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Schafer ES, Chao K, Stevens AM, Jo E, Hilsenbeck SG, Gossai NP, Doan A, Colace SI, Guinipero T, Otterson D, Kaplan JA, Hinson A, Pommert L, Wayne AS, Bhojwani D, Burke MJ. Real-world experience in treating pediatric relapsed/refractory or therapy-related myeloid malignancies with decitabine, vorinostat, and FLAG therapy based on a phase 1 study run by the TACL consortium. Pediatr Blood Cancer 2022; 69:e29812. [PMID: 35726868 DOI: 10.1002/pbc.29812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023]
Abstract
Current therapies for relapsed/refractory (R/R) pediatric myeloid neoplasms are inadequately effective. Real-world data (RWD) can improve care by augmenting traditional studies and include individuals not eligible for clinical trials. The Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL) consortium recently completed T2016-003, a phase 1 study of decitabine, vorinostat, fludarabine, cytarabine, and granulocyte colony-stimulating factor (G-CSF) in R/R acute myeloid leukemia (AML), which added epigenetic drugs to a cytotoxic backbone. We report results of RWD from six centers that treated 28 pediatric patients (26 with AML, two with other myeloid neoplasms) identically to the TACL study but who were not enrolled. This allowed unique analyses and the ability to compare data with the 35 TACL study patients. The overall response rate (ORR) (complete response [CR] plus CR with incomplete count recovery) among 26 RWD evaluable patients was 65%. The ORR of 13 patients with relapsed AML with epigenetic alterations was 69% (T2016-003 + RWD: 68%, n = 25), of eight patients with refractory AML was 38% (T2016-003 + RWD: 41%, n = 17) and of five patients with therapy-related AML (t-AML) was 80% (T2016-003 + RWD: 75%, n = 8). The mean number of Grade 3/4 toxicities experienced by the T2016-003-eligible RWD population (n = 22) (one per patient-cycle) was not meaningfully different than those (n = 6) who would have been TACL study-ineligible secondary to comorbidities (two per patient-cycle). Overall, this therapy was well tolerated and effective in pediatric patients with R/R myeloid neoplasms, particularly those with epigenetic alterations, t-AML, and refractory disease.
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Affiliation(s)
- Eric S Schafer
- Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Cancer Center, Houston, Texas, USA
| | - Karen Chao
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexandra M Stevens
- Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Cancer Center, Houston, Texas, USA
| | - Eunji Jo
- Baylor College of Medicine, Houston, Texas, USA
| | | | - Nathan P Gossai
- Center for Cancer and Blood Diseases, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Doan
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Joel A Kaplan
- Levine Children's Hospital/Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Ashley Hinson
- Levine Children's Hospital/Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Lauren Pommert
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alan S Wayne
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Deepa Bhojwani
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Pommert L, Schafer ES, Malvar J, Gossai N, Florendo E, Pulakanti K, Heimbruch K, Stelloh C, Chi YY, Sposto R, Rao S, Van Huynh T, Brown P, Chang BH, Colace SI, Hermiston ML, Heym K, Hutchinson RJ, Kaplan JA, Mody R, O’Brien TA, Place AE, Shaw PH, Ziegler DS, Wayne A, Bhojwani D, Burke MJ. Decitabine and vorinostat with FLAG chemotherapy in pediatric relapsed/refractory AML: Report from the therapeutic advances in childhood leukemia and lymphoma (TACL) consortium. Am J Hematol 2022; 97:613-622. [PMID: 35180323 PMCID: PMC8986610 DOI: 10.1002/ajh.26510] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 01/26/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Abstract
Survival outcomes for relapsed/refractory pediatric acute myeloid leukemia (R/R AML) remain dismal. Epigenetic changes can result in gene expression alterations which are thought to contribute to both leukemogenesis and chemotherapy resistance. We report results from a phase I trial with a dose expansion cohort investigating decitabine and vorinostat in combination with fludarabine, cytarabine, and G-CSF (FLAG) in pediatric patients with R/R AML [NCT02412475]. Thirty-seven patients enrolled with a median age at enrollment of 8.4 (range, 1-20) years. There were no dose limiting toxicities among the enrolled patients, including two patients with Down syndrome. The recommended phase 2 dose of decitabine in combination with vorinostat and FLAG was 10 mg/m2 . The expanded cohort design allowed for an efficacy evaluation and the overall response rate among 35 evaluable patients was 54% (16 complete response (CR) and 3 complete response with incomplete hematologic recovery (CRi)). Ninety percent of responders achieved minimal residual disease (MRD) negativity (<0.1%) by centralized flow cytometry and 84% (n = 16) successfully proceeded to hematopoietic stem cell transplant. Two-year overall survival was 75.6% [95%CI: 47.3%, 90.1%] for MRD-negative patients vs. 17.9% [95%CI: 4.4%, 38.8%] for those with residual disease (p < .001). Twelve subjects (34%) had known epigenetic alterations with 8 (67%) achieving a CR, 7 (88%) of whom were MRD negative. Correlative pharmacodynamics demonstrated the biologic activity of decitabine and vorinostat and identified specific gene enrichment signatures in nonresponding patients. Overall, this therapy was well-tolerated, biologically active, and effective in pediatric patients with R/R AML, particularly those with epigenetic alterations.
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Affiliation(s)
- Lauren Pommert
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eric S. Schafer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jemily Malvar
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Nathan Gossai
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Ellynore Florendo
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Katelyn Heimbruch
- Blood Research Institute, Versiti, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cary Stelloh
- Blood Research Institute, Versiti, Milwaukee, WI
| | - Yueh-Yun Chi
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, C
| | - Richard Sposto
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, C
| | - Sridhar Rao
- Blood Research Institute, Versiti, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Thu Van Huynh
- Department of Pediatrics, Children’s Hospital of Orange County, Orange, CA
| | - Patrick Brown
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, MD
| | - Bill H. Chang
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Susan I. Colace
- Department of Pediatrics, Hematology and Oncology, Nationwide Children’s Hospital, Columbus, OH
| | - Michelle L. Hermiston
- Division of Hematology/Oncology, University of California, San Francisco Benioff Children’s Hospital, San Francisco, CA
| | - Kenneth Heym
- Department of Pediatrics, Cook Children’s Medical Center, Fort Worth, TX
| | - Raymond J. Hutchinson
- Department of Pediatric and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI
| | - Joel A. Kaplan
- Department of Pediatrics, Carolinas Medical Center/Levine Cancer Institute, Charlotte, NC
| | - Rajen Mody
- Department of Pediatric and Communicable Diseases Division of Pediatric Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI
| | - Tracey A. O’Brien
- Cord & Marrow Transplant Program, Centre for Children’s Cancer & Blood Disorders, Sydney Children’s Hospital, Sydney, Australia
| | - Andrew E. Place
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Peter H. Shaw
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - David S. Ziegler
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| | - Alan Wayne
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, C
| | - Deepa Bhojwani
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, C
| | - Michael J. Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
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Burke MJ, Kostadinov R, Sposto R, Gore L, Kelley SM, Rabik C, Trepel JB, Lee MJ, Yuno A, Lee S, Bhojwani D, Jeha S, Chang BH, Sulis ML, Hermiston ML, Gaynon P, Huynh V, Verma A, Gardner R, Heym KM, Dennis RM, Ziegler DS, Laetsch TW, Oesterheld JE, Dubois SG, Pollard JA, Glade-Bender J, Cooper TM, Kaplan JA, Farooqi MS, Yoo B, Guest E, Wayne AS, Brown PA. Decitabine and Vorinostat with Chemotherapy in Relapsed Pediatric Acute Lymphoblastic Leukemia: A TACL Pilot Study. Clin Cancer Res 2020; 26:2297-2307. [PMID: 31969338 PMCID: PMC7477726 DOI: 10.1158/1078-0432.ccr-19-1251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/16/2019] [Revised: 09/20/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Treatment failure from drug resistance is the primary reason for relapse in acute lymphoblastic leukemia (ALL). Improving outcomes by targeting mechanisms of drug resistance is a potential solution. PATIENTS AND METHODS We report results investigating the epigenetic modulators decitabine and vorinostat with vincristine, dexamethasone, mitoxantrone, and PEG-asparaginase for pediatric patients with relapsed or refractory B-cell ALL (B-ALL). Twenty-three patients, median age 12 years (range, 1-21) were treated in this trial. RESULTS The most common grade 3-4 toxicities included hypokalemia (65%), anemia (78%), febrile neutropenia (57%), hypophosphatemia (43%), leukopenia (61%), hyperbilirubinemia (39%), thrombocytopenia (87%), neutropenia (91%), and hypocalcemia (39%). Three subjects experienced dose-limiting toxicities, which included cholestasis, steatosis, and hyperbilirubinemia (n = 1); seizure, somnolence, and delirium (n = 1); and pneumonitis, hypoxia, and hyperbilirubinemia (n = 1). Infectious complications were common with 17 of 23 (74%) subjects experiencing grade ≥3 infections including invasive fungal infections in 35% (8/23). Nine subjects (39%) achieved a complete response (CR + CR without platelet recovery + CR without neutrophil recovery) and five had stable disease (22%). Nine (39%) subjects were not evaluable for response, primarily due to treatment-related toxicities. Correlative pharmacodynamics demonstrated potent in vivo modulation of epigenetic marks, and modulation of biologic pathways associated with functional antileukemic effects. CONCLUSIONS Despite encouraging response rates and pharmacodynamics, the combination of decitabine and vorinostat on this intensive chemotherapy backbone was determined not feasible in B-ALL due to the high incidence of significant infectious toxicities. This study is registered at http://www.clinicaltrials.gov as NCT01483690.
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Affiliation(s)
- Michael J Burke
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Rumen Kostadinov
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Richard Sposto
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lia Gore
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon M Kelley
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Cara Rabik
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Deepa Bhojwani
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sima Jeha
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Bill H Chang
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Maria Luisa Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle L Hermiston
- Department of Pediatrics, UCSF Medical Center-Mission Bay, San Francisco, California
| | - Paul Gaynon
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Van Huynh
- Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Anupam Verma
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Rebecca Gardner
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Kenneth M Heym
- Department of Pediatrics, Cook Children's Medical Center, Fort Worth, Texas
| | - Robyn M Dennis
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Theodore W Laetsch
- Department of Pediatrics, UT Southwestern/Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas
| | - Javier E Oesterheld
- Department of Pediatrics, Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina
| | - Steven G Dubois
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jessica A Pollard
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Julia Glade-Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Todd M Cooper
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Joel A Kaplan
- Department of Pediatrics, Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina
| | - Midhat S Farooqi
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Byunggil Yoo
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Erin Guest
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Alan S Wayne
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Patrick A Brown
- Division of Pediatric Oncology, Johns Hopkins University, Baltimore, Maryland
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Affiliation(s)
- Joel A Kaplan
- Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC
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Kaplan JA. REMOVED: Plus Les Choses Changent Plus Elles Restent Les Mêmes. J Cardiothorac Vasc Anesth 2019; 33:1. [DOI: 10.1053/j.jvca.2018.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Riley LG, Heeney MM, Rudinger-Thirion J, Frugier M, Campagna DR, Zhou R, Hale GA, Hilliard LM, Kaplan JA, Kwiatkowski JL, Sieff CA, Steensma DP, Rennings AJ, Simons A, Schaap N, Roodenburg RJ, Kleefstra T, Arenillas L, Fita-Torró J, Ahmed R, Abboud M, Bechara E, Farah R, Tamminga RYJ, Bottomley SS, Sanchez M, Huls G, Swinkels DW, Christodoulou J, Fleming MD. The phenotypic spectrum of germline YARS2 variants: from isolated sideroblastic anemia to mitochondrial myopathy, lactic acidosis and sideroblastic anemia 2. Haematologica 2018; 103:2008-2015. [PMID: 30026338 PMCID: PMC6269294 DOI: 10.3324/haematol.2017.182659] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 10/17/2017] [Accepted: 07/12/2018] [Indexed: 01/19/2023] Open
Abstract
YARS2 variants have previously been described in patients with myopathy, lactic acidosis and sideroblastic anemia 2 (MLASA2). YARS2 encodes the mitochondrial tyrosyl-tRNA synthetase, which is responsible for conjugating tyrosine to its cognate mt-tRNA for mitochondrial protein synthesis. Here we describe 14 individuals from 11 families presenting with sideroblastic anemia and YARS2 variants that we identified using a sideroblastic anemia gene panel or exome sequencing. The phenotype of these patients ranged from MLASA to isolated congenital sideroblastic anemia. As in previous cases, inter- and intra-familial phenotypic variability was observed, however, this report includes the first cases with isolated sideroblastic anemia and patients with biallelic YARS2 variants that have no clinically ascertainable phenotype. We identified ten novel YARS2 variants and three previously reported variants. In vitro amino-acylation assays of five novel missense variants showed that three had less effect on the catalytic activity of YARS2 than the most commonly reported variant, p.(Phe52Leu), associated with MLASA2, which may explain the milder phenotypes in patients with these variants. However, the other two missense variants had a more severe effect on YARS2 catalytic efficiency. Several patients carried the common YARS2 c.572 G>T, p.(Gly191Val) variant (minor allele frequency =0.1259) in trans with a rare deleterious YARS2 variant. We have previously shown that the p.(Gly191Val) variant reduces YARS2 catalytic activity. Consequently, we suggest that biallelic YARS2 variants, including severe loss-of-function alleles in trans of the common p.(Gly191Val) variant, should be considered as a cause of isolated congenital sideroblastic anemia, as well as the MLASA syndromic phenotype.
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Affiliation(s)
- Lisa G Riley
- Genetic Metabolic Disorders Research Unit, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Australia
| | - Matthew M Heeney
- Dana Farber-Boston Children's Center for Cancer and Blood Disorders, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joëlle Rudinger-Thirion
- Architecture et Réactivité de l'ARN, Université de Strasbourg, CNRS, IBMC, Strasbourg, France
| | - Magali Frugier
- Architecture et Réactivité de l'ARN, Université de Strasbourg, CNRS, IBMC, Strasbourg, France
| | - Dean R Campagna
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Ronghao Zhou
- Dana Farber-Boston Children's Center for Cancer and Blood Disorders, Boston, MA, USA
| | - Gregory A Hale
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Lee M Hilliard
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, AL, USA
| | | | - Janet L Kwiatkowski
- The Children's Hospital of Philadelphia, Division of Hematology, Philadelphia, PA, USA.,University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Colin A Sieff
- Dana Farber-Boston Children's Center for Cancer and Blood Disorders, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - David P Steensma
- Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA USA
| | - Alexander J Rennings
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Annet Simons
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nicolaas Schaap
- Department of Hematology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Richard J Roodenburg
- Radboud Center for Mitochondrial Medicine, Translational Metabolic Laboratory, Department of Pediatrics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tjitske Kleefstra
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leonor Arenillas
- Laboratorio Citología Hematológica, Servicio Patología, GRETNHE, IMIM Hospital del Mar Research Institute, Hospital del Mar, Barcelona, Spain
| | - Josep Fita-Torró
- Iron metabolism: regulation and disease group, Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Campus Can Ruti, Carretera de Can Ruti, Cami de les Escoles, Badalona, Spain
| | - Rasha Ahmed
- Department of Pediatrics and Adolescents, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel Abboud
- Department of Pediatrics and Adolescents, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Bechara
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Roula Farah
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rienk Y J Tamminga
- Beatrix Children's Hospital, Department of Pediatric Hematology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Sylvia S Bottomley
- Department of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Mayka Sanchez
- Iron metabolism: regulation and disease group, Josep Carreras Leukaemia Research Institute (IJC), Campus ICO-Germans Trias i Pujol, Campus Can Ruti, Carretera de Can Ruti, Cami de les Escoles, Badalona, Spain.,Programme of Predictive and Personalized Medicine of Cancer, Germans Trias i Pujol Research Institute (PMPPC-IGTP), Badalona, Spain.,BloodGenetics, S.L., Esplugues de Llobregat, Barcelona, Spain
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, the Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - John Christodoulou
- Genetic Metabolic Disorders Research Unit, Kids Research Institute, Children's Hospital at Westmead, Sydney, Australia .,Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Australia.,Neurodevelopmental Genomics Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, Melbourne Medical School, University of Melbourne, Australia
| | - Mark D Fleming
- Dana Farber-Boston Children's Center for Cancer and Blood Disorders, Boston, MA, USA.,Department of Pathology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA USA
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Kaplan JA, Barthélémy P, Grinstaff MW. Self-assembled nanofiber hydrogels for mechanoresponsive therapeutic anti-TNFα antibody delivery. Chem Commun (Camb) 2016; 52:5860-3. [PMID: 27049283 DOI: 10.1039/c6cc02221a] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Low molecular weight hydrogels, prepared from glycosyl-nucleoside-lipid amphiphiles, exhibit shear-thinning behaviour and reversible thermally- and mechanically-triggered sol-gel transitions. Using mechanical shear stimulation, the release of entrapped anti-TNFα increases and the released anti-TNFα demonstrates efficacy in in vitro neutralization bioassays. Delivery of anti-TNFα is of general interest and broad medicinal utility for treating autoimmune diseases such as rheumatoid arthritis.
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Affiliation(s)
- J A Kaplan
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, Massachusetts 02215, USA.
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Affiliation(s)
- Joel A Kaplan
- University of Louisville School of Medicine, 307 Abell Administration Bldg., Louisville, KY 40202, USA
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Langston JW, Forno LS, Tetrud J, Reeves AG, Kaplan JA, Karluk D. Evidence of active nerve cell degeneration in the substantia nigra of humans years after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine exposure. Ann Neurol 1999; 46:598-605. [PMID: 10514096 DOI: 10.1002/1531-8249(199910)46:4<598::aid-ana7>3.0.co;2-f] [Citation(s) in RCA: 733] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This report provides the first detailed neuropathological study of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonism in humans. All 3 subjects self-administered the drug under the impression it was "synthetic heroin" and subsequently developed severe and unremitting parkinsonism, which was L-dopa responsive, at least in the earlier stages of illness. Survival times ranged from 3 to 16 years. Neuropathological examination revealed moderate to severe depletion of pigmented nerve cells in the substantia nigra in each case. Lewy bodies were not present. In Patients 1 and 2, there was gliosis and clustering of microglia around nerve cells. Patient 3 had a similar picture and also showed large amounts of extraneuronal melanin. These findings are indicative of active, ongoing nerve cell loss, suggesting that a time-limited insult to the nigrostriatal system can set in motion a self-perpetuating process of neurodegeneration. Although the mechanism by which this occurs is far from clear, the precedent set by the cases could have broad implications for human neurodegenerative disease.
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Affiliation(s)
- J W Langston
- The Parkinson's Institute, Sunnyvale, CA 94089-1605, USA
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Abstract
Infants who die of hypernatremic dehydration usually demonstrate at autopsy an underlying condition or disease process that predisposes to increased water loss. In the absence of such findings, forensic concerns may focus sharply on parental or caretaker neglect as an underlying cause of death. In this case report, we describe unrecognized fatal hypernatremic dehydration in two exclusively breast-fed neonates due solely to failure of maternal lactation. We further describe epidemiologic and etiologic features of such deaths and discuss forensic difficulties encountered in their certification.
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Affiliation(s)
- J A Kaplan
- New Hampshire State Medical Examiner's Office, Concord 03301, USA
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Kaplan JA, Krieff DM. Quinolones for the treatment and prophylaxis of tuberculosis. Ann Pharmacother 1996; 30:1020-2. [PMID: 8876865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Quinolones possess enormous potential as antimycobacterial agents, and have been proven to have excellent in vitro activity against M. tuberculosis, as well as limited in vivo efficacy. These drugs appear to be safe and well tolerated even when taken for an extended period. This is important considering that one of the most significant factors contributing to resistance is compliance. Quinolones exhibit great promise for initial treatment and retreatment of MDRTB, a rapidly growing problem, as well as for prevention. They have shown to be as effective as some of the first-line agents currently used in treating TB. There appears to be overwhelming need to further study these agents and determine their role in the treatment of TB. In the future, quinolones may emerge as first-line therapy for TB.
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Affiliation(s)
- J A Kaplan
- Department of Pharmacy, Long Island Jewish Medical Center, NY 11040, USA
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Sargent S, Kennedy JG, Kaplan JA. "Hyperacute" subdural hematoma: CT mimic of recurrent episodes of bleeding in the setting of child abuse. J Forensic Sci 1996; 41:314-6. [PMID: 8871392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mixed density extraaxial hematomae on computed tomography (CT) scanning generally represent recurrent episodes of bleeding (chronic subdural hematoma with rebleeding). Hyperacute hemorrhages in which the patient is actively bleeding or has a coagulopathy have also been described as mixed density. We report a case of child abuse in a fourteen month old child who presented with a CT scan showing a mixed density subdural hematoma which was originally interpreted as recurrent episodes of hemorrhage, but who had evidence of only acute, active bleeding at surgery and by histologic examination. There is a proportionally high incidence of subdural hematoma in cases of child abuse, due in part to the increased susceptibility of the immature brain to trauma. Because the mechanism of injury is different for hemorrhage due to hyperacute subdural hematoma (SDH) and that of acute bleeding within a chronic SDH, the distinction between these entities has potentially important legal implications in cases of suspected child abuse. This potential pitfall in interpretation of the CT scan has not to our knowledge been reported in the forensic literature.
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Affiliation(s)
- S Sargent
- Dartmouth Hitchcock Medical Center, Department of Radiology, Lebanon, NH, USA
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Affiliation(s)
- J F Yale
- Yale Podiatry Group, Ansonia, CT, USA
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22
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23
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Abstract
BACKGROUND Sudden death from cardiac arrest in a young person may occur during sports play after a blunt blow to the chest in the absence of structural cardiovascular disease or traumatic injury (cardiac concussion or commotio cordis). We studied the clinical features of this apparently uncommon but important phenomenon. METHODS We identified cases from the registries of relevant agencies and organizations, as well as newsmedia accounts, and developed a clinical profile of 25 children and young adults, 3 to 19 years of age. RESULTS Each victim collapsed with cardiac arrest immediately after an unexpected blow to the chest, which was usually inflicted by a projectile (such as a baseball or hockey puck). Incidents took place during organized competitive sports in 16 cases and in recreational settings at home, at school, or on the playground in 9. In each instance, the impact to the chest was not judged to be extraordinary for the sport involved and did not appear to have sufficient force to cause death. Twelve victims collapsed virtually instantaneously on impact, whereas 13 remained conscious and physically active for a brief time before cardiac arrest. Cardiopulmonary resuscitation was administered within about three minutes to 19 victims, but normal cardiac rhythm could be restored in only 2 (both incurred irreversible brain damage and died shortly thereafter). Seven victims (28 percent) were wearing some form of protective chest padding. CONCLUSIONS We speculate that most sudden deaths related to impact to the chest (not associated with traumatic injury) are due to ventricular dysrhythmia induced by an abrupt, blunt precordial blow, presumably delivered at an electrically vulnerable phase of ventricular excitability. This profile of blunt chest impact leading to cardiac arrest adds to our understanding of the range of causes of sudden death on the athletic field and may help in the development of preventive measures.
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Affiliation(s)
- B J Maron
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, MN 55407-3984, USA
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24
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Abstract
Cardiopulmonary resuscitation (CPR)-related artifacts in pediatric rescue that have the potential for serious complications in surviving patients have been well described in the medical literature. Medically trivial soft-tissue injuries, especially of the face and neck, carry predominantly forensic significance and have received less attention. We describe such injuries in nine of 25 consecutive cases of infants who received CPR, and correlate those injuries with specific rescue maneuvers. Techniques for effective investigation and interpretation of such injuries are suggested.
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Affiliation(s)
- J A Kaplan
- Office of the Chief Medical Examiner, Concord, NH 03301
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25
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Kaplan JA. Delayed fatal hemothorax due to traumatic carotid dissection: a case report of a previously unreported cause of death. J Forensic Sci 1994; 39:552-6. [PMID: 8195765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A unique case of delayed fatal hemothorax in a 12-year-old girl resulting from atypical dissection of a traumatic carotid aneurysm is reported, due to occult neck trauma received in a sledding accident which occurred one week prior to death. Aspects of traumatic carotid dissection and forensic implications of delayed presentation of such findings in the setting of occult trauma are discussed.
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Affiliation(s)
- J A Kaplan
- New Hampshire State Medical Examiners Office, Concord 03301
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Kaplan JA. Health care reform. Introduction. Mt Sinai J Med 1994; 61:175-6. [PMID: 8022430] [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: 01/28/2023]
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28
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Kaplan JA, Karofsky PS, Volturo GA. Commotio cordis in two amateur ice hockey players despite the use of commercial chest protectors: case reports. J Trauma 1993; 34:151-3. [PMID: 8437184 DOI: 10.1097/00005373-199301000-00030] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We describe two recent deaths in 15-year-old male ice hockey players. Both adolescents died of commotio cordis from chest impacts by ice hockey pucks despite their use of commercially designed and manufactured chest protectors. Commotio cordis is discussed as a preventable sports-related injury in the adolescent age group, and the need for improved chest protective equipment in preventing such injuries is also examined.
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Affiliation(s)
- J A Kaplan
- Office of the Chief Medical Examiner, State of New Hampshire, Concord 03301
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Affiliation(s)
- J A Kaplan
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY
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Abstract
In many cases of self-inflicted contact wounds of the head with rimfire rifles, we have noted that the entrance wound appears unusual: in 50% of cases studied, a pencil-like extension or zone of blackened and seared skin extends downward from the entrance. The most probable cause for the appearance of this wound is a momentary break in contact between the muzzle and skin as the victim reaches for the trigger with resultant escape of a jet of hot sooty gas. Whereas not unique for rimfire rifles, such a wound from a handgun is uncommon.
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Affiliation(s)
- V J Di Maio
- Medical Examiner's Office of Bexar County, San Antonio, Texas 78207
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34
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35
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36
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Abstract
The incidence of postoperative hypertension after both cardiac and noncardiac surgery is a major concern. alpha-Adrenergic-blocking drugs, such as phentolamine, and direct-acting vasodilators, such as nitroglycerin and nitroprusside, are commonly used to treat hypertension. Nifedipine, a calcium channel blocker, may also be used, but because no intravenous preparation is available, its effects are not titratable. A new short-acting calcium channel blocker, nicardipine, is a potent vasodilator and produces more selective responses in the coronary versus the systemic vascular circulation. It is an effective cerebral vasodilator, increasing cerebral blood flow and oxygen delivery. Nicardipine can be administered as an intravenous loading infusion of 10 to 15 mg/hr for 25 minutes, followed by a maintenance infusion of 3 to 5 mg/hr. Nicardipine has a short duration factor, is easily titratable and is as effective as nitroglycerin or nitroprusside in the control of hypertension. In summary, nicardipine has many properties of an ideal drug for the treatment of postoperative hypertension.
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Affiliation(s)
- J A Kaplan
- Department of Anesthesiology, Mt. Sinai School of Medicine, Mt. Sinai Medical Center, New York, NY 10029
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38
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39
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Affiliation(s)
- D M Thys
- Division of Cardiothoracic Anesthesia, Mount Sinai School of Medicine, New York, NY 10029
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40
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Affiliation(s)
- J A Kaplan
- Mount Sinai School of Medicine, New York, NY
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41
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Reich DL, Konstadt SN, Thys DM, Hillel Z, Raymond R, Kaplan JA. Effects of doxacurium chloride on biventricular cardiac function in patients with cardiac disease. Br J Anaesth 1989; 63:675-81. [PMID: 2532920 DOI: 10.1093/bja/63.6.675] [Citation(s) in RCA: 22] [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: 01/01/2023] Open
Abstract
The effects of doxacurium chloride, a new long-acting non-depolarizing neuromuscular blocking drug, on cardiac performance were studied in 45 patients undergoing high-dose fentanyl-diazepam-oxygen anaesthesia for cardiac surgery. Data were collected at baseline (10 min after tracheal intubation), and at 2, 5 and 10 min after an i.v. bolus of doxacurium with a rapid-response thermistor pulmonary arterial catheter, using two-dimensional transoesophageal echocardiography, and direct arterial pressure measurement. The patients were allocated to four groups based on the type of surgery and dose of doxacurium (0.05 or 0.08 mg kg-1). No changes in left or right ventricular dimensions or contractility were detected in any group. Although significant changes (P less than 0.05) occurred in several groups, all these changes were clinically insignificant (less than 10% change from baseline values), and were similar to those seen in unstimulated anaesthetized patients. Doxacurium appears to be a safe drug for use in patients undergoing cardiac surgery, and is devoid of significant cardiovascular side effects in the doses tested.
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Affiliation(s)
- D L Reich
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029
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42
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High KM, Hensley FA, Campbell D, Pierce WS, Kaplan JA. Case conference 5--1989. A 39-year-old female admitted for mitral valve surgery and myocardial revascularization. J Cardiothorac Anesth 1989; 3:643-53. [PMID: 2520947 DOI: 10.1016/0888-6296(89)90166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- K M High
- Department of Anesthesia and Surgery, Pennsylvania State University College of Medicine, Hershey
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43
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Silvay G, Salter O, Nussbaum J, Grossbarth D, Ostapkovich N, Kuni D, Kaplan JA. Assessment of depth of anesthesia during hypothermic cardiopulmonary bypass. J Cardiothorac Anesth 1989; 3:70. [PMID: 2535307 DOI: 10.1016/0888-6296(89)90813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- G Silvay
- Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029
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46
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Turlapaty P, Vary R, Kaplan JA. Nicardipine, a new intravenous calcium antagonist: a review of its pharmacology, pharmacokinetics, and perioperative applications. J Cardiothorac Anesth 1989; 3:344-55. [PMID: 2520662 DOI: 10.1016/0888-6296(89)90120-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- P Turlapaty
- Mt. Sinai School of Medicine, Department of Anesthesiology, New York, NY 10029
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47
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Griffin RM, Dimich I, Gurado R, Chiang H, Kaplan JA. Hemodynamic effects of verapamil during fentanyl-nitrous oxide anesthesia. Mt Sinai J Med 1989; 56:93-6. [PMID: 2747674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The hemodynamic effects of a verapamil infusion were investigated in six dogs given fentanyl-nitrous oxide anesthesia. Verapamil, 0.2 mg/kg, was given followed by an infusion of 3, 6, and 9 micrograms/kg per minute, which produced plasma verapamil concentrations ranging from 98 to 204 ng/ml. Verapamil significantly reduced the systemic vascular resistance index and mean arterial pressure. The decrease in afterload led to an increase in cardiac index, since there was little change in myocardial contractility (LV dP/dt). Administration of calcium chloride, 20 mg/kg, did not reverse the hemodynamic effects of verapamil. The data indicate that in dogs verapamil can be given, even in high concentrations, during fentanyl-nitrous oxide anesthesia without serious adverse electrophysiologic or hemodynamic consequences.
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Griffin RM, Dimich I, Jurado R, Pratilas V, Shiang H, Fagerstrom R, Kaplan JA. Cardiovascular effects of a nifedipine infusion during fentanyl-nitrous oxide anesthesia in dogs. J Cardiothorac Anesth 1989; 3:52-7. [PMID: 2520640 DOI: 10.1016/0888-6296(89)90011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The hemodynamic effects of a nifedipine infusion were investigated in eight dogs given fentanyl/pancuronium/nitrous oxide/oxygen anesthesia. Nifedipine (20 micrograms/kg) was given intravenously over two minutes immediately prior to each 30-minute infusion at 2 micrograms/kg/min, 4 micrograms/kg/min, and 6 micrograms/kg/min. The range of plasma nifedipine levels obtained was 52.1 to 113.7 ng/mL. The predominant hemodynamic effects were significant reductions in systemic vascular resistance (SVR) and mean aortic pressure (MAP), accompanied by a rise in cardiac index and heart rate (HR). Administration of calcium chloride (20 mg/kg) after the nifedipine infusion had no effect on SVR or MAP, but HR was significantly reduced. Serum epinephrine and norepinephrine levels increased after the infusion of nifedipine and suggested that fentanyl did not completely overcome the sympathetic response to the profound vasodilatation. The resulting tachycardia in combination with diastolic hypotension from nifedipine could have a detrimental effect on the myocardial oxygen balance.
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Affiliation(s)
- R M Griffin
- Department of Anesthesiology, School of Medicine, (CUNY), New York 10029
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49
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Dimich I, Lingham R, Gabrielson G, Singh PP, Kaplan JA. Comparative hemodynamic effects of labetalol and hydralazine in the treatment of postoperative hypertension. J Clin Anesth 1989; 1:201-6. [PMID: 2627388 DOI: 10.1016/0952-8180(89)90042-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The antihypertensive efficacy and safety of IV labetalol were evaluated and compared with the efficacy and safety of IV hydralazine in the treatment of postoperative hypertension. Twenty patients undergoing major noncardiac surgery were entered into the study. Patients were randomized and treated for postoperative hypertension with either labetalol (n = 10) or hydralazine (n = 10). Labetalol and hydralazine both produced significant reductions in arterial blood pressure (p less than 0.001) within 10 minutes, which lasted at least 2 hours. In addition, labetalol produced a significant reduction in the heart rate and rate-pressure product without creating any adverse effects. In contrast, hydralazine produced significant sinus tachycardia requiring IV propranolol in three patients, two of whom developed transient ST segment depression. These results indicate that labetalol is safe and effective for the control of postoperative hypertension, especially in those patients who are least able to tolerate tachycardia.
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Affiliation(s)
- I Dimich
- Department of Anesthesiology, Mount Sinai School of Medicine, (CUNY), New York 10029-6574
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50
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Sampson IH, Plosker H, Cohen M, Kaplan JA. Comparison of propofol and thiamylal for induction and maintenance of anaesthesia for outpatient surgery. Br J Anaesth 1988; 61:707-11. [PMID: 3264709 DOI: 10.1093/bja/61.6.707] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [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: 01/05/2023] Open
Abstract
In an open, randomized study we have compared the safety and efficacy of propofol with thiamylal for induction and maintenance of anaesthesia supplemented by nitrous oxide in elective termination of pregnancy. Induction of anaesthesia was achieved with either propofol 2.5 mg kg-1 or thiamylal 4.0 mg kg-1 followed by maintenance with 70% nitrous oxide in oxygen and repeat boluses of 25% of the induction dose i.v. as indicated clinically. Both drugs induced and maintained anaesthesia reliably, with some minor differences. Recovery from propofol was significantly more rapid. The patients in the propofol group were alert and orientated early in the postoperative period, with less nausea or vomiting. Propofol has properties that are of particular benefit in anaesthesia for ambulatory surgery.
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Affiliation(s)
- I H Sampson
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York 10029
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