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Thompson AM, Fernandez JM, Rick J, Hendricks AJ, Maarouf M, Mata EM, Collier EK, Grogan TR, Hsiao JL, Shi VY. Identifying triggers for hidradenitis suppurativa flare: a patient survey. Br J Dermatol 2021; 185:225-226. [PMID: 33665807 DOI: 10.1111/bjd.19926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A M Thompson
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - J M Fernandez
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - J Rick
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A J Hendricks
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - M Maarouf
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - E M Mata
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - E K Collier
- David Geffen School of Medicine, Los Angeles, CA, USA
| | - T R Grogan
- David Geffen School of Medicine, Los Angeles, CA, USA
| | - J L Hsiao
- University of California Los Angeles, Los Angeles, CA, USA
| | - V Y Shi
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Boukoucha M, Klaii M, Khelifa R, Maarouf M, Daghfous A, Rbaii L, Dhieb F. Arthrite infectieuse inter-apophysaire postérieure - À propos de 3 cas. J Neuroradiol 2020. [DOI: 10.1016/j.neurad.2020.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maarouf M, Maarouf C, Yosipovitch G, Shi V. 应激对表皮屏障功能的影响. Br J Dermatol 2019. [DOI: 10.1111/bjd.18589] [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: 11/27/2022]
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Maarouf M, Maarouf C, Yosipovitch G, Shi V. Impact of stress on epidermal barrier function. Br J Dermatol 2019. [DOI: 10.1111/bjd.18577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maarouf M, Costello CM, Gonzalez S, Angulo I, Curiel-Lewandrowski CN, Shi VY. In Vivo Reflectance Confocal Microscopy: Emerging Role in Noninvasive Diagnosis and Monitoring of Eczematous Dermatoses. Actas Dermosifiliogr (Engl Ed) 2019; 110:626-636. [PMID: 31202471 DOI: 10.1016/j.ad.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/20/2022] Open
Abstract
Dermatologic diagnosis and monitoring have been dependent largely on visual grading. A skin biopsy is performed in case of diagnostic uncertainty, but can be traumatic, and results are delayed due to time for specimen transport and processing. Biopsies also destroy specimens, prohibiting lesion evolution monitoring. In vivo reflectance confocal microscopy (RCM) offers a diagnostic alternative to skin biopsy. RCM captures real-time, high-resolution images, and has been piloted for the evaluation of various dermatologic conditions. Identification of unique RCM features may distinguish dermatoses with similar clinical morphologies. Allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) are diagnosed by patch testing that currently uses a subjective scoring system. RCM has increasingly been studied for early detection and severity grading of CD. Common RCM features shared by ACD and ICD are stratum corneum disruption, vesicle formation, exocytosis, spongiosis, and parakeratosis. Features unique to ACD are vasodilation, increased epidermal thickness, intercellular edema, and acanthosis. Features unique to ICD are detached corneocytes and targetoid keratinocytes. This review summarizes the use of RCM in evaluating contact eccematous conditions and aims to spark future research and interest in this promising tool.
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Affiliation(s)
- M Maarouf
- Facultad de Medicina, Universidad de Arizona, Tucson, Arizona, Estados Unidos
| | - C M Costello
- Departamento de Dermatología, Clínica Mayo, Scottsdale, Arizona, Estados Unidos
| | - S Gonzalez
- Servicio de Dermatología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - I Angulo
- Departamento de Medicina, Universidad de ArizonaTucson, Arizona, Estados Unidos
| | - C N Curiel-Lewandrowski
- División de Dermatología, Departamento de Medicina, Universidad de Arizona, Tucson, Arizona, Estados Unidos
| | - V Y Shi
- División de Dermatología, Departamento de Medicina, Universidad de Arizona, Tucson, Arizona, Estados Unidos.
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Maarouf M, Maarouf CL, Yosipovitch G, Shi VY. The impact of stress on epidermal barrier function: an evidence-based review. Br J Dermatol 2019; 181:1129-1137. [PMID: 30614527 DOI: 10.1111/bjd.17605] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The epidermal barrier functions to limit skin infection and inflammation by inhibiting irritant and immunogen invasion. Abundant evidence suggests that psychological stress stemming from crowding, isolation, nicotine smoking, insomnia, mental arithmetic tasks, physical pain, real-life stressors (examinations and marital strain) and lack of positive personality traits may impart both acute and chronic epidermal dysfunction. OBJECTIVES To review the relationship between stress and epidermal barrier dysfunction. METHODS A review of the PubMed and Embase databases was conducted to identify all English-language case-control, cross-sectional and randomized control trials that have reported the effect of stress on epidermal barrier function. The authors' conclusions are based on the available evidence from 21 studies that met the inclusion and exclusion criteria. RESULTS Psychological stressors upregulate the hypothalamic-pituitary-adrenal axis to stimulate local and systemic stress hormone production. This ultimately leads to aberrant barrier dysfunction, characterized by decreased epidermal lipid and structural protein production, decreased stratum corneum hydration and increased transepidermal water loss. CONCLUSIONS This evidence-based review explores the adverse effects of psychological stressors on epidermal barrier function. Future investigations using more real-life stressors are needed to elucidate further their impact on skin physiology and identify practical stress-relieving therapies that minimize and restore epidermal barrier dysfunction, particularly in at-risk populations. What's already known about this topic? The literature reports the negative effect of stress on prolonged wound healing. Less is known about the relationship between stress and epidermal barrier dysfunction, a chronic, superficial wound involving the upper epidermal layers. What does this study add? Psychological stressors impact epidermal barrier function by activating the hypothalamic-pituitary-adrenal axis to stimulate local and systemic stress hormone production. Stress hormones negatively affect the epidermal barrier by decreasing epidermal lipids and structural proteins, decreasing stratum corneum hydration and increasing transepidermal water loss. Identification of such stressors can promote stress-avoidance and stress-reduction behaviours that protect epidermal barrier function and prevent certain dermatological conditions.
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Affiliation(s)
- M Maarouf
- College of Medicine, University of Arizona, Tucson, AZ, U.S.A
| | - C L Maarouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, U.S.A
| | - G Yosipovitch
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, U.S.A
| | - V Y Shi
- Department of Medicine, Division of Dermatology, University of Arizona, Tucson, AZ, U.S.A
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Maarouf M, Hendricks A, Culpepper KS, Shi VY. Multiple eruptive cutaneous horns on the scalp. Clin Exp Dermatol 2019; 44:906-908. [PMID: 30604475 DOI: 10.1111/ced.13866] [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] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M Maarouf
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | - A Hendricks
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | | | - V Y Shi
- University of Arizona, Department of Medicine, Division of Dermatology, Tucson, AZ, USA
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Maarouf M, Yozwiak M, Zhang H, Alberts D. LB1482 Predictive karyometric phenotype in metastatic intermediate-thickness melanomas. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.06.011] [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: 11/25/2022]
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Maarouf M, Vaughn AR, Shi VY. Topical micronutrients in atopic dermatitis-An evidence-based review. Dermatol Ther 2018; 31:e12659. [DOI: 10.1111/dth.12659] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023]
Affiliation(s)
- M. Maarouf
- College of Medicine; University of Arizona; Tucson Arizona
| | - A. R. Vaughn
- College of Medicine; Drexel University; Philadelphia Pennsylvania
| | - V. Y. Shi
- Department of Medicine, Division of Dermatology; University of Arizona; Tucson Arizona
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Maarouf M, Tran K, Yozwiak M, Sligh J, Wondrak G, Shi V. 664 Atopic dermatitis: Linking skin barrier function with antioxidant defense. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Noreik M, Kuhn J, Hardenacke K, Lenartz D, Bauer A, Bührle CP, Häussermann P, Hellmich M, Klosterkötter J, Wiltfang J, Maarouf M, Freund HJ, Visser-Vandewalle V, Sturm V, Schulz RJ. Changes in Nutritional Status after Deep Brain Stimulation of the Nucleus Basalis of Meynert in Alzheimer's Disease--Results of a Phase I Study. J Nutr Health Aging 2015; 19:812-8. [PMID: 26412285 DOI: 10.1007/s12603-015-0595-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The progression of Alzheimer's disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the progression of AD. DBS is an approved method in the treatment of Parkinson's disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status. DESIGN A 1-year phase I proof-of-concept study. SETTING The Department of Psychiatry and Psychotherapy at the University of Cologne. PARTICIPANTS We assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent. INTERVENTION Bilateral low-frequency DBS of the nucleus basalis of Meynert. MEASUREMENTS Nutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate. RESULTS With a normal body mass index (BMI) at baseline (mean 23.75 kg/m²) and after 1 year (mean 24.59 kg/m²), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman's rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman's rho = -0.829, p = 0.042). CONCLUSION Patients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
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Affiliation(s)
- M Noreik
- M. Noreik, University of Cologne, Medical Faculty, Geriatrics Department, Cologne, Germany,
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Kuhn J, Hardenacke K, Lenartz D, Gruendler T, Ullsperger M, Bartsch C, Mai JK, Zilles K, Bauer A, Matusch A, Schulz RJ, Noreik M, Bührle CP, Maintz D, Woopen C, Häussermann P, Hellmich M, Klosterkötter J, Wiltfang J, Maarouf M, Freund HJ, Sturm V. Deep brain stimulation of the nucleus basalis of Meynert in Alzheimer's dementia. Mol Psychiatry 2015; 20:353-60. [PMID: 24798585 DOI: 10.1038/mp.2014.32] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/06/2014] [Accepted: 02/24/2014] [Indexed: 11/09/2022]
Abstract
Cholinergic neurons of the medial forebrain are considered important contributors to brain plasticity and neuromodulation. A reduction of cholinergic innervation can lead to pathophysiological changes of neurotransmission and is observed in Alzheimer's disease. Here we report on six patients with mild to moderate Alzheimer's disease (AD) treated with bilateral low-frequency deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM). During a four-week double-blind sham-controlled phase and a subsequent 11-month follow-up open label period, clinical outcome was assessed by neuropsychological examination using the Alzheimer's Disease Assessment Scale-cognitive subscale as the primary outcome measure. Electroencephalography and [(18)F]-fluoro-desoxyglucose positron emission tomography were, besides others, secondary endpoints. On the basis of stable or improved primary outcome parameters twelve months after surgery, four of the six patients were considered responders. No severe or non-transitional side effects related to the stimulation were observed. Taking into account all limitations of a pilot study, we conclude that DBS of the NBM is both technically feasible and well tolerated.
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Affiliation(s)
- J Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - K Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - D Lenartz
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - T Gruendler
- 1] Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany [2] Faculty of Economics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany [3] Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - M Ullsperger
- 1] Center for Behavioral Brain Sciences, Magdeburg, Germany [2] Institute of Psychology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - C Bartsch
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J K Mai
- Department of Neuroanatomy, University of Düsseldorf, Düsseldorf, Germany
| | - K Zilles
- 1] Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany [2] University Hospital of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - A Bauer
- 1] Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany [2] Department of Neurology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - A Matusch
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - R-J Schulz
- University of Cologne, Department of Geriatrics and St. Marien-Hospital, Cologne, Germany
| | - M Noreik
- University of Cologne, Department of Geriatrics and St. Marien-Hospital, Cologne, Germany
| | - C P Bührle
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - D Maintz
- University of Cologne, Department for Radiology, Cologne, Germany
| | - C Woopen
- University of Cologne, Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, Cologne, Germany
| | - P Häussermann
- LVR Clinic Cologne, Department of Gerontopsychiatry, Cologne, Germany
| | - M Hellmich
- University of Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August-University, Göttingen, Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Klinikum Merheim, Cologne, Germany
| | - H-J Freund
- Department of Neuroanatomy, University of Düsseldorf, Düsseldorf, Germany
| | - V Sturm
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
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Lewis CJ, Maier F, Horstkötter N, Zywczok A, Witt K, Eggers C, Meyer TD, Dembek TA, Maarouf M, Moro E, Zurowski M, Woopen C, Kuhn J, Timmermann L. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease. Psychol Med 2015; 45:73-85. [PMID: 25066623 DOI: 10.1017/s0033291714001081] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 01/27/2023]
Abstract
BACKGROUND Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients. METHOD In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients' personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed. RESULTS Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group. CONCLUSIONS Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
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Affiliation(s)
- C J Lewis
- Department of Neurology,University of Cologne,Cologne,Germany
| | - F Maier
- Department of Neurology,University of Cologne,Cologne,Germany
| | - N Horstkötter
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - A Zywczok
- Department of Neurology,University of Cologne,Cologne,Germany
| | - K Witt
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - C Eggers
- Department of Neurology,University of Cologne,Cologne,Germany
| | - T D Meyer
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - T A Dembek
- Department of Neurology,University of Cologne,Cologne,Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery,University of Cologne,Cologne,Germany
| | - E Moro
- Movement Disorders Unit, Department of Psychiatry and Neurology,University Hospital Center (CHU) of Grenoble,Grenoble,France
| | - M Zurowski
- Department of Psychiatry,University of Toronto, University Health Network,Toronto,Canada
| | - C Woopen
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - L Timmermann
- Department of Neurology,University of Cologne,Cologne,Germany
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Alesch F, Jain R, Chen L, Brücke T, Seijo F, Martin ESS, Haegelen C, Verin M, Maarouf M, Barbe M, Gill S, Whone A, Porta M, Servello D, Timmermann L. Essai VANTAGE : suivi de douze (12) mois d’une étude prospective multicentrique évaluant la stimulation cérébrale profonde avec un nouveau système rechargeable à sources de courant multiples indépendantes (Vercise™) dans la maladie de Parkinson. Neurochirurgie 2014. [DOI: 10.1016/j.neuchi.2014.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Huys D, Bartsch C, Poppe P, Lenartz D, Huff W, Prütting J, Timmermann L, Klosterkötter J, Maarouf M, Rommel T, Hartmann A, Sturm V, Kuhn J. Management and outcome of pallidal deep brain stimulation in severe Huntington's disease. Fortschr Neurol Psychiatr 2013; 81:202-5. [PMID: 23589113 DOI: 10.1055/s-0033-1335097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neurodegenerative movement disorders, such as Huntington's disease (HD), have become a promising field for Deep Brain Stimulation (DBS). This study aims to contribute to the establishment of a well-grounded database including both expected and unexpected effects of pallidal DBS in HD, and to discuss the ethical and legal restrictions of DBS in cognitively limited patients. Evaluation of the outcome data indicates that pallidal DBS exerted an independent effect on motor symptoms but probably also on the patient's cognitive and affective state. The cognitive decline, however, that characterizes the late stage of neurodegenerative disorders implicates ethical and legal problems given the patients' inability to give informed consent to DBS.
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Affiliation(s)
- D Huys
- Department of Psychiatry and Psychotherapy, University-Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Florin E, Dafsari HS, Reck C, Barbe MT, Pauls KAM, Maarouf M, Sturm V, Fink GR, Timmermann L. Modulation of local field potential power of the subthalamic nucleus during isometric force generation in patients with Parkinson's disease. Neuroscience 2013; 240:106-16. [PMID: 23454540 DOI: 10.1016/j.neuroscience.2013.02.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
Abstract
Investigations of local field potentials of the subthalamic nucleus of patients with Parkinson's disease have provided evidence for pathologically exaggerated oscillatory beta-band activity (13-30 Hz) which is amenable to physiological modulation by, e.g., voluntary movement. Previous functional magnetic resonance imaging studies in healthy controls have provided evidence for an increase of subthalamic nucleus blood-oxygenation-level-dependant signal in incremental force generation tasks. However, the modulation of neuronal activity by force generation and its relationship to peripheral feedback remain to be elucidated. We hypothesised that beta-band activity in the subthalamic nucleus is modulated by incremental force generation. Subthalamic nucleus local field potentials were recorded intraoperatively in 13 patients with Parkinson's disease (37 recording sites) during rest and five incremental isometric force generation conditions of the arm with applied loads of 0-400 g (in 100-g increments). Repeated measures analysis of variance (ANOVA) revealed a modulation of local field potential (LFP) power in the upper beta-band (in 24-30 Hz; F(₃.₀₄₂)=4.693, p=0.036) and the gamma-band (in 70-76 Hz; F(₄)=4.116, p=0.036). Granger-causality was computed with the squared partial directed coherence and showed no significant modulation during incremental isometric force generation. Our findings indicate that the upper beta- and gamma-band power of subthalamic nucleus local field potentials are modulated by the physiological task of force generation in patients with Parkinson's disease. This modulation seems to be not an effect of a modulation of peripheral feedback.
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Affiliation(s)
- E Florin
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
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Schuepbach WMM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, Hälbig TD, Hesekamp H, Navarro SM, Meier N, Falk D, Mehdorn M, Paschen S, Maarouf M, Barbe MT, Fink GR, Kupsch A, Gruber D, Schneider GH, Seigneuret E, Kistner A, Chaynes P, Ory-Magne F, Brefel Courbon C, Vesper J, Schnitzler A, Wojtecki L, Houeto JL, Bataille B, Maltête D, Damier P, Raoul S, Sixel-Doering F, Hellwig D, Gharabaghi A, Krüger R, Pinsker MO, Amtage F, Régis JM, Witjas T, Thobois S, Mertens P, Kloss M, Hartmann A, Oertel WH, Post B, Speelman H, Agid Y, Schade-Brittinger C, Deuschl G. Neurostimulation for Parkinson's disease with early motor complications. N Engl J Med 2013; 368:610-22. [PMID: 23406026 DOI: 10.1056/nejmoa1205158] [Citation(s) in RCA: 851] [Impact Index Per Article: 77.4] [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: 11/19/2022]
Abstract
BACKGROUND Subthalamic stimulation reduces motor disability and improves quality of life in patients with advanced Parkinson's disease who have severe levodopa-induced motor complications. We hypothesized that neurostimulation would be beneficial at an earlier stage of Parkinson's disease. METHODS In this 2-year trial, we randomly assigned 251 patients with Parkinson's disease and early motor complications (mean age, 52 years; mean duration of disease, 7.5 years) to undergo neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, as assessed with the use of the Parkinson's Disease Questionnaire (PDQ-39) summary index (with scores ranging from 0 to 100 and higher scores indicating worse function). Major secondary outcomes included parkinsonian motor disability, activities of daily living, levodopa-induced motor complications (as assessed with the use of the Unified Parkinson's Disease Rating Scale, parts III, II, and IV, respectively), and time with good mobility and no dyskinesia. RESULTS For the primary outcome of quality of life, the mean score for the neurostimulation group improved by 7.8 points, and that for the medical-therapy group worsened by 0.2 points (between-group difference in mean change from baseline to 2 years, 8.0 points; P=0.002). Neurostimulation was superior to medical therapy with respect to motor disability (P<0.001), activities of daily living (P<0.001), levodopa-induced motor complications (P<0.001), and time with good mobility and no dyskinesia (P=0.01). Serious adverse events occurred in 54.8% of the patients in the neurostimulation group and in 44.1% of those in the medical-therapy group. Serious adverse events related to surgical implantation or the neurostimulation device occurred in 17.7% of patients. An expert panel confirmed that medical therapy was consistent with practice guidelines for 96.8% of the patients in the neurostimulation group and for 94.5% of those in the medical-therapy group. CONCLUSIONS Subthalamic stimulation was superior to medical therapy in patients with Parkinson's disease and early motor complications. (Funded by the German Ministry of Research and others; EARLYSTIM ClinicalTrials.gov number, NCT00354133.).
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Affiliation(s)
- W M M Schuepbach
- Assistance Publique–Hôpitaux de Paris, Centre d'Investigation Clinique (CIC) 9503, Institut du Cerveau et de la Moelle Épinière, Département de Neurologie, Université Pierre et Marie Curie–Paris 6 and INSERM, Centre Hospitalier Universitaire (CHU) Pitié–Salpêtrière, Paris, France
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Fuetsch M, El Majdoub F, Hoevels M, Müller RP, Sturm V, Maarouf M. Stereotactic LINAC radiosurgery for the treatment of brainstem cavernomas. Strahlenther Onkol 2012; 188:311-6. [PMID: 22314579 DOI: 10.1007/s00066-011-0050-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/15/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of deep-seated cerebral cavernous malformations (CCMs) is still controversial. Although surgery remains the treatment of choice in patients with recurrent hemorrhage, patients with CCMs located in the brainstem are in many cases not eligible for resection due to high procedure-related morbidity and mortality. We evaluated the long-term outcome of LINAC radiosurgery (LINAC-RS) for the treatment of brainstem CCMs. PATIENTS AND METHODS Between December 1992 and March 2008, 14 patients (6 men, 8 women) harboring brainstem CCMs underwent LINAC-RS. Pretreatment neuroimaging showed no associated developmental venous angiomas (DVAs) in any of our patients. Prior to treatment, all patients suffered at least from one symptomatic hemorrhage (median 1.8, range 1–3). A median follow-up of 7.1 years (range 2.0–16.8 years) could be obtained in 12 patients. We applied a median tumor surface dose of 13.9 Gy (range 11–18 Gy; median tumor volume 1.6 ml, range 0.4–4.3 ml). RESULTS Following LINAC-RS, neurological outcome improved in 4 (33.3%) and remained unchanged in 8 patients (66.7%). Rebleeding with subsequent transient neurological status deterioration occurred in 4 patients (33.3%), leading to additional surgical resection in 2 patients (16.7%). The corresponding annual hemorrhage rate was 4.8% (4/82.8 patient–years). Adverse radiation effects (ARE, defined by perilesional hyperintensity on T2-weighted MR images) were revealed in 3 patients (25%), leading to transient neurological deficits in 2 patients (16.7%). There were no procedure-related complications leading to either permanent morbidity or mortality. CONCLUSION Our results support the role of LINAC-RS as an efficient and safe treatment to significantly reduce the annual hemorrhage rate in patients suffering from brainstem CCMs not eligible to microsurgery. Compared with radiosurgery for arteriovenous malformations (AVMs), the intervention-related morbidity is higher.
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Affiliation(s)
- M Fuetsch
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne
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Florin E, Himmel M, Reck C, Maarouf M, Schnitzler A, Sturm V, Fink G, Timmermann L. Subtype-specific statistical causalities in parkinsonian tremor. Neuroscience 2012; 210:353-62. [DOI: 10.1016/j.neuroscience.2012.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/18/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
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Pauls A, Braun N, Quatuor EL, Maarouf M, Timmermann L. Electrophysiologial mapping of alpha and beta activity across the ventrolateral (motor) thalamus: a local field potential study. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Florin E, Salimi Dafsari H, Reck C, Barbe MT, Pauls A, Maarouf M, Maarouf M, Sturm V, Fink GR, Timmermann L. Modulation of subthalamic nucleus local field potential power during incremental isometric force generation in Parkinson's disease patients. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pedrosa DJ, Reck C, Maarouf M, Wojtecki L, Pauls A, Sturm V, Schnitzler A, Fink GR, Timmermann L. Tremor clusters in the VIM associated with Essential tremor and Parkinson's disease. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Klein JC, Barbe MT, Seifried C, Baudrexel S, Runge M, Maarouf M, Gasser T, Hattingen E, Liebig T, Deichmann R, Timmermann L, Weise L, Hilker R. The tremor network targeted by successful VIM deep brain stimulation in humans. Neurology 2012; 78:787-95. [PMID: 22377809 DOI: 10.1212/wnl.0b013e318249f702] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the ventral intermediate nucleus of thalamus (VIM) is a treatment option in medically intractable tremor, such as essential tremor or tremor-dominant Parkinson disease (PD). Although functional studies demonstrated modulation of remote regions, the structural network supporting this is as yet unknown. In this observational study, we analyzed the network mediating clinical tremor modulation. METHODS We studied 12 patients undergoing VIM stimulation for debilitating tremor. We initiated noninvasive diffusion tractography from tremor-suppressive VIM electrode contacts. Moreover, we tested for the contribution of primary motor projections in this structural correlate of a functional tremor network, comparing the connectivity of effective DBS contacts with those of adjacent, but clinically ineffective, stimulation sites. RESULTS VIM stimulation resulted in decrease of tremor and improvement in quality of life. Tractography initiated from the effective stimulation site reconstructed a highly reproducible network of structural connectivity comprising motor cortical, subcortical, and cerebellar sites and the brainstem, forming the anatomic basis for remote effects of VIM stimulation. This network is congruent with functional imaging studies in humans and with thalamic projections found in the animal literature. Connectivity to the primary motor cortex seemed to play a key role in successful stimulation. CONCLUSIONS Patients undergoing DBS provide a unique opportunity to assess an electrophysiologically defined seed region in human thalamus, a technique that is usually restricted to animal research. In the future, preoperative tractography could aid with stereotactic planning of individual subcortical target points for stimulation in tremor and in other disease entities.
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Affiliation(s)
- J C Klein
- Department of Neurology, Goethe-University Frankfurt, Frankfurt Germany.
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Deckert M, Engert A, Brück W, Ferreri AJM, Finke J, Illerhaus G, Klapper W, Korfel A, Küppers R, Maarouf M, Montesinos-Rongen M, Paulus W, Schlegel U, Lassmann H, Wiestler OD, Siebert R, DeAngelis LM. Modern concepts in the biology, diagnosis, differential diagnosis and treatment of primary central nervous system lymphoma. Leukemia 2011; 25:1797-807. [PMID: 21818113 DOI: 10.1038/leu.2011.169] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent studies addressing the molecular characteristics of PCNSL, which is defined as malignant B-cell lymphoma with morphological features of DLBCL, have significantly improved our understanding of the pathogenesis of this lymphoma entity, which is associated with an inferior prognosis as compared with DLBCL outside the CNS. This unfavorable prognosis stimulated intense efforts to improve therapy and induced recent series of clinical studies, which addressed the role of radiotherapy and various chemotherapeutic regimens. This review combines the discussion of diagnosis, differential diagnosis and recent progress in studies addressing the molecular pathogenesis as well as therapeutic options in PCNSL.
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Affiliation(s)
- M Deckert
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany.
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Daghfous A, Daiki M, Ben Khélifa El Moncer R, Maarouf M, Felah S, Zoghlami A, Rezgui-Marhoul L. [Acute traumatic thoracic aortic rupture in double localisation]. Ann Cardiol Angeiol (Paris) 2011; 63:51-4. [PMID: 22118924 DOI: 10.1016/j.ancard.2011.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/20/2010] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Traumatic thoracic aortic rupture are commonly localised in one site essentially in the aortic isthmus but multiple localisation are not uncommon. The authors reported the case of a young man who had a double localisation of RTA after a violent car accident. CASE REPORT A 23-year-old man had a violent car crush involving sudden deceleration. He had multiple injuries essentially: a traumatic thoracic injury with acute posttraumatic aortic rupture in double localization, in the isthmus and in the descending thoracic aorta. He underwent thoracic endovascular aortic repair (TEVAR) with the use of stent graft three weeks after his car accident. The endovascular treatment was successful and no case of perigraft leakage has been detected during a meaning follow-up of five months. CONCLUSION The systematic analysis of the whole thoracic aortic vessel is crucial to not misdiagnose eventual multiple aortic rupture.
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Affiliation(s)
- A Daghfous
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie.
| | - M Daiki
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
| | - R Ben Khélifa El Moncer
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
| | - M Maarouf
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
| | - S Felah
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
| | - A Zoghlami
- Service de chirurgie générale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
| | - L Rezgui-Marhoul
- Service d'imagerie médicale, centre de traumatologie et des grands brûlés, Ben-Arous, Tunis, Tunisie
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Pauls KAM, Reck C, Barbe MT, Maarouf M, Sturm V, Fink GR, Timmermann L. Post-traumatic hyperkinesias in patients with Parkinson's disease with stimulation of the subthalamic nucleus. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Krämer S, Maarouf M, Müller-Lung U. [Prolonged fever and monocytosis after hemorrhoidectomy and treatment with methotrexate--listeriosis with cerebral abscess]. Dtsch Med Wochenschr 2009; 134:1218-21. [PMID: 19472093 DOI: 10.1055/s-0029-1222597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 58-year-old man was admitted because of septic fever for about one week with onset two weeks after an hemorrhoidectomy. He had been receiving methotrexate (MTX) since boyhood for severe psoriasis. Fifteen years before he had undergone a splenectomy after abdominal trauma. The patient was found to have diminished cognitive functions and memory disturbance, but no focal neurological deficits. INVESTIGATIONS Laboratory tests were negative for inflammatory disease (normal white blood cell count, CRP and procalcitonin) and serial blood cultures remained sterile. Cranial computed tomography (CCT), done because viral encephalitis was suspected, revealed a large focus in the left hemisphere, further identified as abscess on magnetic imaging. TREATMENT AND COURSE The patient's fever subsided within two days of treatment with ampicillin and ciprofloxacin. The patient was sent to the department of neurosurgery for further diagnosis. Stereotactic biopsy revealed Listeria monocytogenes. Antibiotic treatment was modified in accordance with the microbiological results and the patient was transferred to a rehabilitation unit. CONCLUSIONS Lack of pathological levels of CRP, procalcitonin and white blood cell count does not exclude cerebral abscess in a patient with prolonged fever and without marked neurological deficits. Preceding treatment with immunosuppressive drugs, especially MTX, and failing response to cephalosporins should lead to consideration of listeriosis in the differential diagnosis.
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Affiliation(s)
- S Krämer
- Malteser Krankenhaus St. Hildegardis Köln, Medizinische Abteilung, Bachemer Strasse 29-33, Köln.
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Gossmann A, Poggenborg J, Maarouf M, Berg F, Sturm V, Lackner K. Evaluation of residual perfusion of treated AVMs using a 4D MR angiography at 3T in correlation to i.a. DSA. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1052585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Roggendorf J, Vent J, Maarouf M, Haense C, Thiel A, Fink G, Hilker R. Geschmacksstörung unter tiefer Hirnstimulation des Thalamus bei essenziellem Tremor. Nervenarzt 2008; 79:454-6. [DOI: 10.1007/s00115-007-2407-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wojtecki L, Timmermann L, Elben S, Jörgens S, Südmeyer M, Groiss S, Ploner M, Maarouf M, Voges J, Sturm V, Niedeggen M, Schnitzler A. Modulierbarkeit von Zeitwahrnehmung durch Tiefe Hirnstimulation des Nucleus subthalamicus bei Patienten mit Morbus Parkinson. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Poggenborg J, Gossmann A, Maarouf M, Berg F, Lackner K, Sturm V. Beurteilung der Restperfusion bei vorbehandelten AVM Patienten mittels der 4D MR Angiographie bei 3 Tesla in Korrelation zur i.a. DSA. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reck C, Florin E, Gross J, Ostrowski S, Krause H, Groiss S, Wojtecki L, Ploner M, Südmeyer M, Voges J, Maarouf M, Lehrke R, Treuer H, Fink GR, Sturm V, Schnitzler A, Timmermann L. Räumliche und zeitlich-dynamische Kohärenzanalyse zwischen lokalen Feldpotentialen im Nucleus subthalamicus und Tremor EMG Aktivität bei Patienten mit idiopathischem Morbus Parkinson. Akt Neurol 2007. [DOI: 10.1055/s-2007-987671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Florin E, Reck C, Gross J, Ostrowski S, Krause H, Groiss S, Wojtecki L, Ploner M, Südmeyer M, Voges J, Maarouf M, Lehrke R, Treuer H, Fink GR, Sturm V, Schnitzler A, Timmermann L. Efferente und afferente Kausalitätsbeziehungen zwischen lokalen Feldpotentialen im Nucleus ventralis intermedius thalami und EMG-Aktivität bei Patienten mit Multiple Sklerose Tremor. Akt Neurol 2007. [DOI: 10.1055/s-2007-987559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V. Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery--experiences from a single centre. J Neurol Neurosurg Psychiatry 2006; 77:868-72. [PMID: 16574733 PMCID: PMC2117492 DOI: 10.1136/jnnp.2005.081232] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [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: 11/04/2022]
Abstract
OBJECTIVE To determine the surgery-related and hardware-related complications of deep-brain stimulation (DBS) at a single centre. METHODS 262 consecutive patients (472 electrodes) operated for DBS in our department from February 1996 to March 2003 were retrospectively analysed to document acute adverse events (30 days postoperatively). The data of 180 of these patients were additionally revised to assess long-term complications (352 electrodes, mean follow-up 36.3 (SD 20.8) months). RESULTS The frequency of minor intraoperative complications was 4.2% (11/262 patients). Transient (0.2%) or permanent (0.4%) neurological deficits, and in one case asymptomatic intracranial haemorrhage (0.2%), were registered as acute severe adverse events caused by surgery. Among minor acute complications were subcutaneous bleeding along the extension wire (1.2%) and haematoma at the pulse generator implantation site (1.2%). Skin infection caused by the implanted material was registered in 15 of 262 patients (5.7%). The infection rate during the first observation period was 1.5% (4/262 patients) and the late infection rate was 6.1% (11/180 patients). Partial or complete removal of the stimulation system was necessitated in 12 of 262 (4.6%) patients because of skin infection. During the long-term observation period, hardware-related problems were registered in 25 of 180 (13.9%) patients. CONCLUSIONS Stereotactic implantation of electrodes for DBS, if performed with multiplanar three-dimensional imaging and advanced treatment planning software, is a safe procedure with no mortality and low morbidity. The main causes for the patients' prolonged hospital stay and repeated surgery were wound infections and hardware-related complications.
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Affiliation(s)
- J Voges
- Department of Stereotaxy and Functional Neurosurgery, University Köln, Kerpenerstr 62, 50924 Köln, Germany.
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Maarouf M, Voges J, El Majdoub F, Treuer H, Kocher M, Sturm V. Stereotactic LINAC Radiosurgery for Glomus Jugulare Tumors: Long-Term Follow-Up. Skull Base 2005. [DOI: 10.1055/s-2005-916474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maarouf M, Runge M, Kocher M, Zähringer M, Treuer H, Sturm V. Radiosurgery for cerebral arteriovenous malformations in hereditary hemorrhagic telangiectasia. Neurology 2005; 63:367-9. [PMID: 15277641 DOI: 10.1212/01.wnl.0000130197.31844.16] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors evaluated the efficacy of radiosurgery (RS) for cerebral arteriovenous malformations in hereditary hemorrhagic telangiectasia (HHT AVMs). Two patients with seven HHT AVMs were treated by linear accelerator-RS. Complete obliteration was achieved 18 to 24 months post-treatment without side effects. Because HHT AVMs are small and multiple, RS is superior to microsurgery because it is noninvasive and all AVMs can be treated in one session regardless of their location.
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Affiliation(s)
- M Maarouf
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Joseph-Stelzmann-Strasse 9, D-50924 Cologne, Germany.
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Treuer H, Hunsche S, Hoevels M, Luyken K, Maarouf M, Voges J, Sturm V. The influence of head frame distortions on stereotactic localization and targeting. Phys Med Biol 2004; 49:3877-87. [PMID: 15470911 DOI: 10.1088/0031-9155/49/17/004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A strong attachment of a stereotactic head frame to the patient's skull may cause distortions of the head frame. The aim of this work was to identify possible distortions of the head frame, to measure the degree of distortion occurring in clinical practice and to investigate its influence on stereotactic localization and targeting. A model to describe and quantify the distortion of the Riechert-Mundinger (RM) head frame was developed. Distortions were classified as (a) bending and (b) changes from the circular ring shape. Ring shape changes were derived from stereotactic CT scans and frame bending was determined from intraoperative stereotactic x-ray images of patients with implanted 125I-seeds acting as landmarks. From the examined patient data frame bending was determined to be 0.74 mm+/-0.32 mm and 1.30 mm in maximum. If a CT-localizer with a top ring is used, frame bending has no influence on stereotactic CT-localization. In stereotactic x-ray localization, frame bending leads to an overestimation of the z-coordinate by 0.37 mm+/-0.16 mm on average and by 0.65 mm in maximum. The accuracy of patient positioning in radiosurgery is not affected by frame bending. But in stereotactic surgery with an RM aiming bow trajectory displacements are expected. These displacements were estimated to be 0.36 mm+/-0.16 mm (max. 0.74 mm) at the target point and 0.65 mm+/-0.30 mm (max. 1.31 mm) at the entry point level. Changes from the circularring shape are small and do not compromise the accuracy of stereotactic targeting and localization. The accuracy of CT-localization was found to be close to the resolution limit due to voxel size. Our findings for frame bending of the RM frame could be validated by statistical analysis and by comparison with an independent patient examination. The results depend on the stereotactic system and details of the localizers and instruments and also reflect our clinical practice. Therefore, a generalization is not possible. Preliminary experience with a new MR-compatible RM head frame made of ceramics shows no frame distortions as with the conventional frame made of an Al-Cu-Mg alloy.
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Affiliation(s)
- H Treuer
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, 50924 Cologne, Germany.
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Hunsche S, Sauner D, Maarouf M, Hoevels M, Luyken K, Schulte O, Lackner K, Sturm V, Treuer H. MR-guided stereotactic neurosurgery—comparison of fiducial-based and anatomical landmark transformation approaches. Phys Med Biol 2004; 49:2705-16. [PMID: 15272683 DOI: 10.1088/0031-9155/49/12/016] [Citation(s) in RCA: 6] [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: 11/12/2022]
Abstract
For application in magnetic resonance (MR) guided stereotactic neurosurgery, two methods for transformation of MR-image coordinates in stereotactic, frame-based coordinates exist: the direct stereotactic fiducial-based transformation method and the indirect anatomical landmark method. In contrast to direct stereotactic MR transformation, indirect transformation is based on anatomical landmark coregistration of stereotactic computerized tomography and non-stereotactic MR images. In a patient study, both transformation methods have been investigated with visual inspection and mutual information analysis. Comparison was done for our standard imaging protocol, including t2-weighted spin-echo as well as contrast enhanced t1-weighted gradient-echo imaging. For t2-weighted spin-echo imaging, both methods showed almost similar and satisfying performance with a small, but significant advantage for fiducial-based transformation. In contrast, for t1-weighted gradient-echo imaging with more geometric distortions due to field inhomogenities and gradient nonlinearity than t2-weighted spin-echo imaging, mainly caused by a reduced bandwidth per pixel, anatomical landmark transformation delivered markedly better results. Here, fiducial-based transformation yielded results which are intolerable for stereotactic neurosurgery. Mean Euclidian distances between both transformation methods were 0.96 mm for t2-weighted spin-echo and 1.67 mm for t1-weighted gradient-echo imaging. Maximum deviations were 1.72 mm and 3.06 mm, respectively.
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Affiliation(s)
- S Hunsche
- Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
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Wojtecki L, Nickel J, Timmermann L, Maarouf M, Jörgens S, Südmeyer M, Schneider F, Seitz R, Voges J, Sturm V, Schnitzler A. Pathological crying induced by deep brain stimulation. Akt Neurol 2004. [DOI: 10.1055/s-2004-833147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Maarouf M, Kuchta J, Miletic H, Ebel H, Hesselmann V, Hilker R, Sturm V. Acute demyelination: diagnostic difficulties and the need for brain biopsy. Acta Neurochir (Wien) 2003; 145:961-9; discussion 969. [PMID: 14628201 DOI: 10.1007/s00701-003-0113-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the rapid development in neuro-imaging over the past two decades, ring like contrast-enhancing lesions on CCT or MRI still may pose a diagnostic challenge. The main differential diagnoses of these lesions include metastatic carcinoma, high-grade glioma and brain abscess. Acute demyelination seldom turns out to be the underlying pathology. METHOD Retrospective analysis was done on six patients with acute demyelination treated at our neurosurgical department between 1990 and 2001. Clinical, radiological, PET, intra-operative and histological findings were evaluated. FINDINGS In five patients, the diagnosis of acute demyelination was established by histopathological evaluation of stereotactic biopsy specimen, in the sixth patient following microsurgical extirpation of the lesion. Neuropathology revealed demyelination with the presence of myelin-phagocytosing macrophages. In addition, lymphocytic infiltrates were present. Symptoms and signs improved significantly after high-dose steroid therapy. CONCLUSIONS Despite CNS tissue destruction, necrosis and cyst formation are not usually found in demyelinating disease, being rather more common in young patients with ring-like contrast-enhancing lesions on CCT and MRI. Though an incorrect diagnosis can lead to a potentially fatal therapeutic intervention, histological diagnosis should be made in all cases. Due to minimum morbidity, stereotactic biopsy is the method of choice to obtain representative specimens for histological diagnosis. Open microsurgery of these lesions is not indicated since conservative medical treatment with steroids results in a favourable outcome in most cases.
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Affiliation(s)
- M Maarouf
- Department of Stereotactic and Functional Neurosurgery, Cologne University, Cologne, Germany.
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Wojtecki L, Timmermann L, Jörgens S, Südmeyer M, Gross J, Maarouf M, Lehrke R, Koulousakis A, Voges J, Sturm V, Schnitzler A. Niederfrequente tiefe Hirnstimulation des Nucleus subthalamicus mit 10Hz erhöht Wortflüssigkeit bei Patienten mit Morbus Parkinson. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Timmermann L, Wojtecki L, Gross J, Lehrke R, Voges J, Maarouf M, Sturm V, Schnitzler A. Klinischer Hinweis auf die Relevanz pathologischer oszillatorischer 10-Hz-Kopplung bei Patienten mit Morbus Parkinson. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Harzallah L, Amara H, Maarouf M, Bellara I, Garrouch A, Bakir D, Jarray M, Kraiem C. [Right tracheal bronchus associated with tuberculosis pneumonia. A case report]. Rev Pneumol Clin 2003; 59:45-48. [PMID: 12717326] [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: 05/24/2023]
Abstract
Right tracheal bronchus is a rare almost always asymptotic congenital malformation. We report a case of right tracheal bronchus associated with pneumonia tuberculosis of the apical segment of the upper right lobe. We describe the characteristic of this malformation and stress the role of computed tomography scan to detect these anomalies.
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Affiliation(s)
- L Harzallah
- Service de Radiologie, Hôpital Farhat-Hached, 4000 Sousse, Tunisie.
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Lenartz D, Kocher M, Voges J, Lehrke R, Maarouf M, Treuer H, Müller RP, Sturm V. LINAC radiosurgery for brain metastases. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schellhammer F, Schwamborn D, Maarouf M, Benz-Bohm G, Lackner K. [Primary intracranial germinoma. Problems in determining the diagnosis exemplified by 4 cases]. ROFO-FORTSCHR RONTG 2000; 172:770-4. [PMID: 11079091 DOI: 10.1055/s-2000-7217] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Primary intracranial germinoma is a possible cause of "idiopathic" diabetes insipidus in childhood and adolescence. The histopathologic appearance can be similar to inflammation, and may delay the final diagnosis. Further diagnostic difficulties are demonstrated by the use of anamnestic and clinical data as well as diagnostic imaging findings in four children with histologically proven primary intracranial germinoma.
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Affiliation(s)
- F Schellhammer
- Institut und Poliklinik für Radiologische Diagnostik, Universität zu Köln
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Koot RW, Maarouf M, Hulshof MC, Voges J, Treuer H, Koedooder C, Sturm V, Bosch DA. Brachytherapy: Results of two different therapy strategies for patients with primary glioblastoma multiforme. Cancer 2000; 88:2796-802. [PMID: 10870063] [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: 02/16/2023]
Abstract
BACKGROUND In the current study, the authors describe and compare two different strategies of brachytherapy for the treatment of patients with primary glioblastoma multiforme (GBM). METHODS The study was comprised of 84 patients. Forty-five patients were implanted with permanent or temporary low activity iodine-125 ((125)I) seeds in Cologne and 21 patients were implanted with temporary iridium-192 ((192)Ir) wires in Amsterdam. Both groups received external beam radiation therapy (EBRT); the (125)I group received 10-30 grays (Gy) with the implant in situ and the (192)Ir group received 60 Gy before implantation. In Cologne, implantation was performed after a diagnostic stereotactic biopsy whereas in Amsterdam implantation took place after cytoreductive diagnostic surgery. In addition, 18 patients in Amsterdam served as a control group. This group received only EBRT after cytoreductive surgery. RESULTS In both groups the mean age of the patients was between 50-55 years, with 80% of the patients age > 45 years. The mean implantation volume encompassed by the referenced isodose was 23 cm(3) for (125)I and 48 cm(3) for (192)Ir. Initial dose rates were 2. 5-2.9 centigrays (cGy)/hour for permanent (125)I, 4.6 cGy/hour for temporary (125)I, and 44-100 cGy/hour (mean, 61 cGy) for (192)Ir. A total dose of 50-60 Gy, 60-80 Gy, and 40 Gy, respectively, was administered at the outer margins of the tumor. The median survival was approximately 16 months for both the (125)I group and the (192)Ir group. This was 6 months longer than the median survival in the control group. Reoperations were performed in 4 patients in the (125)I group (9%) versus 7 patients in the (192)Ir group (33%). No complications or late reactions were reported in the (125)I group, whereas one case of hemorrhage and three cases of delayed stroke were observed in the (192)Ir group. CONCLUSIONS The equal median survival times in these two brachytherapy groups with such different dose rate radiation schedules support the hypothesis that dose rate does not play a major role in the survival of patients with primary GBM.
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Affiliation(s)
- R W Koot
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
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Maarouf M, Adeline MT, Solignac M, Vautrin D, Robert-Gero M. Development and characterization of paromomycin-resistant Leishmania donovani promastigotes. Parasite 1998; 5:167-73. [PMID: 9754313 DOI: 10.1051/parasite/1998052167] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [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: 11/14/2022] Open
Abstract
Paromomycin is an antileishmanial chemotherapeutic agent. Leishmania donovani promastigotes resistant to 800 microM of paromomycin were selected by increasing drug pressure and cloned. These promastigotes did not acquire multidrug resistance. Paromomycin resistance was stable in the absence of the drug in the culture. It remained stable also in amastigotes isolated after a passage in mice. Furthermore the resistant parasites were still infective to macrophages in vitro and for mice in vivo. A sensitive method to detect and to quantify intracellular paromomycin by HPLC was developed and allowed to show that the main mechanism of resistance seems to be due to decreased drug uptake probably as a consequence of altered membrane composition.
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Affiliation(s)
- M Maarouf
- University of Damascus, Faculty of Pharmacy, Dept of Biochemistry & Microbiology, Syria
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Abstract
Paromomycin is an aminocyclitol aminoglycoside antibiotic used for the treatment of leishmaniasis. In view of the central role of mitochondria in cellular energetics and metabolism, its effect on in vivo mitochondrial activities of Leishmania donovani promastigotes-the parasite flagellate form-was investigated. The approach used flow cytometry, amperometric measure of O2 consumption, and, as a global estimate of mitochondrial dehydrogenases, thiazolyl blue reduction (MTT test); some in vitro controls were also made. When added to promastigote cultures for 24-72 h at 150-200 microM (= LC50), paromomycin doubled the generation time, inhibited respiration, and lowered its associated electric potential difference across mitochondrial membranes, as measured by rhodamine 123 fluorescence. The chemical analogue neomycin was ineffective. Furthermore, the in vivo mitochondrial dehydrogenase activities were lower, seemingly because of the shortage of respiratory substrates. Indeed, succinate addition to paromomycin-treated cultures partly restored mitochondrial membrane potential. However, no immediate effect of paromomycin on respiration was observed, neither inhibition of redox chain nor increase of membrane permeability (uncoupling). It is proposed that paromomycin acts at a metabolic level upstream of the respiratory chain itself. This would have the observed delayed consequence because the cell energy supply would progressively decline since it depends upon the proton gradient-viz., membrane potential-generated by respiration. In conclusion, paromomycin is an antibiotic affecting the cell's energetic metabolism; the respiratory dysfunction it induces may be a crucial aspect of its action against Leishmania and possibly other cells.
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Affiliation(s)
- M Maarouf
- Institut de Chimie des Substances Naturelles (UPR 2301), Gif-sur-Yvette, France
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