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Söderström H, Moons J, Nafteux P, Uzun E, Grimminger P, Luyer MDP, Nieuwenhuijzen GAP, Nilsson M, Hayami M, Degisors S, Piessen G, Vanommeslaeghe H, Van Daele E, Cheong E, Gutschow CA, Vetter D, Schuring N, Gisbertz SS, Räsänen J. ASO Visual Abstract: Major Intraoperative Complications During Minimally Invasive Esophagectomy. Ann Surg Oncol 2023; 30:8294-8295. [PMID: 37821789 DOI: 10.1245/s10434-023-14386-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- H Söderström
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - J Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - P Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - E Uzun
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - M Nilsson
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - M Hayami
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Degisors
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - H Vanommeslaeghe
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Van Daele
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Cheong
- Norfolk and Norwich University Hospital NHS FT, Norwich, UK
| | - Ch A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - N Schuring
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Räsänen
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Söderström H, Moons J, Nafteux P, Uzun E, Grimminger P, Luyer MDP, Nieuwenhuijzen GAP, Nilsson M, Hayami M, Degisors S, Piessen G, Vanommeslaeghe H, Van Daele E, Cheong E, Gutschow CA, Vetter D, Schuring N, Gisbertz SS, Räsänen J. Major Intraoperative Complications During Minimally Invasive Esophagectomy. Ann Surg Oncol 2023; 30:8244-8250. [PMID: 37782412 PMCID: PMC10625950 DOI: 10.1245/s10434-023-14340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Studies have shown minimally invasive esophagectomy (MIE) to be a feasible surgical technique in treating esophageal carcinoma. Postoperative complications have been extensively reviewed, but literature focusing on intraoperative complications is limited. The main objective of this study was to report major intraoperative complications and 90-day mortality during MIE for cancer. METHODS Data were collected retrospectively from 10 European esophageal surgery centers. All intention-to-treat, minimally invasive laparoscopic/thoracoscopic esophagectomies with gastric conduit reconstruction for esophageal and GE junction cancers operated on between 2003 and 2019 were reviewed. Major intraoperative complications were defined as loss of conduit, erroneous transection of vascular structures, significant injury to other organs including bowel, heart, liver or lung, splenectomy, or other major complications including intubation injuries, arrhythmia, pulmonary embolism, and myocardial infarction. RESULTS Amongst 2862 MIE cases we identified 98 patients with 101 intraoperative complications. Vascular injuries were the most prevalent, 41 during laparoscopy and 19 during thoracoscopy, with injuries to 18 different vessels. There were 24 splenic vascular or capsular injuries, 11 requiring splenectomies. Four losses of conduit due to gastroepiploic artery injury and six bowel injuries were reported. Eight tracheobronchial lesions needed repair, and 11 patients had significant lung parenchyma injuries. There were 2 on-table deaths. Ninety-day mortality was 9.2%. CONCLUSIONS This study offers an overview of the range of different intraoperative complications during minimally invasive esophagectomy. Mortality, especially from intrathoracic vascular injuries, appears significant.
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Affiliation(s)
- H Söderström
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - J Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - P Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - E Uzun
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - M Nilsson
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - M Hayami
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Degisors
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - H Vanommeslaeghe
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Van Daele
- Department of Gastro-Intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Cheong
- Norfolk and Norwich University Hospital NHS FT, Norwich, UK
| | - Ch A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - N Schuring
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Räsänen
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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3
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Müller PC, Kapp JR, Vetter D, Bonavina L, Brown W, Castro S, Cheong E, Darling GE, Egberts J, Ferri L, Gisbertz SS, Gockel I, Grimminger PP, Hofstetter WL, Hölscher AH, Low DE, Luyer M, Markar SR, Mönig SP, Moorthy K, Morse CR, Müller-Stich BP, Nafteux P, Nieponice A, Nieuwenhuijzen GAP, Nilsson M, Palanivelu C, Pattyn P, Pera M, Räsänen J, Ribeiro U, Rosman C, Schröder W, Sgromo B, van Berge Henegouwen MI, van Hillegersberg R, van Veer H, van Workum F, Watson DI, Wijnhoven BPL, Gutschow CA. Fit-for-Discharge Criteria after Esophagectomy: An International Expert Delphi Consensus. Dis Esophagus 2021; 34:5909885. [PMID: 32960264 DOI: 10.1093/dote/doaa101] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/03/2020] [Accepted: 08/15/2020] [Indexed: 12/11/2022]
Abstract
There are no internationally recognized criteria available to determine preparedness for hospital discharge after esophagectomy. This study aims to achieve international consensus using Delphi methodology. The expert panel consisted of 40 esophageal surgeons spanning 16 countries and 4 continents. During a 3-round, web-based Delphi process, experts voted for discharge criteria using 5-point Likert scales. Data were analyzed using descriptive statistics. Consensus was reached if agreement was ≥75% in round 3. Consensus was achieved for the following basic criteria: nutritional requirements are met by oral intake of at least liquids with optional supplementary nutrition via jejunal feeding tube. The patient should have passed flatus and does not require oxygen during mobilization or at rest. Central venous catheters should be removed. Adequate analgesia at rest and during mobilization is achieved using both oral opioid and non-opioid analgesics. All vital signs should be normal unless abnormal preoperatively. Inflammatory parameters should be trending down and close to normal (leucocyte count ≤12G/l and C-reactive protein ≤80 mg/dl). This multinational Delphi survey represents the first expert-led process for consensus criteria to determine 'fit-for-discharge' status after esophagectomy. Results of this Delphi survey may be applied to clinical outcomes research as an objective measure of short-term recovery. Furthermore, standardized endpoints identified through this process may be used in clinical practice to guide decisions regarding patient discharge and may help to reduce the risk of premature discharge or prolonged admission.
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Affiliation(s)
- P C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - J R Kapp
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - L Bonavina
- IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - W Brown
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - S Castro
- Department of Surgery, Vall d'Hebron Hospital, Barcelona, Spain
| | - E Cheong
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - G E Darling
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - J Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - L Ferri
- Departments of Surgery and Oncology, Montreal General Hospital, McGill University, Montreal, Canada
| | - S S Gisbertz
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Gockel
- Department of Visceral, Thoracic, Transplant and Vascular surgery, University Hospital of Leipzig, Leipzig, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - W L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A H Hölscher
- Center for Oesophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany
| | - D E Low
- Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, USA
| | - M Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - S R Markar
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - S P Mönig
- Division of Visceral Surgery, Department of Surgery, University of Geneva, Hospitals and School of Medicine, Geneva, Switzerland
| | - K Moorthy
- Imperial College Healthcare NHS Trust and Imperial College, London, UK
| | - C R Morse
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Nafteux
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Nieponice
- Esophageal Institute, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - C Palanivelu
- Department of Surgical Gastroenterology, GEM Hospital & Research Centre, Coimbatore, India
| | - P Pattyn
- Department of Surgery, University Center Ghent, Ghent, Belgium
| | - M Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - U Ribeiro
- Department of Gastroenterology, Cancer Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - C Rosman
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W Schröder
- Department of General, Visceral and Cancer Surgery, University of Cologne, Germany
| | - B Sgromo
- Department of Upper GI Surgery, Oxford University Hospitals, UK
| | | | - R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, The Netherlands
| | - H van Veer
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - F van Workum
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D I Watson
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - C A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
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Abraham JD, Salvetat N, Checa-Robles F, Patel V, Cayzac C, Dubuc B, Vetter D, Lang JP, Courtet P, Kupfer D, Weissmann D. Game changer in the diagnosis of bipolar disorder using RNA editing-based blood biomarkers. Eur Psychiatry 2021. [PMCID: PMC9471217 DOI: 10.1192/j.eurpsy.2021.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction In clinical practice, differentiating Bipolar Disorder (BD) from unipolar depression is challenging due to the depressive symptoms, which are the core presentations of both disorders. Patients with BD are often misdiagnosed during depressive episodes resulting in a delay in proper treatment and a poor management of their condition. Objectives The aim of the present study is to discriminate between unipolar depression and BD using a panel of RNA edited blood biomarkers. Methods Depressed patients were classified according to clinical scores in MADRS and IDSC-30 depression scales. After blood collection and RNA extraction, we used whole-transcriptome sequencing to identify differential A-to-I editing events, and Targeted Next Generation Sequencing to validate those biomarkers. Results We discovered 646 variants differentially edited between depressed patients and control in a discovery cohort of 57 participants. After using stringent criteria and biological pathway analysis, 6 biomarker candidates were singled out and tested in a validation cohort of 160 patients suffering from unipolar depression and 95 BD patients in a depressive episode, which allowed a differential diagnosis of BD with an AUC of 0.935 and high specificity (Sp=84.6%) and sensitivity (Se=90.9%). Conclusions We have shown that a combination of 6 blood RNA editing-related biomarkers allows to discriminate unipolar and bipolar depression This 6 BMKs panel may be crucial to improve BD diagnosis and orientate the treatment therefore addressing the needs of millions of patients suffering from misdiagnosis and incorrect treatment for their diseases. This will change the game for the management of patients. Disclosure No significant relationships.
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6
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Gubler C, Vetter D, Schmidt HM, Müller PC, Morell B, Raptis D, Gutschow CA. Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach? Dis Esophagus 2019; 32:5267098. [PMID: 30596963 DOI: 10.1093/dote/doy126] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 10/09/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022]
Abstract
Endoluminal vacuum therapy (EVT) is an accepted treatment for anastomotic leakage (AL) after esophagectomy. A novel concept is to use this technology in a preemptive setting, with the aim to reduce the AL rate and postoperative morbidity. Preemptive EVT (pEVT) was performed intraoperatively in 19 consecutive patients undergoing minimally invasive esophagectomy, immediately after completion of esophagogastrostomy. Twelve patients (63%) were high-risk cases with severe comorbidity. The EVT device was removed routinely three to six (median 5) days after esophagectomy. The endpoints of this study were AL rate and postoperative morbidity. There were 20 anastomoses at risk in 19 patients. One patient (5.3%) experienced major morbidity (Clavien-Dindo grade IIIb) unrelated to anastomotic healing. He underwent open reanastomosis at postoperative day 12 with pEVT for redundancy of the gastric tube and failure of transition to oral diet. Mortality after 30 days was 0% and anastomotic healing was uneventful in 19/20 anastomoses (95%). One minor contained AL healed after a second course of EVT. Except early proximal dislodgement in one patient, there were no adverse events attributable to pEVT. The median comprehensive complication index 30 days after surgery was 20.9 (IQR 0-26.2). PEVT appears to be a safe procedure that may have the potential to improve surgical outcome in patients undergoing esophagectomy.
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Affiliation(s)
- C Gubler
- Department of Gastroenterology, and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - H M Schmidt
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - B Morell
- Department of Gastroenterology, and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Raptis
- Department of HPB Surgery and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - C A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
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Stafa K, Huang J, Chen C, Vetter D, Eagle W, Goyarts E, Pernodet N. 643 Skin cells can sense and integrate signals coming from eucalyptus extract to combat environmental insults and regenerate from within. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.719] [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: 11/30/2022]
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8
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Huber GF, Hüllner M, Schmid C, Brunner A, Sah B, Vetter D, Kaufmann PA, von Schulthess GK. Benefit of 18F-fluorocholine PET imaging in parathyroid surgery. Eur Radiol 2018; 28:2700-2707. [PMID: 29372312 DOI: 10.1007/s00330-017-5190-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the additional diagnostic value of 18F-fluorocholine PET imaging in preoperative localization of pathologic parathyroid glands in clinically manifest hyperparathyroidism in case of negative or conflicting ultrasound and scintigraphy results. METHODS A retrospective, single-institution study of 26 patients diagnosed with hyperparathyroidism. In cases where ultrasound and scintigraphy failed to detect the location of an adenoma in order to allow a focused surgical approach, an additional 18F-fluorocholine PET scan was performed and its results were compared with the intraoperative findings. RESULTS A total of 26 patients underwent 18F-fluorocholine PET/CT (n = 11) or PET/MRI (n = 15). Adenomas were detected in 25 patients (96.2%). All patients underwent surgery, and the location predicted by PET hybrid imaging was confirmed intraoperatively by frozen section and adequate parathyroid hormone drop after removal. None of the patients needed revision surgery during follow-up. CONCLUSIONS These results demonstrate that 18F-fluorocholine PET imaging is a highly accurate method to detect parathyroid adenomas even in case of previous localization failure by other imaging examinations. KEY POINTS • With 18 F-fluorocholine PET imaging, parathyroid adenomas could be detected in 96.2%. • 18 F-fluorocholine imaging is a highly accurate method to detect parathyroid adenomas. • We encourage its use, where ultrasound fails to detect an adenoma.
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Affiliation(s)
- G F Huber
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
| | - M Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - C Schmid
- Department of Endocrinology, Diabetology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - A Brunner
- Department of Endocrinology, Diabetology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - B Sah
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of General Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - P A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - G K von Schulthess
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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9
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Burn F, Schirpenbach C, Bidlingmaier M, Reincke M, Vetter D, Weishaupt D, Brockmann JG, Müller MK, Weber M, Dahm F, Nocito A. Left-Sided Living Kidney Donation Leads to Transiently Reduced Adrenocortical Responsiveness. Am J Transplant 2017; 17:1879-1884. [PMID: 28024112 DOI: 10.1111/ajt.14184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/28/2016] [Revised: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
Living kidney donation is safe and established, but can lead to long-term complications such as chronic fatigue. Since the adrenal vein is usually transected during left-sided donor nephrectomy-which is not necessary on the right-we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanation. In this prospective open label, monocentric cohort study, adrenal function was compared in left- and right-sided living kidney donors. The primary endpoint was plasma cortisol response to low-dose adrenocorticotropic hormone (ACTH) stimulation. Secondary endpoints included plasma renin and ACTH concentration as well as adrenal volume in response to donor nephrectomy. A total of 30 healthy donors-20 left- and 10 right-sided donations-were included. On postoperative day 1, response to low-dose ACTH stimulation was intact, but significantly lower after left-sided donor nephrectomy. After 28 days, adrenal responsiveness to ACTH stimulation did not differ any longer. Magnetic resonance imaging volumetry showed no significant adrenal volume change over 4 weeks, neither after left- nor after right-sided nephrectomy. In conclusion, left-sided living kidney donation entails a transiently reduced adrenocortical responsiveness, which returns to baseline after 28 days.
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Affiliation(s)
- F Burn
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - C Schirpenbach
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - M Bidlingmaier
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - M Reincke
- Division of Endocrinology, Department of Internal Medicine, University Hospital Munich, Munich, Germany
| | - D Vetter
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Weishaupt
- Department of Radiology and Nuclear Medicine, Triemli Hospital Zurich, Zurich, Switzerland
| | - J G Brockmann
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M K Müller
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - M Weber
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland
| | - F Dahm
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - A Nocito
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland
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Fisher OM, Raptis DA, Vetter D, Novak A, Dindo D, Hahnloser D, Clavien PA, Nocito A. An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. Colorectal Dis 2015; 17:619-26. [PMID: 25641401 DOI: 10.1111/codi.12888] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 09/15/2014] [Accepted: 11/23/2014] [Indexed: 12/16/2022]
Abstract
AIM The study aimed to compare the rate of success and cost of anal fistula plug (AFP) insertion and endorectal advancement flap (ERAF) for anal fistula. METHOD Patients receiving an AFP or ERAF for a complex single fistula tract, defined as involving more than a third of the longitudinal length of of the anal sphincter, were registered in a prospective database. A regression analysis was performed of factors predicting recurrence and contributing to cost. RESULTS Seventy-one patients (AFP 31, ERAF 40) were analysed. Twelve (39%) recurrences occurred in the AFP and 17 (43%) in the ERAF group (P = 1.00). The median length of stay was 1.23 and 2.0 days (P < 0.001), respectively, and the mean cost of treatment was €5439 ± €2629 and €7957 ± €5905 (P = 0.021), respectively. On multivariable analysis, postoperative complications, underlying inflammatory bowel disease and fistula recurring after previous treatment were independent predictors of de novo recurrence. It also showed that length of hospital stay ≤ 1 day to be the most significant independent contributor to lower cost (P = 0.023). CONCLUSION Anal fistula plug and ERAF were equally effective in treating fistula-in-ano, but AFP has a mean cost saving of €2518 per procedure compared with ERAF. The higher cost for ERAF is due to a longer median length of stay.
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Affiliation(s)
- O M Fisher
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - A Novak
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D Dindo
- Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - P-A Clavien
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - A Nocito
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland
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11
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Lipska BS, Balasz-Chmielewska I, Morzuch L, Wasielewski K, Vetter D, Borzecka H, Drozdz D, Firszt-Adamczyk A, Gacka E, Jarmolinski T, Ksiazek J, Kuzma-Mroczkowska E, Litwin M, Medynska A, Silska M, Szczepanska M, Tkaczyk M, Wasilewska A, Schaefer F, Zurowska A, Limon J. Mutational analysis in podocin-associated hereditary nephrotic syndrome in Polish patients: founder effect in the Kashubian population. J Appl Genet 2013; 54:327-33. [PMID: 23645318 PMCID: PMC3721000 DOI: 10.1007/s13353-013-0147-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 01/18/2023]
Abstract
Hereditary nephrotic syndrome is caused by mutations in a number of different genes, the most common being NPHS2. The aim of the study was to identify the spectrum of NPHS2 mutations in Polish patients with the disease. A total of 141 children with steroid-resistant nephrotic syndrome (SRNS) were enrolled in the study. Mutational analysis included the entire coding sequence and intron boundaries of the NPHS2 gene. Restriction fragment length polymorphism (RFLP) and TaqMan genotyping assay were applied to detect selected NPHS2 sequence variants in 575 population-matched controls. Twenty patients (14 %) had homozygous or compound heterozygous NPHS2 mutations, the most frequent being c.1032delT found in 11 children and p.R138Q found in four patients. Carriers of the c.1032delT allele were exclusively found in the Pomeranian (Kashubian) region, suggesting a founder effect origin. The 14 % NPHS2 gene mutation detection rate is similar to that observed in other populations. The heterogeneity of mutations detected in the studied group confirms the requirement of genetic testing the entire NPHS2 coding sequence in Polish patients, with the exception of Kashubs, who should be initially screened for the c.1032delT deletion.
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Affiliation(s)
- Beata S Lipska
- Department of Biology and Genetics, Medical University of Gdansk, Debinki str. 1, 80211, Gdansk, Poland.
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12
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Vetter D. WE-C-217A-03: Biology versus Epidemiology: The Need for an Integrated Model of Radiation Risk. Med Phys 2012; 39:3952-3953. [DOI: 10.1118/1.4736131] [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: 11/07/2022] Open
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13
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Klimek L, Vetter D, von Bernus L, Thorn C. [Microarray technique for component resolved diagnosis (CRD) in type-I allergies. An innovative technology at the border between research tool and routine diagnostics]. HNO 2012; 59:988-93. [PMID: 21181390 DOI: 10.1007/s00106-010-2224-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 25% of the population in industrialized countries suffer from IgE-associated Type-1 allergies. Multiple allergens can be tested simultaneously in one assay by using the protein microarray. Moreover, it is possible to measure more than one analytical parameter (e.g. allergen specific IgEs and IgGs) in one assay by combining different fluorescent markers with specific secondary antibodies. The different allergen components that are of interest are immobilized on a planar surface. By adding the patient's serum (a smaller amount of serum is needed compared to an immunoassay) the inherent IgE antibodies are captured by the corresponding allergens. Secondary fluorescing anti-IgE antibodies are added subsequently, thus the intensity of each spot on the microarray can be measured by using a biochipscanner. The detected signal is then transformed into quantitative data, which allows the classification of the patient's serum IgE level for the tested allergens. There are different approaches to reduce the complexity of the original extracts used for the production of the solid microarray phase to a smaller number of relevant pathogenic molecules. The component-resolved diagnosis still needs to be clinically validated, but initial studies show positive results concerning the sensitivity and specificity of the protein microarray. Protein microarrays are promising tools for screening diagnoses in allergic diseases as well as for the improvement of allergen-specific immunotherapy.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland.
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14
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15
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Doffoël M, Bonnetain F, Bouché O, Vetter D, Abergel A, Fratté S, Grangé JD, Stremsdoerfer N, Blanchi A, Bronowicki JP, Caroli-Bosc FX, Causse X, Masskouri F, Rougier P, Bedenne L. Multicentre randomised phase III trial comparing Tamoxifen alone or with Transarterial Lipiodol Chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402). Eur J Cancer 2008; 44:528-38. [PMID: 18242076 DOI: 10.1016/j.ejca.2008.01.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 12/21/2007] [Accepted: 01/07/2008] [Indexed: 01/13/2023]
Abstract
The FFCD 9402 multicentre phase III trial was designed to compare the effects of the combination of Transarterial Lipiodol Chemoembolisation (TACE) and tamoxifen with tamoxifen alone on overall survival and quality of life in the palliative treatment of hepatocellular carcinoma with cirrhosis. From 1995 to 2002, 138 patients were randomised between the two groups. One hundred and twenty three patients were eligible including 61 in the Tamoxifen group and 62 in the TACE group. Baseline characteristics were similar: Child-Pugh class A: 70%, alcoholic cirrhosis: 76%, Okuda stage I: 71%, multinodular tumour: 70% and segmental portal vein thrombosis: 10%. At 2years, the overall survival was 22% and 25% in the Tamoxifen and TACE groups (P=.68), respectively. Multivariate analysis identified four independent prognostic factors for survival: alpha-fetoprotein (AFP)>400ng/mL (P=.008), abdominal pain (P=.011), hepatomegaly (P=.023) and Child-Pugh score (P=.032). The Spitzer Index level assessing the quality of life during follow-up did not differ between the two groups (P=.70). Amongst patients with stage Okuda I, the 2-year overall survival was 28% in the Tamoxifen group and 32% in the TACE group (P=.58). In this subgroup, two prognostic factors were statistically significant for survival: AFP>400ng/mL (P=.004) and Spitzer Index (P=.013) as shown by multivariable analysis. In conclusion, this study suggests that TACE improves neither the survival nor the quality of life in patients with HCC and cirrhosis.
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Affiliation(s)
- M Doffoël
- Service d'Hépatogastroentérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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16
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Fauvet F, Charpiot A, Schultz P, Riehm S, Vetter D, Veillon F, Hémar P, Debry C. [Cine-MRI contribution to assess swallowing mechanism and oro-pharyngeal dysphagia]. Rev Laryngol Otol Rhinol (Bord) 2008; 129:85-90. [PMID: 18767325] [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: 05/26/2023]
Abstract
OBJECTIVE This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer. MATERIALS AND METHODS 10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing. RESULTS Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks. CONCLUSION Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.
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Affiliation(s)
- F Fauvet
- CHRU Hôpital de Hautepierre, Service d'ORL et de Chirurgie Cervico-Faciale, 1 av. Molière, 67098 Strasbourg, France.
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17
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Bonnetain F, Doeffel M, Bouche O, Vetter D, Abergel A, Fratté S, Grangé JP, Barbare JC, Masskouri F, Bedenne L. Multivariate quality of life (QoL) prognostic factor analysis in hepatocellular carcinoma (HCC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4162] [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: 11/20/2022] Open
Affiliation(s)
- F. Bonnetain
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - M. Doeffel
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - O. Bouche
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - D. Vetter
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - A. Abergel
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - S. Fratté
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - J. P. Grangé
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - J. C. Barbare
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - F. Masskouri
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
| | - L. Bedenne
- INSERM EMI 106, Dijon, France; CHRU, Strasbourg, France; CHU Robert Debré, Reims, France; CHRU, Strasbourg, France; CHU Clermont-Ferrand, Clermont-Ferrand, France; Ctr Hospitalier de Belfort, Belfort, France; Assistance-publique des Hôpitaux de Paris, Paris, France; Ctr Hospitalier, Compiegne, France; FFCD, Dijon, France; CHRU Le Bocage, Dijon, France
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Doffoel M, Vetter D, Bouche O, Bonnetain F, Abergel A, Fratte S, Grange JP, Stremdoerfer N, Blanchi A, Bedenne L. Multicenter randomized phase III trial comparing tamoxifen alone or with transarterial lipiodol chemoembolization (TLC) for unresectable hepatocellular carcinoma (HCC) in cirrhotic patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Doffoel
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - D. Vetter
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - O. Bouche
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - F. Bonnetain
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - A. Abergel
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - S. Fratte
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - J. P. Grange
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - N. Stremdoerfer
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - A. Blanchi
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
| | - L. Bedenne
- Fédération Francophone de Cancérologie Digestive (FFCD); Hôpital Civil - Hôpitaux Univ de Strasb, Strasbourg, France; CHU R. Debré, Reims, France; INSERM EMI 106, Dijon, France; Service d’Hépatogastroentérologie, Clermont-Ferrand, France; Ctr Hospitalier, Belfort, France; AP-HP, Paris, France; Ctr Hospitalier, Bourgoin Jallieu, France; Ctr Hospitalier, Le Mans, France; CHU Le Bocage, Dijon, France
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Schmitt KU, Muser M, Vetter D, Walz F. Biomechanical assessment of soft tissue neck injuries in cases with long sick leave times. Traffic Inj Prev 2003; 4:162-8. [PMID: 16210201 DOI: 10.1080/15389580309872] [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: 05/04/2023]
Abstract
A database was established by collecting 919 cases of claimed cervical spine disorders (CSDs) sustained in automotive accidents. All cases had a sick leave time of more than 4 weeks. Data was obtained from a major Swiss accident insurer. An assessment scheme was developed that took into account technical, medical, and biomechanical aspects. All cases were evaluated according to this scheme. The overall biomechanical assessment, that stated the extent to which the symptoms claimed could be explained by the impact, was found to be significantly influenced by the patient's history of CSD in terms of preexisting damage or preexisting symptoms. In 52% of the assessed cases, the CSD claimed could be explained with a combination of neck loading and also by considering the patient's medical history. Performing a solely technical analysis of the collision circumstances or a purely medical evaluation based on a Quebec Task Force (QTF) grade alone are insufficient to assess the accident-related explicability of claimed CSD. Biomechanically relevant individual factors have to be considered.
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Affiliation(s)
- K-U Schmitt
- Institute of Biomedical Engineering, and Working Group on Accident Mechanics, University and Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.
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Schmitt KU, Walz F, Vetter D, Muser M. Whiplash injury: cases with a long period of sick leave need biomechanical assessment. Eur Spine J 2003; 12:247-54. [PMID: 12799999 PMCID: PMC3615491 DOI: 10.1007/s00586-002-0490-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Revised: 06/06/2002] [Accepted: 07/15/2002] [Indexed: 10/25/2022]
Abstract
A total of 668 cases of cervical spine disorders (CSD) sustained in automotive collisions were analysed. All cases had a minimum sick leave duration of 4 weeks. To evaluate these cases a scheme was developed that takes into account technical, medical, and biomechanical aspects. For each case, the delta-v value of the underlying collision was estimated, the medical files were analysed, and a QTF (Québec Task Force) grade was assigned. In addition, the medical history of the patient was reviewed. It was found that the QTF grade for patients with pre-existing damage of the neck or pre-existing signs differed significantly from those patients without such a history. The overall assessment, which stated the extent to which the symptoms claimed could be explained by the impact, was also found to be significantly influenced by a history of neck injury. The results of the study showed that in about 50% of the cases where the technical analysis alone would not suggest that the symptoms shown could be explained by the impact, those symptoms could be explained when patient history and the collision circumstances were taken into consideration. It also found that medical evaluation based on a QTF grade alone cannot assess the explicability of claimed CSD without taking into account the collision circumstances. Therefore, the assessment of critical individual relevant biomechanical factors is necessary.
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Affiliation(s)
- K-U Schmitt
- Institute of Biomedical Engineering, University and Swiss Federal Institute of Technology (ETH), Gloriastrasse 35, 8092 Zürich, Switzerland.
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22
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Portal I, Bourlière M, Halfon P, De Lédinghen V, Couzigou P, Bernard PH, Blanc F, Caroli-Bosc F, Arpurt JP, Vetter D, Mathieu-Chandelier C, Chazouillères O, Thiefin G, Pol S, Sogni P, Abergel A, Bailly F, Picon M, Debonne JM, Zamora C, Alleman I, Moreau X, Doll F, Eugène C, Ducloux S, Larrey D, Ouzan D, Grimaud JC, Gouvernet J, Botti G, Gérolami V, Khiri H, Gérolami A, Gauthier AP, Botta-Fridlund D. Retreatment with interferon and ribavirin vs interferon alone according to viraemia in interferon responder-relapser hepatitis C patients: a prospective multicentre randomized controlled study. J Viral Hepat 2003; 10:215-23. [PMID: 12753341 DOI: 10.1046/j.1365-2893.2003.00426.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/09/2022]
Abstract
Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (<2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN-alpha2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN-alpha2b alone for 48 weeks (R1: 42 patients) or IFN-alpha2b plus ribavirin (600 mg/day) for 24 weeks and IFN-alpha2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN-alpha2b plus ribavirin for 24 weeks and then IFN-alpha2b alone for the next 24 weeks (R3: 104 patients) or IFN-alpha2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P < 0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score <6 and alanine aminotransferase pretreatment level >3 x upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR.
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Affiliation(s)
- I Portal
- Department of Hepato-gastroenterology, Hospital La Conception, 13008 Marseille, France
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Abstract
Microstructured silicon wafers were employed as miniaturized solid-phase reaction vessels as well as miniaturized micro titer plates. Employing piezoelectric drop-on-demand liquid jets, a combinatorial library of 256 Peptides was synthesized on single beads. The synthesis protocol was associated to the location in the silicon nano-well arrangement. Products were photolytically cleaved in the same well that was used for synthesis and subsequently interrogated for thrombin inhibition in a homogeneous competition assay. The assay procedure was based on drop-on-demand liquid delivery and laser induced fluorescence imaging. The novel format proved useful for the integration of both synthesis and screening into one platform, a prerequisite for an iterative, evolutionary approach towards drug discovery.
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Affiliation(s)
- D Vetter
- Graffinity Pharmaceutical Design GmbH, Heidelberg, Germany
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Bartel S, Vetter D, Schlegel WP, Wallukat G, Krause EG, Karczewski P. Phosphorylation of phospholamban at threonine-17 in the absence and presence of beta-adrenergic stimulation in neonatal rat cardiomyocytes. J Mol Cell Cardiol 2000; 32:2173-85. [PMID: 11112993 DOI: 10.1006/jmcc.2000.1243] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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]
Abstract
The site-specific phospholamban phosphorylation was studied with respect to the interplay of cAMP- and Ca(2+)signaling in neonatal rat cardiomyocytes. To elucidate the signal pathway(s) for the activation of Ca(2+)/calmodulin-dependent protein kinase (CaMKII) we studied Thr17 phosphorylation of phospholamban in dependence of Ca(2+)channel activation by S(-)-Bay K8644 and in dependence of the depletion of the sarcoplasmic reticulum Ca(2+)stores by ryanodine or thapsigargin in the absence or presence of beta -adrenergic stimulation. The isoproterenol (0.1 microM)-induced Thr17 phosphorylation was potentiated 2.5-fold in presence of 1 microM S(-)-Bay K8644. Interestingly, S(-)-Bay K8644 alone was also able to induce Thr17 phosphorylation in a dose- and time-dependent fashion. Ryanodine (1.0 microM) reduced both the isoproterenol (0.1 microM) and S(-)-Bay K8644-(1 microM) mediated Thr17 phosphorylation by about 90%. Thapsigargin (1 microM) diminished the S(-)-Bay K8644 and isoproterenol-associated Thr17 phosphorylation by 53.5+/-6.3% and 92. 5+/-11.1%, respectively. Ser16 phosphorylation was not affected under these conditions. KN-93 reduced the Thr17 phosphorylation by S(-)-Bay K8644 and isoproterenol to levels of 1.1+/-0.3% and 8.6+/-2. 1%, respectively. However, the effect of KN-93 was attenuated (47. 8+/-3.6%) in isoproterenol prestimulated cells. Protein phosphatase inhibition by okadaic acid increased exclusively the Ser16 phosphorylation. In summary, our results reflect a cross-talk between beta -adrenoceptor stimulation and intracellular Ca(2+)at the level of CaMKII-mediated phospholamban phosphorylation in neonatal rat cardiomyocytes. We report conditions which exclusively produce Thr17 or Ser16 phosphorylation. We postulate that Ca(2+)transport systems of the sarcoplasmic reticulum are critical determinants for the activation of CaMKII that catalyzes phosphorylation of phospholamban.
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Affiliation(s)
- S Bartel
- Max Delbrück Center for Molecular Medicine, Berlin, 13125, Germany.
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Molenaar P, Bartel S, Cochrane A, Vetter D, Jalali H, Pohlner P, Burrell K, Karczewski P, Krause EG, Kaumann A. Both beta(2)- and beta(1)-adrenergic receptors mediate hastened relaxation and phosphorylation of phospholamban and troponin I in ventricular myocardium of Fallot infants, consistent with selective coupling of beta(2)-adrenergic receptors to G(s)-protein. Circulation 2000; 102:1814-21. [PMID: 11023937 DOI: 10.1161/01.cir.102.15.1814] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [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: 11/16/2022]
Abstract
BACKGROUND In adult human heart, both beta(1)- and beta(2)-adrenergic receptors mediate hastening of relaxation; however, it is unknown whether this also occurs in infant heart. We compared the effects of stimulation of beta(1)- and beta(2)-adrenergic receptors on relaxation and phosphorylation of phospholamban and troponin I in ventricle obtained from infants with tetralogy of Fallot. METHODS AND RESULTS Myocardium dissected from the right ventricular outflow tract of 27 infants (age range 21/2 to 35 months) with tetralogy of Fallot was set up to contract 60 times per minute. Selective stimulation of beta(1)-adrenergic receptors with (-)-norepinephrine (NE) and beta(2)-adrenergic receptors with (-)-epinephrine (EPI) evoked phosphorylation of phospholamban (at serine-16 and threonine-17) and troponin I and caused concentration-dependent increases in contractile force (-log EC(50) [mol/L] NE 5.5+/-0.1, n=12; EPI 5.6+/-0.1, n=13 patients), hastening of the time to reach peak force (-log EC(50) [mol/L] NE 5.8+/-0.2; EPI 5.8+/-0.2) and 50% relaxation (-log EC(50) [mol/L] NE 5.7+/-0.2; EPI 5.8+/-0.1). Ventricular membranes from Fallot infants, labeled with (-)-[(125)I]-cyanopindolol, revealed a greater percentage of beta(1)- (71%) than beta(2)-adrenergic receptors (29%). Binding of (-)-epinephrine to beta(2)-receptors underwent greater GTP shifts than binding of (-)-norepinephrine to beta(1)-receptors. CONCLUSIONS Despite their low density, beta(2)-adrenergic receptors are nearly as effective as beta(1)-adrenergic receptors of infant Fallot ventricle in enhancing contraction, relaxation, and phosphorylation of phospholamban and troponin I, consistent with selective coupling to G(s)-protein.
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Affiliation(s)
- P Molenaar
- Department of Medicine, The Prince Charles Hospital, University of Queensland, Australia.
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Poupon RE, Bonnand AM, Queneau PE, Trépo C, Vetter D, Raabe JJ, Thieffin G, Larrey D, Grangé JD, Capron JP, Serfaty L, Chrétien Y, St Marc Girardin MF, Mathiex-Fortunet H, Zafrani ES, Guéchot J, Beuers U, Paumgartner G, Poupon R. Randomized trial of interferon-alpha plus ursodeoxycholic acid versus interferon plus placebo in patients with chronic hepatitis C resistant to interferon. Scand J Gastroenterol 2000; 35:642-9. [PMID: 10912666 DOI: 10.1080/003655200750023624] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 02/04/2023]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) could potentiate the effect of interferon (IFN) in patients with chronic hepatitis C resistant to IFN. We compared the efficacy of IFN with that of a combination of IFN and UDCA. METHODS Patients were randomized to receive UDCA (13-15 mg/kg/day) (n = 47) or placebo (n = 44) plus interferon (3 MU three times weekly) for 6 months and were then followed up for 6 additional months. RESULTS At entry 30% of patients had cirrhosis, and 70% had HCV genotype 1. Five and four patients withdrew from the combination and the monotherapy groups, respectively. At 6 months alanine aminotransferase (ALAT) and gamma-glutamyl transferase (GGT) activities were significantly lower (P < 0.001) in the combination group than in the monotherapy group; the differences were no longer significant at 1 year. At 6 months ALAT activities normalized in 10 and 8 patients in the combination and the monotherapy groups, respectively (P = 0.67). In 10 of them (5 in each group) HCV RNA levels became undetectable. At 1 year four versus one patient had a sustained normalization of ALAT, and in one patient the HCV RNA became negative. There was no difference in the histologic progression. In this setting, in contrast to chronic cholestasis, UDCA administration induced an increase in total serum bile acids and did not change primary bile acids. CONCLUSIONS An IFN plus UDCA combination is more effective than IFN alone in terms of ALAT but not in terms of the virologic response. These results favor the hypothesis that UDCA has an effect on the biochemical indices of cellular injury independent of a change in primary bile acids.
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Affiliation(s)
- R E Poupon
- INSERM, Unit 370, Faculté de Médecine Necker, Paris France
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27
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Doffoël M, Vetter D. Virus de l'hépatite C et sa pathologie. Éducation du patient. Med Mal Infect 2000. [DOI: 10.1016/s0399-077x(00)88863-0] [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: 11/30/2022]
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Rey D, Krantz V, Partisani M, Schmitt MP, Meyer P, Libbrecht E, Wendling MJ, Vetter D, Nicolle M, Kempf-Durepaire G, Lang JM. Increasing the number of hepatitis B vaccine injections augments anti-HBs response rate in HIV-infected patients. Effects on HIV-1 viral load. Vaccine 2000; 18:1161-5. [PMID: 10649616 DOI: 10.1016/s0264-410x(99)00389-8] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.6] [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: 12/27/2022]
Abstract
Preventing hepatitis B by vaccination is essential in HIV-infected patients (higher progression rate of HBV infection to chronicity, lower rate of serum HBe Ag loss). However, it has been shown a decreased anti-HBs response in these individuals after a standard vaccination (3 doses of 20 micrograms). Thus, we tested the hypothesis that doubling the number of hepatitis B vaccine injections might increase anti-HBs response rate. HIV-infected patients with CD4 > 200/microliter, who were on stable antiretroviral treatment, as well as seronegative for HBV markers, and who have never been vaccinated against HBV, were given 3 intramuscular injections of Genhevac B 20 micrograms at 1 month intervals. Initial non responders were given 3 additional monthly injections. Anti-HBs titer was followed. We also evaluated the effects on HIV-1 viral load. Twenty patients with a median CD4 cell count of 470/microliter were enrolled. The response rate after three 20 micrograms injections was 55% (11/20), lower in individuals with CD4 between 200 and 500/microliter (4/12 = 33.3%), compared to patients with CD4 above 500/microliter (7/8 = 87.5%, P = 0.02). Among 9 initial non-responders, only 2 did not respond to 3 additional doses; thus, the overall response rate was 90% (18/20). Geometric mean titers of anti-HBs were 133 IU/l and 77.5 IU/l, after 3 and 6 Genhevac doses, respectively (P = 0.38). One year later, only 10/17 (58.8%) patients had protective anti-HBs. Five patients experienced a significant viral load increase, transient in 3 cases. These preliminary results suggest that doubling the number of hepatitis B vaccinations in HIV-infected patients might significantly improve anti-HBs response rate; however, close monitoring of anti-HBs is necessary because of its short-lived persistence. The effects on HIV-1 viral load are limited.
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Affiliation(s)
- D Rey
- CISIH, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France.
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Cribier B, Uhl G, Schmitt C, Doffoël M, Vetter D, Kirn A, Stoll-Keller F. Follow-up of hepatitis C virus RNA in peripheral blood mononuclear cells during interferon therapy. Arch Virol 1999; 144:355-64. [PMID: 10470259 DOI: 10.1007/s007050050509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mononuclear cells can be infected in vitro by hepatitis C virus and the viral RNA can be detected in mononuclear cells of chronically infected patients. It was suggested that the virus could persist in the mononuclear cells of some patients treated by interferon. The aim of this study was to follow the presence of viral RNA in the plasma and peripheral blood mononuclear cells of 16 chronically infected patients treated by alpha 2b interferon for 1 year. The RNA was detected by reverse transcription followed by nested PCR and quantified using the branched DNA method at regular intervals for at least one year. Before PCR, the mononuclear cells were treated by RNase and trypsin in order to eliminate the viral particles that could be stuck at the cell surface. Six patients were non responders and had persistent plasmatic viral RNA during the treatment. Two patients were good responders and had persistently negative PCR in both plasma and mononuclear cells. Eight patients had initial negativation of plasmatic hepatitis C virus RNA but showed a relapse characterized by positive plasmatic PCR. Positive PCR in mononuclear cells despite negativity of plasmatic PCR was noted 18 times in 8 patients. Persistently positive PCR in mononuclear cells in absence of detectable viraemia was followed by a virological relapse in 5 of these patients. This study confirms that hepatitis C virus RNA can be detected in mononuclear cells despite negative plasmatic PCR in patients treated by interferon. Moreover, the persistence of viral RNA in peripheral mononuclear cells could be a predictive factor of treatment failure. Our data also suggest that detection of viral RNA in mononuclear cells is probably not only due to passive virus adsorption from plasma.
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Affiliation(s)
- B Cribier
- INSERM U 74, University Hospital, Strasbourg, France
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30
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Calés P, Oberti F, Payen JL, Naveau S, Guyader D, Blanc P, Abergel A, Bichard P, Raymond JM, Canva-Delcambre V, Vetter D, Valla D, Beauchant M, Hadengue A, Champigneulle B, Pascal JP, Poynard T, Lebrec D. Lack of effect of propranolol in the prevention of large oesophageal varices in patients with cirrhosis: a randomized trial. French-Speaking Club for the Study of Portal Hypertension. Eur J Gastroenterol Hepatol 1999; 11:741-5. [PMID: 10445794 DOI: 10.1097/00042737-199907000-00011] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [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: 12/10/2022]
Abstract
OBJECTIVE Beta-blockers have been shown to reduce portal pressure in patients with cirrhosis and limit the development of portosystemic shunts in portal hypertensive animals. Thus, a randomized double-blind trial was conducted to evaluate propranolol in the prevention of the development of large oesophageal varices in patients with cirrhosis without varices or with small varices. METHODS One hundred and two patients received long-acting propranolol (160 mg/day) and 104 patients received a placebo. At inclusion, there was no significant difference between the two groups in terms of clinical characteristics or biochemical tests. At 2 years, the size of varices was estimated on video recordings. RESULTS One-third of the patients were lost to follow-up, and 95%/97% of the remaining patients were compliant in the propranolol and placebo groups, respectively. At 2 years, the proportion of patients with large varices was 31% in the propranolol group and 14% in the placebo group (P< 0.05). Three and four patients bled in the propranolol and placebo groups, respectively, and nine and ten died, respectively. CONCLUSION This trial suggests that propranolol administration cannot be recommended for the prevention of the development of large oesophageal varices in patients with cirrhosis; thus other studies are needed in selected subgroups of patients.
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Affiliation(s)
- P Calés
- Department of Hepato-Gastroenterology, University Hospital of Angers, France
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Doffoël M, Wolf P, Portolani N, Vetter D, Boudjema K, Jaeck D, Poynard T. [Results and indications of liver transplantation in alcoholic cirrhosis]. Gastroenterol Clin Biol 1999; 23:B56-65. [PMID: 10897775] [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: 02/17/2023]
Affiliation(s)
- M Doffoël
- Hépato-Gastroentérologie, Hôpital Civil, Strasbourg
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Kaumann A, Bartel S, Molenaar P, Sanders L, Burrell K, Vetter D, Hempel P, Karczewski P, Krause EG. Activation of beta2-adrenergic receptors hastens relaxation and mediates phosphorylation of phospholamban, troponin I, and C-protein in ventricular myocardium from patients with terminal heart failure. Circulation 1999; 99:65-72. [PMID: 9884381 DOI: 10.1161/01.cir.99.1.65] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [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: 11/16/2022]
Abstract
BACKGROUND Catecholamines hasten cardiac relaxation through beta-adrenergic receptors, presumably by phosphorylation of several proteins, but it is unknown which receptor subtypes are involved in human ventricle. We assessed the role of beta1- and beta2-adrenergic receptors in phosphorylating proteins implicated in ventricular relaxation. METHODS AND RESULTS Right ventricular trabeculae, obtained from freshly explanted hearts of patients with dilated cardiomyopathy (n=5) or ischemic cardiomyopathy (n=5), were paced at 60 bpm. After measurement of the contractile and relaxant effects of epinephrine (10 micromol/L) or zinterol (10 micromol/L), mediated through beta2-adrenergic receptors, and of norepinephrine (10 micromol/L), mediated through beta1-adrenergic receptors, tissues were freeze clamped. We assessed phosphorylation of phospholamban, troponin I, and C-protein, as well as specific phosphorylation of phospholamban at serine 16 and threonine 17. Data did not differ between the 2 disease groups and were therefore pooled. Epinephrine, zinterol, and norepinephrine increased contractile force to approximately the same extent, hastened the onset of relaxation by 15+/-3%, 5+/-2%, and 20+/-3%, respectively, and reduced the time to half-relaxation by 26+/-3%, 21+/-3%, and 37+/-3%. These effects of epinephrine, zinterol, and norepinephrine were associated with phosphorylation (pmol phosphate/mg protein) of phospholamban 14+/-3, 12+/-4, and 12+/-3; troponin I 40+/-7, 33+/-7, and 31+/-6; and C-protein 7.2+/-1.9, 9.3+/-1.4, and 7.5+/-2.0. Phosphorylation of phospholamban occurred at both Ser16 and Thr17 residues through both beta1- and beta2-adrenergic receptors. CONCLUSIONS Norepinephrine and epinephrine hasten human ventricular relaxation and promote phosphorylation of implicated proteins through both beta1- and beta2-adrenergic receptors, thereby potentially improving diastolic function.
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Vetter D, Bronowicki JP, Doffoël M. [Chemoembolization techniques for hepatocellular carcinoma in cirrhosis]. Ann Chir 1998; 52:527-34. [PMID: 9752502] [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: 02/08/2023]
Abstract
Transcatherter oily chemoembolisation, that should not be confused with other different and less effective techniques also called "chemoembolisation" is the most widely used therapy for loco-regional palliative treatment of hepatocellular carcinoma, which will become increasingly frequent, due to HCV infection; the cancer itself is often discovered at an advanced stage, when neoplastic extension precludes radical treatment that is liver transplantation. Performed with the best techniques, it offers a 1- and 5-yr survival of 60 and 30%, that is under confirmation by a randomized trial.
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Affiliation(s)
- D Vetter
- Service d'Hépato-Gastroentérologie, Hôpitaux Universitaires de Strasbourg, Hôpital Civil
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Abstract
The purpose of this study was to evaluate the frequency of skin changes among 100 patients from the Hepatogastroenterology Department of the University Hospital, Strasbourg, France who were hepatitis C virus-positive (HCV) and HIV-negative. Their clinical data were compared to those of 50 HCV-, and HIV-negative patients from the same Department, who suffered from various liver diseases. Psoriasis, rosacea, seborrheic dermatitis, cherry angiomas, spider nevus and skin cancers were noted in similar proportions in the two groups. In 15% of HCV-positive patients vs. 4% of controls, chronic pruritus was noted (p < 0.05). In 9 HCV-positive patients, pruritus was not related to itching dermatosis, and only 2 of these patients had mild cholestasis. Four cases of lichen planus vs. 0 in the control group were recorded. The virological data of patients with pruritus or lichen planus were not different than those of the rest of the group. Our findings indicate that systematic skin check-up in HCV-positive patients is valuable.
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Affiliation(s)
- B Cribier
- Department of Dermatology, University Hospital, Strasbourg, France
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35
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Bronowicki JP, Weber-Larivaille F, Gut JP, Doffoël M, Vetter D. [Comparison of immunogenicity of vaccination and serovaccination against hepatitis B virus in patients with alcoholic cirrhosis]. Gastroenterol Clin Biol 1998; 21:848-53. [PMID: 9587536] [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: 02/07/2023]
Abstract
OBJECTIVES The association of anti-HBs immunoglobulins and anti-HBV vaccine could increase the immunogenicity of the latter. The aim of this prospective randomized trial was to compare the immunogenicity of anti-HBs vaccination and serovaccination in alcoholic patients with cirrhosis. METHODS Alcoholic patients with cirrhosis were randomized in 2 groups: a) Vaccination group: 3 i.m. injections of GenHevac B followed by one booster at month 9; b) Serovaccination group: same vaccination schedule followed by one i.m. injection of anti-HBs immunoglobulins (500 IU). RESULTS Twenty-five patients (17 males and 8 females, mean age 56 years) were included in the study: 13 received a vaccination and 12 received a serovaccination. After 12 months, the seroconversion rates were 69% and 67% in vaccination and in serovaccination groups, respectively. The predictive factors of non responsiveness were as following: Child B cirrhosis, low number of CD8, a high CD4/CD8 rate, the existence of HLA DR7 antigen, and the absence of HLA DR1 antigen. CONCLUSION In alcoholic patients with cirrhosis, serovaccination does not increase the immunogenicity of anti-HBs vaccination and should not be recommended.
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Jaeck D, Bronowicki JP, Boudejma K, Bachellier P, Chone L, Nisand G, Bazin C, Pflumio F, Uhl G, Wenger JJ, Boissel P, Bigard MA, Gaucher P, Vetter D, Wolf P, Doffoel M. Comparison of resection, liver transplantation and transcatheter oily chemoembolisation in the treatment of hepatocellular carcinoma. Wiad Lek 1998; 50 Suppl 1 Pt 1:413-5. [PMID: 9383352] [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: 02/05/2023]
Affiliation(s)
- D Jaeck
- Centre de Chirurgie Viscérale et de Transplantation, Hopitaux Universitaires de Strasbourg
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Bronowicki JP, Vetter D, Uhl G, Hudziak H, Uhrlacher A, Vetter JM, Doffoel M. Lymphocyte reactivity to hepatitis C virus (HCV) antigens shows evidence for exposure to HCV in HCV-seronegative spouses of HCV-infected patients. J Infect Dis 1997; 176:518-22. [PMID: 9237722 DOI: 10.1086/517279] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [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: 02/04/2023] Open
Abstract
Lymphocyte reactivity against hepatitis C virus (HCV) antigens was studied in 20 couples in which 1 member had chronic hepatitis C. This was done to investigate the possibility of HCV transmission between spouses that was not followed by seroconversion. Twenty healthy subjects without any risk factors for HCV transmission served as negative controls. All the patients' spouses and the healthy controls were negative for HCV RNA and for anti-HCV antibody. Lymphocytes were cultured with recombinant HCV core and nonstructural antigens (c22, c33, c100, c200, and NS5) and with control antigens (sperm whale myoglobin, chicken lysozyme, and superoxide dismutase). Lymphocytes from 10 patients and 4 seronegative spouses proliferated in the presence of at least one HCV antigen. No proliferation was shown with nonspecific antigens or in the control group. This study gives evidence for possible in vivo priming with HCV antigens that did not lead to seroconversion in spouses of HCV-positive patients.
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Affiliation(s)
- J P Bronowicki
- Laboratoire d'Histo-compatibilitié, and Institut de Pathologie, Hôpitaux Universitaires et Faculté de Médecine de Strasbourg, France
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Cribier B, Schmitt C, Rey D, Uhl G, Lang JM, Vetter D, Kirn A, Stoll-Keller F. HIV increases hepatitis C viraemia irrespective of the hepatitis C virus genotype. Res Virol 1997; 148:267-71. [PMID: 9272577 DOI: 10.1016/s0923-2516(97)88363-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In case of coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV), HCV viraemia is increased. Because the HCV genotype 1 is associated with elevated viraemia, the increase in HCV viraemia observed and described in HIV+ patients could be attributed to the predominance of HCV genotype 1 in these patients. Therefore, the purpose of this study was to quantify HCV RNA in patients coinfected with HIV and HCV, according to the HCV genotype. The HCV genotype was thus determined in serum samples of 59 HIV+HCV+ patients and 51 HIV-HCV+ patients. HCV RNA was quantified using a branched DNA assay and the HCV genotype was determined using the "InnoLiPA" technique. The distribution of the HCV genotype was not significantly different in the two groups of patients, and there were even more patients infected by genotype 1 in the HIV-HCV+ group. The mean HCV viraemia of patients infected by HCV genotype 1 and by HCV genotype 3 was higher in patients coinfected by HIV than in HIV- patients (p < 10(-7) and p = 0.05, respectively). The increase in HCV viraemia observed in HIV+ patients was not the result of a specific distribution of HCV genotype in these patients. HIV infection was responsible for an increase in HCV viraemia irrespective of the HCV genotype.
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39
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Doffoël M, Gabanyi J, Vetter D. [Etiological treatment of cirrhosis in adults]. Rev Prat 1997; 47:503-6. [PMID: 9138412] [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: 02/04/2023]
Abstract
Etiological treatment is based upon: abstinence in case of alcoholic cirrhosis; alpha-interferon in case of B or C viral cirrhosis; corticosteroids in case of autoimmune cirrhosis; ursodeoxycholic acid in case of primary biliary cirrhosis; stopping the drug in case of drug-induced cirrhosis; surgery in case of secondary biliary cirrhosis; venesections in case of genetic haemochromatosis; liver transplantation in cases of Wilson's disease and alpha 1-anti-trypsin deficiency. Overall, these treatment are more effective when undertaken early in the course of the liver disease.
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Affiliation(s)
- M Doffoël
- Service d'hépato-gastroentérologie Hôpital civil, Strasbourg
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40
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Kurtz-Illig V, Pflumio F, Ott C, Wenger JJ, Doffoël M, Boudjema K, Cinqualbre J, Jaeck D, Vetter D. [Chemoembolization of hepatic metastases of small intestine leiomyosarcoma. 2 cases]. Gastroenterol Clin Biol 1997; 21:235-6. [PMID: 9161505] [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: 02/04/2023]
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41
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Cribier B, Rey D, Uhl G, Le Coz C, Hirth C, Libbrecht E, Vetter D, Lang JM, Stoll-Keller F, Grosshans E. Abnormal urinary coproporphyrin levels in patients infected by hepatitis C virus with or without human immunodeficiency virus. A study of 177 patients. Arch Dermatol 1996; 132:1448-52. [PMID: 8961873] [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: 02/03/2023]
Abstract
OBJECTIVE Many cases of porphyria cutanea tarda have been described in association with human immunodeficiency virus (HIV) infection in young individuals. The link between hepatitis C virus (HCV) and porphyria cutanea tarda is even stronger as more than 50% of patients who have this diagnosis in Italy, France, or Spain are also infected by HCV. To study the role of viral infections on the metabolism of porphyrins, we measured the urinary porphyrin levels in patients with HIV and HCV infections. DESIGN Survey; prospective study. SETTING University Hospital of Strasbourg, France. PATIENTS Sixty-one HIV-positive patients, 56 HCV-positive patients, 60 HIV- and HCV-positive patients, and 51 HIV- and HCV-negative control subjects were randomly selected. None had clinical signs of porphyria or a familial history of porphyria. MAIN OUTCOME MEASURES The porphyrin-excretion profile was determined by high-performance liquid chromatography on fresh urine samples. The HIV and HCV viremias were quantified in the serum by the branched DNA assay. Measures were planned before data collection began. RESULTS The porphyrin-excretion profile typical of porphyria cutanea tarda was found in only 1 of 177 patients. In the remaining 176 patients, the mean coproporphyrin level was significantly raised in HCV-positive patients and even higher in patients who were HIV- and HCV-positive. The coproporphyrin level was not correlated to the alanine aminotransferase level, the CD4+ cell count, or the HCV and HIV viremias. CONCLUSIONS In cases of infection with HIV, HCV, or both, the development of a porphyria cutanea tarda urinary profile is a rare event (0.56% in this study), but coproporphyrin excretion is increased. This could be related to hepatic changes induced by the viruses. Our results do not support the hypothesis of a direct viral effect on the porphyrin metabolism. Infection with HIV, HCV, or both may be a major triggering factor, but is not sufficient to induce porphyria.
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Affiliation(s)
- B Cribier
- Dermatology Clinic, Strasbourg University Hospital, France
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42
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Cribier B, Rey D, Uhl G, Schmitt C, Libbrecht E, Vetter D, Lang JM, Kirn A, Stoll-Keller F. Quantification of hepatitis C virus RNA in peripheral blood mononuclear cells: a comparison between patients chronically infected by HCV and patients coinfected by HIV. Res Virol 1996; 147:325-32. [PMID: 8958585 DOI: 10.1016/s0923-2516(97)85124-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In patients chronically infected by hepatitis C virus (HCV), peripheral blood mononuclear cells (PBMCs) were shown to be targets for virus replication and in those coinfected with HIV, HCV viraemia was considerably increased. The purpose of this study was to quantify HCV RNA in PBMCs from 25 patients infected by HCV and from 25 patients coinfected by HCV and HIV. We used the branched DNA assay after extraction of total RNA on 5 x 10(6) cells to quantify HCV RNA, and the Inno LiPA assay to determine the HCV genotype. HCV RNA in PBMCs could be quantified in 8/25 patients in each group, but the HCV RNA concentration was very low in comparison with viraemia, since the highest result was 8.1 x 10(4) Eq genome/10(6) cells. In 10 ml of total blood, there was approximately 100 to 5,000 times less HCV RNA in PBMCs than in the plasma. It is therefore likely that PBMCs play only a minor part in the viral load present in the plasma. There was no preferential genotype associated with quantifiable HCV RNA in the PBMCs. In the case of HIV coinfection, there was no increase in the HCV-RNA concentration in PBMCs that could explain the increased viraemia observed in these patients. On the contrary, HCV RNA could not even be detected by RT-PCR in some of our coinfected patients.
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Lehmann M, Mann H, Gastmann U, Keul J, Vetter D, Steinacker JM, Häussinger D. Unaccustomed high-mileage vs intensity training-related changes in performance and serum amino acid levels. Int J Sports Med 1996; 17:187-92. [PMID: 8739572 DOI: 10.1055/s-2007-972830] [Citation(s) in RCA: 18] [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: 02/01/2023]
Abstract
To test the overtraining-related "imbalanced amino acid hypothesis" (19), the influence of an unaccustomed average 103 %.4 wk-1 increase in training mileage (ITV) on performance and on serum levels of individual amino acids (AAs) was examined in distance runners and controlled by an unaccustomed average 152%.4 wk-1 increase in tempo-pace and interval runs (ITI). Two mmol.l-1 lactate performance (2 LP) increased, 4 LP stagnated and total running distance (TD) decreased in the incremental test during ITV--which may indicate an ITV-dependent overtraining--in contrast to an ITI-related increase in 2 LP, 4 LP and TD. The summed serum AAs decreased in ITV (2744 +/- 534 vs 2933 +/- 663 umol.l-1; p < 0.05) in contrast to an ITI-related increase (3541 +/- 657 vs 3252 +/- 885 umol.l-1; p < 0.05) with an average 29% higher final summed AAs concentration during ITI (p < 0.05). During ITV 12 individual AAs decreased by 6-17%, 8 remained constant and 3 increased (Cys, Met, fTrp) by 6-19%, as opposed to an ITI-related increase in 16 AA by 6-55%. The observed ITV-related changes in serum AAs profile were smaller than after completing contests as a marathon, a 100 km-run or an ultra-triathlon. It may be concluded that the observed small changes in AAs profile or AAA/BCAA and AA/LNAA ratios only represent an epiphenomenon without recognizable influence on incremental test performance, since increases in fTrp/LNAA ratios (+28% in ITV vs +45% in ITI) were found to be related both to performance impairment (ITV) and improvement (ITI).
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Affiliation(s)
- M Lehmann
- Department of Sports Medicine, University Medical Hospital Freiburg
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44
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Bronowicki JP, Boudjema K, Chone L, Nisand G, Bazin C, Pflumio F, Uhl G, Wenger JJ, Jaeck D, Boissel P, Bigard MA, Gaucher P, Vetter D, Doffoel M. Comparison of resection, liver transplantation and transcatheter oily chemoembolization in the treatment of hepatocellular carcinoma. J Hepatol 1996; 24:293-300. [PMID: 8778195 DOI: 10.1016/s0168-8278(96)80007-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [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: 02/02/2023]
Abstract
BACKGROUND/AIMS Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors. METHODS Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group. RESULTS The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p < 0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery. CONCLUSION Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.
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Affiliation(s)
- J P Bronowicki
- Centre de Chirurgie Viscérale et de Transplantation, Hôpitaux Universitaires de Strasbourg, France
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45
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Cribier B, Petiau P, Keller F, Schmitt C, Vetter D, Heid E, Grosshans E. Porphyria cutanea tarda and hepatitis C viral infection. A clinical and virologic study. Arch Dermatol 1995; 131:801-4. [PMID: 7611796] [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: 01/26/2023]
Abstract
BACKGROUND AND DESIGN The role of hepatitis C virus (HCV) infection in porphyria cutanea tarda (PCT) is probable since the global HCV antibody prevalence among patients with PCT is about 70%. The purpose of this study was to evaluate the virologic characteristics in 12 patients with sporadic PCT and in one patient with familial PCT. Anti-HCV antibodies were detected by enzyme-linked immunosorbent assay and confirmed by recombinant immunoblot assay. Hepatitis B virus and antihuman immunodeficiency virus markers were also determined. The polymerase chain reaction was performed to detect the following: (1) both positive and negative HCV RNA strands, (2) HCV RNA titer, and (3) HCV RNA genotype. RESULTS Seven of the 12 patients with sporadic PCT were HCV positive, and the patient with familial PCT was HCV negative. The age at onset of PCT was significantly lower in HCV-positive patients than in HCV-negative patients. The HCV RNA was detected in all patients who had HCV antibodies, and the replicative intermediate of HCV was detected in three of them. The positive RNA titer ranged from 1:10 to 1:10(6). Four patients were infected by HCV genotype I, two by genotype II, and one patient was coinfected by type I and type II. Three of the seven HCV-positive patients also had HBV antibodies, but HBV DNA was never detected. All patients were negative for the human immunodeficiency virus. CONCLUSIONS The HCV infection rate was high (58%) in this series, and all HCV-infected patients had HCV RNA, reflecting an active replication of the virus. The young age at onset of PCT suggests that HCV is a major triggering factor of PCT. Nevertheless, the clinical changes of PCT were not related to the virologic findings, suggesting an indirect role of HCV.
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Affiliation(s)
- B Cribier
- Dermatology Clinic, University Hospital, Strasbourg, France
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46
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Massard G, Dabbagh A, Vetter D, Gasser B, Dumont P, Wihlm JM, Morand G. [Preoperative evaluation of cancers of the esophagus. Contribution of in vivo staining]. Presse Med 1995; 24:975-8. [PMID: 7545291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We assessed the effectiveness of a dye-endoscopy to detect inapparent multicentric carcinomas of the oesophagus. METHODS The study included 95 patients scheduled for oesophagectomy. A lugol stain was applied to the oesophageal mucosa and any non-stained area was biopsied. The proximal oesophagus was reexamined on the pathology specimen obtained after oesophagectomy. RESULTS Intramucosal epithelioma of the proximal oesophagus was found in 7 patients (7.4%) and severe dysplasia was seen in 3 (3.1%). Abnormal stains were seen in 33 patients including 9 with diffuse parakeratosis. There were 24 focal anomalies including 6 cases of intramucosal carcinoma, 3 severe dysplasias, 3 gastric metaplasias and 12 parakeratoses. One intramucosal epithelioma observed on the surgical specimen had not been detected by the staining technique. Overall sensitivity was 85.7% and specificity was 71.7%. Including focal anomalies only, specificity was 79.5%. CONCLUSION Vital staining is a useful tool for pre-operative assessment of cancer of the oesophagus, in particular for superficial forms.
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Affiliation(s)
- G Massard
- Service de Chirurgie thoracique, Hôpitaux universitaires de Strasbourg
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47
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Abstract
Glycosylamines are readily available carbohydrate derivatives that undergo acylation reactions with homobifunctional N-hydroxysuccinimidyl esters. The product glycosylamides carry a spacer group equipped with one active ester functionality. This route provides well-defined glycoconjugates, which may be cross-linked to various amino-functionalized resins. Carbohydrate recognition of the resulting sugar-bead conjugates is probed by lectin immunostaining or flow cytometry using a fluorescently labeled lectin.
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Affiliation(s)
- D Vetter
- Affymax Research Institute, Palo Alto, California 94304, USA
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48
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Abstract
A simple one-step procedure is found to be highly effective for the "functionalization" of glycodiversity. This study encompasses 50 unprotected mono- and oligosaccharides, which are subjected to Kochetkov aminations in saturated aqueous ammonium carbonate. The reaction allows for the stereo- and regioselective introduction of an amino group into all oligosaccharides tested, as well as into a great variety of monosaccharides including charged species. The resulting unprotected glycosylamines are stable compounds, and the inherent amino group provides a convenient site for chemoselective conjugation and modification as described in the following paper in this issue.
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Affiliation(s)
- D Vetter
- Affymax Research Institute, Palo Alto, California 94304, USA
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49
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Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, Wenger JJ, Boissel P, Bigard MA, Doffoel M. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer 1994. [PMID: 7516263 DOI: 10.1002/1097-0142(19940701)74:1<16::aid-cncr2820740105>3.0.co;2-v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In Western countries, only a small proportion of patients with hepatocellular carcinoma (HCC) can be treated with surgical resection. For other patients, locoregional management by transcatheter oily chemoembolization seems to be useful and warrants evaluation. METHODS One hundred and twenty-seven French patients with an inoperable HCC were treated by transcatheter oily chemoembolization. The efficiency of the treatment was assessed by a comparison of this group with a group of 127 untreated patients. Each patient of the treated group was matched closely with an untreated patient for all the main clinical, anatomic, and biologic features that characterize the spontaneous evolution of HCC. RESULTS The overall probabilities of survival in the treated group were 64%, 38%, 27%, and 27% at 1, 2, 3, and 4 years, respectively; those for the untreated group were 18%, 6%, and 5% at 1, 2 and 3 years, respectively (P < 0.0001). The survival was significantly increased in patients with Okuda Stage I and II disease (P < 0.0001), but not in those with Stage III. Karnofsky and Child-Pugh scores remained stable during the follow-up period and dropped only shortly before patients died. CONCLUSION Transcatheter oily chemoembolization is an efficient treatment for unresectable HCC for the palliation of symptoms as well as for the prolongation of survival with a good quality of life.
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Affiliation(s)
- J P Bronowicki
- Services d'Hépatogastroentérologie et de Chirurgie, Centre Hospitalier Universitaire, Strasbourg, France
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50
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Bronowicki JP, Vetter D, Dumas F, Boudjema K, Bader R, Weiss AM, Wenger JJ, Boissel P, Bigard MA, Doffoel M. Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients. Cancer 1994; 74:16-24. [PMID: 7516263 DOI: 10.1002/1097-0142(19940701)74:1<16::aid-cncr2820740105>3.0.co;2-v] [Citation(s) in RCA: 132] [Impact Index Per Article: 4.4] [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: 01/25/2023]
Abstract
BACKGROUND In Western countries, only a small proportion of patients with hepatocellular carcinoma (HCC) can be treated with surgical resection. For other patients, locoregional management by transcatheter oily chemoembolization seems to be useful and warrants evaluation. METHODS One hundred and twenty-seven French patients with an inoperable HCC were treated by transcatheter oily chemoembolization. The efficiency of the treatment was assessed by a comparison of this group with a group of 127 untreated patients. Each patient of the treated group was matched closely with an untreated patient for all the main clinical, anatomic, and biologic features that characterize the spontaneous evolution of HCC. RESULTS The overall probabilities of survival in the treated group were 64%, 38%, 27%, and 27% at 1, 2, 3, and 4 years, respectively; those for the untreated group were 18%, 6%, and 5% at 1, 2 and 3 years, respectively (P < 0.0001). The survival was significantly increased in patients with Okuda Stage I and II disease (P < 0.0001), but not in those with Stage III. Karnofsky and Child-Pugh scores remained stable during the follow-up period and dropped only shortly before patients died. CONCLUSION Transcatheter oily chemoembolization is an efficient treatment for unresectable HCC for the palliation of symptoms as well as for the prolongation of survival with a good quality of life.
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Affiliation(s)
- J P Bronowicki
- Services d'Hépatogastroentérologie et de Chirurgie, Centre Hospitalier Universitaire, Strasbourg, France
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