Zurich, Zurich, Switzerland
| | - M Goncalves
- University Hospital Zurich, Zurich, Switzerland
| | | | - G Rampidis
- University Hospital Zurich, Zurich, Switzerland
| | - O Clerc
- University Hospital Zurich, Zurich, Switzerland
| | - D Benz
- University Hospital Zurich, Zurich, Switzerland
| | - K Gebhard
- University Hospital Zurich, Zurich, Switzerland
| | - T Fuchs
- University Hospital Zurich, Zurich, Switzerland
| | | | - P Kaufmann
- University Hospital Zurich, Zurich, Switzerland
| | - R Buechel
- University Hospital Zurich, Zurich, Switzerland
| | - C Graeni
- University Hospital Zurich, Zurich, Switzerland
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Taniguchi Y, Takahashi Y, Toba T, Yamada S, Yokoi K, Kobayashi S, Okajima S, Shimane A, Kawai H, Yasaka Y, Smanio P, Oliveira MA, Machado L, Cestari P, Medeiros E, Fukuzawa S, Okino S, Ikeda A, Maekawa J, Ichikawa S, Kuroiwa N, Yamanaka K, Igarashi A, Inagaki M, Patel K, Mahan M, Ananthasubramaniam K, Mouden M, Yokota S, Ottervanger J, Knollema S, Timmer J, Jager P, Padron K, Peix A, Cabrera L, Pena Bofill V, Valera D, Rodriguez Nande L, Carrillo Hernandez R, Mena Esnard E, Fernandez Columbie Y, Bertella E, Baggiano A, Mushtaq S, Segurini C, Loguercio M, Conte E, Beltrama V, Petulla' M, Andreini D, Pontone G, Guzic Salobir B, Dolenc Novak M, Jug B, Kacjan B, Novak Z, Vrtovec M, Mushtaq S, Pontone G, Bertella E, Conte E, Segurini C, Volpato V, Baggiano A, Formenti A, Pepi M, Andreini D, Ajanovic R, Husic-Selimovic A, Zujovic-Ajanovic A, Mlynarski R, Mlynarska A, Golba K, Sosnowski M, Ameta D, Goyal M, Kumar D, Chandra S, Sethi R, Puri A, Dwivedi SK, Narain VS, Saran RK, Nekolla S, Rischpler C, Nicolosi S, Langwieser N, Dirschinger R, Laugwitz K, Schwaiger M, Goral JL, Napoli J, Forcada P, Zucchiatti N, Damico A, Damico A, Olivieri D, Lavorato M, Dubesarsky E, Montana O, Salgado C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez De Mora E, Lopez-Aguilar R, Manovel A, Martinez A, Rivera F, Soriano E, Maroz-Vadalazhskaya N, Trisvetova E, Vrublevskaya O, Abazid R, Kattea M, Saqqah H, Sayed S, Smettei O, Winther S, Svensson M, Birn H, Jorgensen H, Botker H, Ivarsen P, Bottcher M, Maaniitty T, Stenstrom I, Saraste A, Pikkarainen E, Uusitalo V, Ukkonen H, Kajander S, Bax J, Knuuti J, Choi T, Park H, Lee C, Lee J, Seo Y, Cho Y, Hwang E, Cho D, Sanchez Enrique C, Ferrera C, Olmos C, Jimenez - Ballve A, Perez - Castejon MJ, Fernandez C, Vivas D, Vilacosta I, Nagamachi S, Onizuka H, Nishii R, Mizutani Y, Kitamura K, Lo Presti M, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Madeo A, Malouf J, Buffa V, Musumeci F, Rosales S, Puente A, Zafrir N, Shochat T, Mats A, Solodky A, Kornowski R, Lorber A, Boemio A, Pellegrino T, Paolillo S, Piscopo V, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Perrone-Filardi P, Cuocolo A, Piscopo V, Pellegrino T, Boemio A, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Petretta M, Cuocolo A, Amirov N, Ibatullin M, Sadykov A A, Saifullina G, Ruano R, Diego Dominguez M, Rodriguez Gabella T, Diego Nieto A, Diaz Gonzalez L, Garcia-Talavera J, Sanchez Fernandez P, Leen A, Al Younis I, Zandbergen-Harlaar S, Verberne H, Gimelli A, Veltman C, Wolterbeek R, Bax J, Scholte A, Mooney D, Rosenblatt J, Dunn T, Vasaiwala S, Okuda K, Nakajima K, Nystrom K, Edenbrandt L, Matsuo S, Wakabayashi H, Hashimoto M, Kinuya S, Iric-Cupic V, Milanov S, Davidovic G, Zdravkovic V, Ashikaga K, Yoneyama K, Akashi Y, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Baranovich V, Faibushevich A, El Tahlawi M, Elmurr A, Alzubaidi S, Sakrana A, Gouda M, El Tahlawi R, Sellem A, Melki S, Elajmi W, Hammami H, Okano M, Kato T, Kimura M, Funasako M, Nakane E, Miyamoto S, Izumi T, Haruna T, Inoko M, Massardo T, Swett E, Fernandez R, Vera V, Zhindon J, Fernandez R, Swett E, Vera V, Zhindon J, Alay R, Massardo T, Ohshima S, Nishio M, Kojima A, Tamai S, Kobayashi T, Murohara T, Burrell S, Van Rosendael A, Van Den Hoogen I, De Graaf M, Roelofs J, Kroft L, Bax J, Scholte A, Rjabceva I, Krumina G, Kalvelis A, Chanakhchyan F, Vakhromeeva M, Kankiya E, Koppes J, Knol R, Wondergem M, Van Der Ploeg T, Van Der Zant F, Lazarenko SV, Bruin VS, Pan XB, Declerck JM, Van Der Zant FM, Knol RJJ, Juarez-Orozco LE, Alexanderson E, Slart R, Tio R, Dierckx R, Zeebregts C, Boersma H, Hillege H, Martinez-Aguilar M, Jordan-Rios A, Christensen TE, Ahtarovski KA, Bang LE, Holmvang L, Soeholm H, Ghotbi AA, Andersson H, Ihlemann N, Kjaer A, Hasbak P, Gulya M, Lishmanov YB, Zavadovskii K, Lebedev D, Stahle M, Hellberg S, Liljenback H, Virta J, Metsala O, Yla-Herttuala S, Saukko P, Knuuti J, Saraste A, Roivainen A, Thackeray J, Wang Y, Bankstahl J, Wollert K, Bengel F, Saushkina Y, Evtushenko V, Minin S, Efimova I, Evtushenko A, Smishlyaev K, Lishmanov Y, Maslov L, Okuda K, Nakajima K, Kirihara Y, Sugino S, Matsuo S, Taki J, Hashimoto M, Kinuya S, Ahmadian A, Berman J, Govender P, Ruberg F, Miller E, Piriou N, Pallardy A, Valette F, Cahouch Z, Mathieu C, Warin-Fresse K, Gueffet J, Serfaty J, Trochu J, Kraeber-Bodere F, Van Dijk J, Mouden M, Ottervanger J, Van Dalen J, Jager P, Zafrir N, Ofrk H, Vaturi M, Shochat T, Hassid Y, Belzer D, Sagie A, Kornowski R, Kaminek M, Metelkova I, Budikova M, Koranda P, Henzlova L, Sovova E, Kincl V, Drozdova A, Jordan M, Shahid F, Teoh Y, Thamen R, Hara N, Onoguchi M, Hojyo O, Kawaguchi Y, Murai M, Udaka F, Matsuzawa Y, Bulugahapitiya DS, Avison M, Martin J, Liu YH, Wu J, Liu C, Sinusas A, Daou D, Sabbah R, Bouladhour H, Coaguila C, Aguade-Bruix S, Pizzi M, Romero-Farina G, Candell-Riera J, Castell-Conesa J, Patchett N, Sverdlov A, Miller E, Daou D, Sabbah R, Bouladhour H, Coaguila C, Smettei O, Abazid R, Boulaamayl El Fatemi S, Sallam L, Snipelisky D, Park J, Ray J, Shapiro B, Kostkiewicz M, Szot W, Holcman K, Lesniak-Sobelga A, Podolec P, Clerc O, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Herzog B, Gaemperli O, Kaufmann P. Poster Session 1: Sunday 3 May 2015, 08:30-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sedda L, Morley DW, Braks MAH, De Simone L, Benz D, Rogers DJ. Risk assessment of vector-borne diseases for public health governance. Public Health 2014; 128:1049-58. [PMID: 25443135 DOI: 10.1016/j.puhe.2014.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 03/28/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVES In the context of public health, risk governance (or risk analysis) is a framework for the assessment and subsequent management and/or control of the danger posed by an identified disease threat. Generic frameworks in which to carry out risk assessment have been developed by various agencies. These include monitoring, data collection, statistical analysis and dissemination. Due to the inherent complexity of disease systems, however, the generic approach must be modified for individual, disease-specific risk assessment frameworks. STUDY DESIGN The analysis was based on the review of the current risk assessments of vector-borne diseases adopted by the main Public Health organisations (OIE, WHO, ECDC, FAO, CDC etc…). METHODS Literature, legislation and statistical assessment of the risk analysis frameworks. RESULTS This review outlines the need for the development of a general public health risk assessment method for vector-borne diseases, in order to guarantee that sufficient information is gathered to apply robust models of risk assessment. Stochastic (especially spatial) methods, often in Bayesian frameworks are now gaining prominence in standard risk assessment procedures because of their ability to assess accurately model uncertainties. CONCLUSIONS Risk assessment needs to be addressed quantitatively wherever possible, and submitted with its quality assessment in order to enable successful public health measures to be adopted. In terms of current practice, often a series of different models and analyses are applied to the same problem, with results and outcomes that are difficult to compare because of the unknown model and data uncertainties. Therefore, the risk assessment areas in need of further research are identified in this article.
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Affiliation(s)
- L Sedda
- Department of Zoology, University of Oxford, South Parks Road, OX1 3PS Oxford, United Kingdom.
| | - D W Morley
- Department of Zoology, University of Oxford, South Parks Road, OX1 3PS Oxford, United Kingdom
| | - M A H Braks
- Centre for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - L De Simone
- Surveillance and Response Support Unit (SRS), European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11 A, 171 83 Stockholm, Sweden
| | - D Benz
- Department of Zoology, University of Oxford, South Parks Road, OX1 3PS Oxford, United Kingdom
| | - D J Rogers
- Department of Zoology, University of Oxford, South Parks Road, OX1 3PS Oxford, United Kingdom
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Aschwanden M, Daikeler T, Kesten F, Baldi T, Benz D, Tyndall A, Imfeld S, Staub D, Hess C, Jaeger KA. Temporal artery compression sign--a novel ultrasound finding for the diagnosis of giant cell arteritis. Ultraschall Med 2013; 34:47-50. [PMID: 22693039 DOI: 10.1055/s-0032-1312821] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE In patients with suspected giant cell arteritis (GCA), a search for the perivascular halo sign, a sophisticated color duplex ultrasound (CDU) finding, at experienced centers reliably identifies inflamed temporal arteries (TA). We tested whether TA compression in patients with GCA, a simple, largely operator-independent maneuver, elicits contrasting echogenicity between the diseased artery wall and the surrounding tissue (compression sign). MATERIALS AND METHODS 80 individuals with suspected GCA were prospectively enrolled in this single-center study. In all study participants, bilateral ultrasound examination of the TA established the presence/absence of the halo and compression sign. A positive compression sign was defined as visibility of the TA upon transducer-imposed compression of the artery. Based on ACR criteria, a team of specialized physicians independently grouped patients as GCA versus non-GCA. RESULTS 43/80 study participants were grouped as GCA. Both the halo sign and the compression sign were positive in 34/43 patients in the GCA group, and negative in all 37/37 of the non-GCA group, resulting in a sensitivity of 79 % and a specificity of 100 % for both the halo and the compression sign. CONCLUSION In this cohort of individuals with suspected GCA, the halo sign and the compression sign were equal in their diagnostic performance. The simplicity of the compression sign suggests a level of reliability warranting further evaluation.
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Affiliation(s)
- M Aschwanden
- Departement of Angiology, University Hospital Basel, Switzerland.
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8
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Koligi K, Mertz D, Benz D, Vogt T, Bloemberg G, Winter L, Tyndall A, Battegay M, Walker U. Oligoarthritis durch Tropheryma whipplei. Internist (Berl) 2010; 52:884-8. [DOI: 10.1007/s00108-010-2741-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Wehner F, Wehner HD, Fritz P, Benz D, Schulz MM. [Sudden death in the presence of systemic mastocytosis and urticaria pigmentosa]. Arch Kriminol 2008; 222:187-194. [PMID: 19216369] [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: 05/27/2023]
Abstract
Systemic mastocytosis is an extremely rare disease characterised by abnormal mast cell production and accumulation of mast cells in the bone marrow or organs, and to some extent also in the skin (urticaria pigmentosa). To date there have been no descriptions of death caused by systemic mastocytosis. The present first description of such a fatality is based upon a case of anaphylactic histamine shock, probably caused by the consumption of peanuts. The affected person suffered from urticaria pigmentosa and developed a fairly typical pruritus prior to death. In the serum sample taken post-mortem the tryptase concentration was markedly elevated. The diagnosis of systemic mastocytosis was established on the basis of two primary and three secondary criteria according to the WHO classification, which underlines the importance of histological investigations in cases where the cause of death is unclear.
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Affiliation(s)
- Frank Wehner
- Institut für Gerichtliche Medizin der Universität Tübingen
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10
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Moisa A, Fritz P, Benz D, Wehner HD. Iatrogenically-related, fatal methotrexate intoxication: A series of four cases. Forensic Sci Int 2006; 156:154-7. [PMID: 16343832 DOI: 10.1016/j.forsciint.2004.12.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2003] [Accepted: 12/20/2004] [Indexed: 10/25/2022]
Abstract
Since the early eighties, the folic antagonist methotrexate (MTX) has been used in long-term treatment of rheumatoid arthritis. Because of the high toxic potential clinical and laboratory controls at regular intervals and patient education in order to avoid misadventure is of overriding importance. We present four cases of fatal MTX intoxication due to medical malpractice from the Tübingen Institute of Forensic Medicine autopsy material, which show the severe consequences of MTX overdose. It becomes evident that among non-rheumatologists there still is need for information about toxicity and dose limitation in MTX low-dose treatment.
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Affiliation(s)
- A Moisa
- Institut für Gerichtliche Medizin der Universität Tübingen, Nägelestr. 5, 72074 Tübingen, Germany.
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11
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Szmyrka-Kaczmarek M, Daikeler T, Benz D, Koetter I. Familial inflammatory Sneddon’s syndrome—case report and review of the literature. Clin Rheumatol 2004; 24:79-82. [PMID: 15340865 DOI: 10.1007/s10067-004-0981-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 07/05/2004] [Indexed: 11/28/2022]
Abstract
Sneddon's syndrome (SNS) which originally was a clinical diagnosis, is now regarded as a common clinical manifestation of different disease entities. It has been divided into idiopathic, autoimmune and thromboembolic subsets or in systemic lupus erythematosus (SLE)-associated, antiphospholipid syndrome (APS)-associated and primary forms. Familial occurrence of Sneddon's syndrome is rare. We present a familial case of Sneddon's syndrome with inflammatory disease pattern, early disease onset and association with autoimmune thyroid disease and anticardiolipin antibodies. Although most authors reporting on adult cases of SNS consider it a non-inflammatory, thromboembolic process, the study of cases with early onset brings attention to the possible inflammatory origin of the syndrome.
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12
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Mohren M, Daikeler T, Benz D, Günaydin I, Kanz L, Kötter I. Myeloablative immunosuppressive treatment with autologous haematopoietic stem cell transplantation in a patient with psoriatic arthropathy and monoclonal gammopathy of undetermined significance. Ann Rheum Dis 2004; 63:466-7. [PMID: 15020351 PMCID: PMC1754961 DOI: 10.1136/ard.2003.010702] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Wehner F, Benz D, Wehner HD. [Fatal inhalation of butane-propane gas]. Arch Kriminol 2002; 209:164-8. [PMID: 12134759] [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: 02/25/2023]
Abstract
Fatal intoxications with butane and/or propane are rare although the inhalation of such liquid gases in order to induce hallucinations is not uncommon amongst youngsters, the number of which is difficult to evaluate. Thus the possibility of gas intoxication should be taken into consideration in all cases of unclear death of youngsters, in which case the macroscopic and histological findings will be unspecific whereas the chemical-toxicological analyses, especially of the native brain, lung and liver tissue, lead to definite conclusions.
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Affiliation(s)
- Frank Wehner
- Institut für Gerichtliche Medizin der Universität Tübingen
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14
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Finzen A, Benz D, Hoffmann-Richter U. [Schizophrenia as portrayed by the German weekly "Spiegel" - or can we still uphold the medical concept of schizophrenia as a disease?]. Psychiatr Prax 2001; 28:365-7. [PMID: 11721221 DOI: 10.1055/s-2001-18619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Denzlinger C, Bowen D, Benz D, Gelly K, Brugger W, Kanz L. Low-dose melphalan induces favourable responses in elderly patients with high-risk myelodysplastic syndromes or secondary acute myeloid leukaemia. Br J Haematol 2000; 108:93-5. [PMID: 10651730 DOI: 10.1046/j.1365-2141.2000.01825.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [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: 11/20/2022]
Abstract
We treated 21 elderly patients with high-risk myelodysplasia (n = 14) or secondary acute myeloid leukaemia (n = 7) with 2 mg of melphalan orally once a day until a complete peripheral response was obtained or until there was evidence of treatment failure. We observed seven (30%) complete and two (10%) partial peripheral responses occurring within 4-16 weeks and lasting for 12 + to 55 weeks. In relapse, retreatment was successful in most of the patients. Responses were associated with the absence of complex cytogenetic abnormalities and with a normal or reduced bone marrow cellularity.
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Affiliation(s)
- C Denzlinger
- Department II, Medical Clinic, University of Tübingen, Germany
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Abstract
BACKGROUND In spite of a growing awareness in the population most cases of child abuse remain probably undetected. Ocular changes in this syndrome are manifold. Sometimes ocular signs can help to substantiate the suspicion of child abuse. On the other hand the ophthalmologist may be the first physician to be contacted. Thus, he plays an important role in diagnosis. Though there are a couple of clinical descriptions morphological data are almost completely missing in the German literature. PATIENT A two-year-old girl died two days after severe abuse because of widespread intracranial hemorrhages with brain stem insufficiency. At autopsy both eyes were enucleated and sent for histological investigation. RESULTS The anterior segments were unremarkable. Multiple hemorrhages were found in the inner retina bilaterally. Moreover there were preretinal, intrachoroidal, intrascleral (area of the circle of Zinn-Haller) and subdural hemorrhages. One eye showed a circular, perimacular fold of the central retina and a hemorrhagic retinoschisis. CONCLUSIONS Intraretinal hemorrhages alone are typical though not pathognomonic for the "battered-child syndrome". However, in combination with a crater-like appearance of the central retina, a hemorrhagic retinoschisis; and intrascleral hemorrhages in the area of the circle of Zinn-Haller they suggest child abuse almost with certainty. The pathogenic mechanisms leading to the observed fundus changes lack definite clarification. The date of violence which is essential for legal prosecution can be difficult to evaluate on morphological grounds alone.
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18
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Möller K, Benz D, Perrin D, Söling HD. The role of protein kinase C in carbachol-induced and of cAMP-dependent protein kinase in isoproterenol-induced secretion in primary cultured guinea pig parotid acinar cells. Biochem J 1996; 314 ( Pt 1):181-7. [PMID: 8660281 PMCID: PMC1217023 DOI: 10.1042/bj3140181] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Stimulation of secretion by muscarinic agonists in guinea pig parotid or pancreatic acini is accompanied by a translocation of protein kinase C (PKC) from the cytosol to the particulate fraction [Machado-De Domenech and Söling (1987) Biochem. J. 242, 749-754] and by a PKC-mediated phosphorylation of the ribosomal protein S6 [Padel and Söling (1985) Eur. J. Biochem. 151, 1-10]. In order to decide whether PKC is directly involved in the secretory process, the effect of down regulation of PKC by phorbol 12-myristate 13-acetate (PMA) was studied in primary cultured guinea pig parotid acinar cells. These cells secrete in response to carbachol and isoproterenol. Only the carbachol response is associated with an increase in cytosolic calcium. Carbachol plus isoproterenol lead to an over-additive stimulation of secretion, an effect which depends completely on the presence of external calcium. Down regulation of PKC by about 90% did not significantly affect carbachol-induced exocytosis, whereas isoproterenol-stimulated secretion was almost doubled. The secretory response to permeable cAMP analogues was also enhanced in PKC-down-regulated acini, indicating a post-receptor effect. The increased response to isoproterenol was also observed in the absence of external calcium. The isoproterenol effect was significantly inhibited by the relatively specific cAMP-dependent protein kinase inhibitor H-89, which had only a minor effect on carbachol-induced exocytosis. Although down regulation of total PKC by up to 90% did not significantly affect the secretory response to carbachol, RO 31-8220, a relatively specific inhibitor of PKC, abolished carbachol-induced secretion in normal as well as in PMA-down-regulated cells. This indicates that a PKC isoform resistant to down regulation by PMA is involved in carbachol- but not in cAMP-mediated secretion.
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Affiliation(s)
- K Möller
- Abteilung Klinische Biochemie, Zentrum Innere Medizin der Universität Göttingen, Germany
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19
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Mol M, Benz D, Mori-Ito N, Ezaki M, Parthasarthy S, Steinberg D, Witztum J. 15-Lipoxygenase expression in fibroblasts confers an increased ability to oxidatively modify LDL. Atherosclerosis 1994. [DOI: 10.1016/0021-9150(94)93175-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Fehr P, Müller J, Benz D, Lorenz U. [Semicircular, transurethral bladder neck resection in therapy of the overcorrected bladder neck]. Gynakol Geburtshilfliche Rundsch 1994; 34:106-8. [PMID: 7950435 DOI: 10.1159/000272347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report 4 cases of severe urinary obstruction after abdominal stress incontinence procedures in women. The operative procedure consisted in transurethral resection of the obstructive, overcorrected dorsal bladder neck. After resection of the highly elevated bladder neck between the 3- and 9-o'clock position in the dorsal lithotomy position, the patients were able to regain a normal micturition without residual urine. There was no recurrence of stress incontinence.
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Affiliation(s)
- P Fehr
- Frauenklinik, Kantonsspital, St. Gallen, Schweiz
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21
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Delaloye JF, Benz D. Senologie. Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02346811] [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: 11/29/2022]
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22
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Benz D, Diener PA, Würth R, Fehr P, Lorenz U. [Tuberculosis of the breast]. Gynakol Geburtshilfliche Rundsch 1993; 33:107-10. [PMID: 8400902 DOI: 10.1159/000272078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The case of a 89-year-old women with mammary tuberculosis is reported. The diagnosis was based on histopathological and bacteriological examinations. Chest X-ray showed a lung-pleural tuberculosis, so we considered it a secondary organ manifestation.
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Affiliation(s)
- D Benz
- Frauenklinik, Kantonsspital, St. Gallen, Schweiz
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23
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Fehr P, Diener PA, Benz D, Lorenz U. [Ossification of the endometrium: an unusual finding in secondary sterility]. Gynakol Geburtshilfliche Rundsch 1993; 33:31-3. [PMID: 8471882 DOI: 10.1159/000272002] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The rare fact of endometrial ossification can be found after abortion or chronic inflammation. We describe a case from our clinic. Despite repeated curettages new ossifications occurred. The resulting secondary infertility is persisting.
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Affiliation(s)
- P Fehr
- Frauenklinik, Kantonsspital, St. Gallen, Schweiz
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24
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Benz D, Grabherr D, Fehr P, Iklé FA, Enderlin F, Haller U, Lorenz U. [Treatment of vulvar cancer]. Gynakol Geburtshilfliche Rundsch 1993; 33:158-67. [PMID: 8298309 DOI: 10.1159/000272098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
125 patients with carcinoma of the vulva were evaluated with respect to corrected 5-year survival rates. In our study we try to answer two questions in the therapeutic management of vulval carcinoma: (1) Is organ-preserving surgery in stage I tumors adequate? (2) How important is the radiation therapy in the general treatment concept in more advanced stages of the disease? Our study shows that organ preservation seems to be possible in stage I disease, if resection of the tumor is complete with a margin of normal tissue. If inguinal lymph nodes are involved or the primary tumor is bulky, the best results are obtained with a combination of radical surgery and locoregional radiation therapy. Radiation therapy alone has a good effect during the early stage of the vulval cancer.
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Affiliation(s)
- D Benz
- Frauenklinik des Kantonsspitals St. Gallen, Schweiz
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25
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Abstract
101 homicides caused by stabbing were examined for the presence of defence-injuries. 50 victims showed 174 defence-injuries on hands and forearms (133 incision wounds, 26 stab wounds and 15 cutting through). More than two thirds of lesions were found on left arm. That those lesions mostly were found on left arm is caused by the interaction between perpetrator and victim. Victims left arm is nearest to the perpetrator therefore it is used as a mean of defence first of all. The probability that defence-injuries can be seen is rising with the number of stab wounds. Localisation of a defence-injury on the extensor side ("passive") or on the flexor side ("active") is conditioned by accidentalities. Such a differentiation should be given up because no conclusions on the readiness of defence can be drawn.
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Affiliation(s)
- D Metter
- Institut für Rechtsmedizin der Stadt Stuttgart, Federal Republic of Germany
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Abstract
The effect of renal failure on melphalan pharmacology and toxicity has been poorly understood. Such information is of interest because melphalan is the most commonly used anticancer drug in the treatment of multiple myeloma, which is frequently associated with renal failure. We have studied the disposition and marrow toxicity of parenteral melphalan in dogs before and after induction of renal failure with subtotal nephrectomy. The surgical procedure decreased the creatinine clearance by an average of 62% (P = 0.001). The lowest neutrophil counts following i.v. melphalan (1 mg/kg) averaged 4.9 x 10(3)/mm3 pre-nephrectomy and 0.9 x 10(3)/mm3 post-nephrectomy, respectively (P = 0.002). The mean lowest recorded platelet counts after melphalan (1 mg/kg) were 115 x 10(3)/mm3 in the pre-nephrectomized dogs, and 9.7 x 10(3/mm3 in those who had been nephrectomized (P = 0.002). Following nephrectomy, i.v. melphalan's terminal-phase plasma half-life and renal clearance were both raised (P = 0.02) to 75% over pre-nephrectomy values. These studies show that i.v. melphalan-induced myelosuppression is markedly increased and its plasma elimination and renal clearance significantly decreased in the presence of renal dysfunction in dogs. These data suggest that parenteral melphalan's starting dose be decreased by at least 50% when used in myeloma patients with renal failure.
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