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López-Pinar C, Rosen H, Selaskowski B, Staerk C, Jans T, Retz W, Retz-Junginger P, Roesler M, Sobanski E, Huss M, Matthies S, Tebartz van Elst L, Berger M, Jacob C, Kis B, Colla M, Alm B, Abdel-Hamid M, Martínez-Sanchís S, Carbonell-Vayá E, Lux S, Philipsen A. Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial. Psychother Psychosom 2023; 93:46-64. [PMID: 38142690 DOI: 10.1159/000532043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/06/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.
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Affiliation(s)
- Carlos López-Pinar
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
- Department of Psychology, European University of Valencia, Valencia, Spain
| | - Helena Rosen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Esther Sobanski
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Michael Huss
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Jacob
- Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Bernhard Kis
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Barbara Alm
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Sonia Martínez-Sanchís
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
| | - Enrique Carbonell-Vayá
- Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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López-Pinar C, Selaskowski B, Braun N, Fornés-Ferrer V, Euscher R, Matthies S, Jans T, van Elst LT, Jacob C, Huss M, Sobanski E, Retz W, Roesler M, Retz-Junginger P, Alm B, Kis B, Abdel-Hamid M, Colla M, Berger M, Lux S, Philipsen A. Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial. Psychiatry Res 2023; 330:115610. [PMID: 37992514 DOI: 10.1016/j.psychres.2023.115610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).
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Affiliation(s)
- Carlos López-Pinar
- Department of Psychobiology and Basic Psychology, University of Valencia, Valencia, Spain; Department of Psychology, European University of Valencia, Valencia, Spain.
| | | | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Rebekka Euscher
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Thomas Jans
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Christian Jacob
- Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany; Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Colla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Selaskowski B, Staerk C, Braun N, Matthies S, Graf E, Colla M, Jacob C, Sobanski E, Alm B, Roesler M, Retz W, Retz-Junginger P, Kis B, Abdel-Hamid M, Huss M, Jans T, Tebartz van Elst L, Berger M, Lux S, Mayr A, Philipsen A. Multimodal treatment efficacy differs in dependence of core symptom profiles in adult Attention-Deficit/Hyperactivity Disorder: An analysis of the randomized controlled COMPAS trial. J Psychiatr Res 2022; 151:225-234. [PMID: 35500450 DOI: 10.1016/j.jpsychires.2022.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
There is broad consensus that to improve the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD), the various therapy options need to be tailored more precisely to the individual patient's needs and specific symptoms. This post-hoc analysis evaluates the multimodal effects of first-line medication (methylphenidate [MPH] vs placebo [PLB]) and psychotherapeutic (group psychotherapy [GPT] vs clinical management [CM]) treatments on the ADHD core symptoms inattention, hyperactivity and impulsivity. For the two-by-two factorial, observer-blinded, multicenter, randomized controlled Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201), 419 outpatients with ADHD were considered for analysis. ADHD symptoms were assessed by blind observer-rated and patient-rated Conners Adult ADHD Rating Scales before treatment (T1), 13 weeks (T2) and 26 weeks (T3) after T1, at treatment completion after 52 weeks (T4), and at follow-up (130 weeks, T5). MPH was superior to PLB in improving symptoms of inattention at almost all endpoints (observer-rated T2, T3, T4, T5; patient-rated T2, T3, T4), while a significant decrease in hyperactivity and impulsivity was at first found after 6 months of treatment. CM compared to GPT decreased inattention and impulsivity in the early treatment phase only (observer-rated T2, patient-rated T2, T3). In conclusion, while MPH seems to have a direct and sustained effect on inattention, premature medication discontinuation should particularly be avoided in patients with hyperactive-impulsive symptoms. Also, especially in high inattention and/or impulsivity presentations, initial individual patient management might be beneficial. Consequently, considering individual core symptom profiles may enhance the efficacy of treatments in adult ADHD.
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Affiliation(s)
- Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Michael Colla
- Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Christian Jacob
- Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany; Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Thomas Jans
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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Reimherr FW, Roesler M, Marchant BK, Gift TE, Retz W, Philipp-Wiegmann F, Reimherr ML. Types of Adult Attention-Deficit/Hyperactivity Disorder: A Replication Analysis. J Clin Psychiatry 2020; 81. [PMID: 32220152 DOI: 10.4088/jcp.19m13077] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 09/09/2019] [Accepted: 12/09/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Research supports the importance of emotional symptoms in adults with attention-deficit/hyperactivity disorder (ADHD), which are not reflected in the DSM-5 or ICD-10 criteria. The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) assesses these symptoms, plus inattention, hyperactivity, and impulsivity. This scale allowed us to divide adult ADHD into 2 subtypes in a 2015 publication: ADHD inattentive presentation and ADHD emotional dysregulation presentation. The present study refines this observation using a larger, more diverse sample. METHODS Eight double-blind adult ADHD clinical trials (encompassing 1,490 subjects) were selected because they included assessment with the WRAADDS; a second, alternative ADHD measure; and the Clinical Global Impressions-Severity of Illness scale (CGI-S). These data were subjected to confirmatory factor analyses, and ADHD presentations were compared, including treatment response. RESULTS The original factor structure fit poorly with these new data. However, an alternative 2-factor solution fit both the original and the new subjects. ADHD inattentive presentation (n = 774) was defined by the inattention factor, and ADHD emotional dysregulation presentation (n = 620) was defined by additional elevation of the emotional dysregulation factor. The proportion of ADHD emotional dysregulation presentation ranged from 25% to 73% across the 8 studies. The emotional dysregulation presentation was associated with both a greater severity as measured by the CGI-S (P < .001) and more manifestations of childhood ADHD as measured by the Wender Utah Rating Scale (P < .001). CONCLUSIONS Factor analytic results supported the validity of 2 adult ADHD presentations based on levels of emotional dysregulation. This system offers a more clinically relevant approach to the diagnosis of ADHD in adults than does the DSM system.
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Affiliation(s)
- Frederick W Reimherr
- 1522 South 1100 East, Salt Lake City, UT 84105. .,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Psychiatric and Behavioral Solutions, LLC, Salt Lake City, Utah, USA
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saarland, Germany
| | - Barrie K Marchant
- Psychiatric and Behavioral Solutions, LLC, Salt Lake City, Utah, USA
| | - Thomas E Gift
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Saarland, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | | | - Matthew L Reimherr
- Department of Statistics, Penn State University, State College, Pennsylvania, USA
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6
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Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M, Gentschow L, Langner D, Jacob C, Groß-Lesch S, Sobanski E, Alm B, Schumacher-Stien M, Roesler M, Retz W, Retz-Junginger P, Kis B, Abdel-Hamid M, Heinrich V, Huss M, Kornmann C, Bürger A, Perlov E, Ihorst G, Schlander M, Berger M, Tebartz van Elst L. Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2015; 72:1199-210. [PMID: 26536057 DOI: 10.1001/jamapsychiatry.2015.2146] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence in adulthood. There is a recognized need to assess the efficacy of psychotherapy in adult ADHD. OBJECTIVE To evaluate the efficacy of cognitive behavioral group psychotherapy (GPT) compared with individual clinical management (CM) and that of methylphenidate hydrochloride compared with placebo. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, randomized clinical trial of 18- to 58-year-old outpatients with ADHD from 7 German study centers. Patients were recruited between January 2007 and August 2010, treatment was finalized in August 2011, and final follow-up assessments occurred in March 2013. INTERVENTIONS Sessions of GPT and CM were held weekly for the first 12 weeks and monthly thereafter (9 months). Patients received either methylphenidate or placebo for 1 year. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the ADHD Index of the Conners Adult ADHD Rating Scale from baseline to the end of the 3-month intensive treatment (blinded observer ratings). Secondary outcomes included ADHD ratings after 1 year, blinded observer ratings using the Clinical Global Impression Scale, and self-ratings of depression. RESULTS Among 1480 prescreened patients, 518 were assessed for eligibility, 433 were centrally randomized, and 419 were analyzed as randomized. After 3 months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for GPT and 16.5 for CM, with no significant difference between groups. Methylphenidate (adjusted mean, 16.2) was superior to placebo (adjusted mean, 17.9) (difference, -1.7; 97.5% CI, -3.0 to -0.4; P = .003). After 1 year, treatment effects remained essentially stable. Descriptive analyses showed that methylphenidate was superior to placebo in patients assigned to GPT (difference, -1.7; 95% CI, -3.2 to -0.1; P = .04) or CM (difference, -1.7; 95% CI, -3.3 to -0.2; P = .03). Regarding depression, no significant differences were found. In contrast, GPT was superior to CM for all visits in the Clinical Global Impression global assessment of effectiveness. CONCLUSION AND RELEVANCE Highly structured group intervention did not outperform individual CM with regard to the primary outcome. Psychological interventions resulted in better outcomes during a 1-year period when combined with methylphenidate as compared with placebo. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN54096201.
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Affiliation(s)
- Alexandra Philipsen
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy-University Hospital, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany2Department of Psychiatry and Psychotherapy, University Medical Center Freiburg
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Erika Graf
- Clinical Trials Unit, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Patricia Borel
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Michael Colla
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-University Medicine Berlin, Berlin, Germany6Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Campus Berlin-Buch, Berlin, Germany
| | - Laura Gentschow
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-University Medicine Berlin, Berlin, Germany6Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Campus Berlin-Buch, Berlin, Germany
| | - Daina Langner
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-University Medicine Berlin, Berlin, Germany6Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Campus Berlin-Buch, Berlin, Germany
| | - Christian Jacob
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Silke Groß-Lesch
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Barbara Alm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martina Schumacher-Stien
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany10Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Duisburg and Essen, Germany
| | - Viola Heinrich
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Duisburg and Essen, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Catherine Kornmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Arne Bürger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Evgeniy Perlov
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Michael Schlander
- Institute for Innovation and Valuation in Health Care, Wiesbaden, Germany
| | - Mathias Berger
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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Philipsen A, Graf E, Jans T, Matthies S, Borel P, Colla M, Gentschow L, Langner D, Jacob C, Groß-Lesch S, Sobanski E, Alm B, Schumacher-Stien M, Roesler M, Retz W, Retz-Junginger P, Kis B, Abdel-Hamid M, Heinrich V, Huss M, Kornmann C, Bürger A, van Elst LT, Berger M. A randomized controlled multicenter trial on the multimodal treatment of adult attention-deficit hyperactivity disorder: enrollment and characteristics of the study sample. ACTA ACUST UNITED AC 2013; 6:35-47. [PMID: 24132867 DOI: 10.1007/s12402-013-0120-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
Adult ADHD is a frequent psychiatric disorder affecting relevant aspects of an individual's life. The aim of our study group was to carry out the first randomized controlled multicenter study to evaluate the effects of psychotherapy compared to clinical management in combination with psychopharmacological treatment with methylphenidate (MPH) or placebo (Plac) in a factorial four-arm design. Here, we present the enrollment procedure and description of adult ADHD patients recruited for the trial. Four hundred and thirty-three adult patients with ADHD were randomized at seven study sites in Germany to four treatment conditions: manualized dialectical-behavioral-therapy-based group psychotherapy (GPT) plus MPH or Plac, or clinical management (CM) including supportive counseling plus MPH or Plac with weekly sessions in the first 12 weeks and monthly sessions thereafter. Assessment for eligibility included standardized scales and instruments. After prescreening of 1,480 patients, 518 were evaluated for trial participation and 433 were randomized. The main reasons for prescreening failure were lack of interest in participating (n = 205), difficulties in meeting the time and effort requirements for participation (n = 186), and contraindications for psychopharmacological treatment with MPH (n = 194). The full analysis set (FAS) comprised 419 adult ADHD patients (mean age 35.2 years, males/females 1:1). Fifty-seven percent of the patients suffered from the combined ADHD subtype. Prevalence of at least one current or lifetime axis-I comorbidity was 66 %. Axis-II comorbidity rates was 18 % (patients with comorbid borderline and antisocial personality disorders were excluded). Our network was able to recruit an adult ADHD sample essentially comparable to community samples. A selection bias was created by excluding patients unable or unwilling to participate, or who had somatic and psychiatric contraindications for stimulant treatment (Current Controlled Trials ISRCTN54096201, FUNDING: Federal Ministry of Education and Research 01GV0606).
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Affiliation(s)
- Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104, Freiburg, Germany,
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8
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Poynter JN, Fonstad R, Blair CK, Roesler M, Cerhan JR, Hirsch B, Nguyen P, Ross JA. Exogenous hormone use, reproductive history and risk of adult myeloid leukaemia. Br J Cancer 2013; 109:1895-8. [PMID: 24002589 PMCID: PMC3790163 DOI: 10.1038/bjc.2013.507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/17/2013] [Accepted: 08/04/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A hormonal aetiology is one explanation for the lower incidence of myeloid leukaemia in women compared with men. METHODS In this population-based case-control study, we evaluated associations between exogenous hormone use and reproductive history and myeloid leukaemia, overall and by disease subtype. RESULTS We observed a suggestive association between oral contraceptive use and acute myeloid leukaemia (odds ratio=0.55, 95% confidence interval=0.32-0.96). Hormone replacement therapy and reproductive factors were not associated with risk. CONCLUSION Despite the biological plausibility for a role of oestrogen in leukaemogenesis, other aetiologic factors are likely to explain the differing incidence rates in males and females.
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Affiliation(s)
- J N Poynter
- 1] Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, MMC715, 420 Delaware Street S.E., Minneapolis, MN 55455, USA [2] Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
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9
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Ognjanovic S, Blair C, Spector LG, Robison LL, Roesler M, Ross JA. Analgesic use during pregnancy and risk of infant leukaemia: a Children's Oncology Group study. Br J Cancer 2010; 104:532-6. [PMID: 21157452 PMCID: PMC3049556 DOI: 10.1038/sj.bjc.6606046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Infant leukaemia is likely initiated in utero. Methods: We examined whether analgesic use during pregnancy was associated with risk by completing telephone interviews of the mothers of 441 infant leukaemia cases and 323 frequency-matched controls, using unconditional logistic regression. Results: With the exception of a reduced risk for infant acute myeloid leukaemias with non-aspirin non-steroidal anti-inflammatory drugs (NSAID) use early in pregnancy (odds ratios=0.60; confidence intervals: 0.37–0.97), no statistically significant associations were observed for aspirin, non-aspirin NSAIDs, or acetaminophen use in early pregnancy or after knowledge of pregnancy. Conclusion: Overall, analgesic use during pregnancy was not significantly associated with the risk of infant leukaemia.
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Affiliation(s)
- S Ognjanovic
- Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, 420 Delaware Street SE, MMC 422, Minneapolis, MN 55455, USA.
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Buitelaar J, Roesler M, Kooij S, Casas M, Dejonckheere J, van Oene J, Schaeuble B, Trott GE. P03-373 - Relation between symptomatic and functional outcomes in adults with ADHD treated with OROS MPH - a partial correlation analysis. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70979-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shridharani A, Roesler M, Sandlow J. Fertilization and pregnancy rates in severe male factor infertility: a comparison of sperm source. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.035] [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: 11/16/2022]
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Roesler M, Trott GE, Philipsen A, Gerwe M, Lee E, Medori R, Schauble B. Efficacy and safety of OROS® methylphenidate in adults with ADHD: the long-acting methylphenidate in adult ADHD (LAMDA) trial. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Milosavajevic J, Strawn E, Robb P, Roesler M, Granlund A. A retrospective analysis of pregnancy and birth outcomes from in vitro fertilization compared to spontaneously conceived pregnancies from a single institution. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.410] [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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14
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Philipsen A, Trott GE, Roesler M, Gerwe M, Lee E, Medori R, Schauble B. Open-label (OL) extension trial of the safety and tolerability of OROS® methylphenidate in adults with ADHD – the long-acting methylphenidate in adult ADHD (LAMDA) trial. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Reif A, Roesler M, Freitag C, Schneider M, Kissling C, Eujen A, Wenzler D, Jacob C, Retz-Junginger P, Thome J, Lesch K, Retz W. Nature and nurture influence later-life violence: serotonergic genes and childhood adversity. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.1131] [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: 11/29/2022] Open
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Blair C, Roesler M, Xie Y, Gamis A, Olshan A, Ross J. Vitamin Use Among Children with Down Syndrome and Risk of Leukemia: A Children's Oncology Group (COG) Study. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s103-c] [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: 11/13/2022] Open
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Strawn E, Roesler M, Granlund A, Robb P, Halverson G, Aiman J. Use of Sydney IVF Embryo Transfer Set Dramatically Reduces the Need for Tenaculum Use for Embryo Transfer (ET). Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Strawn E, Hirt A, Robb P, Halverson G, Roesler M, Granlund A. Microdose Lupron and Gonadotropin Releasing Hormone Antagonist Protocols Yield Similar Results in Women at Risk for Poor Response in Fresh Cycles of In Vitro Fertilization. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.856] [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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Ross JA, Blair CK, Spector LG, Robison LL, Davies SM, Roesler M. 404: Pain Reliever use during Pregnancy and Risk of Infant Leukemia: A Children's Oncology Group Study. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s101c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J A Ross
- University of Minnesota, Minneapolis, MN 55455
| | - C K Blair
- University of Minnesota, Minneapolis, MN 55455
| | - L G Spector
- University of Minnesota, Minneapolis, MN 55455
| | - L L Robison
- University of Minnesota, Minneapolis, MN 55455
| | - S M Davies
- University of Minnesota, Minneapolis, MN 55455
| | - M Roesler
- University of Minnesota, Minneapolis, MN 55455
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Spector LG, Davies SM, Robison LL, Roesler M, Ross JA. 406: Birth Weight and the MLL Gene in Infant Leukemia: A Children's Oncology Group Study. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s102a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L G Spector
- University of Minnesota, Minneapolis, MN 55455
| | - S M Davies
- University of Minnesota, Minneapolis, MN 55455
| | - L L Robison
- University of Minnesota, Minneapolis, MN 55455
| | - M Roesler
- University of Minnesota, Minneapolis, MN 55455
| | - J A Ross
- University of Minnesota, Minneapolis, MN 55455
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21
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Canfield KN, Spector LG, Robison LL, Lazovich D, Roesler M, Olshan AF, Smith FO, Heerema NA, Barnard DR, Blair CK, Ross JA. Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Group. Br J Cancer 2005; 91:1866-72. [PMID: 15520821 PMCID: PMC2409774 DOI: 10.1038/sj.bjc.6602223] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Children with Down syndrome (DS) are highly susceptible to acute leukaemia. Given the potential role of infections in the aetiology of leukaemia in children without DS, we investigated whether there was an association between early-life infections and acute leukaemia in children with DS. Maternal infections during pregnancy were also examined. We enrolled 158 incident cases of acute leukaemia in children with DS (97 acute lymphoblastic leukaemia (ALL) and 61 acute myeloid leukaemia (AML)) diagnosed at Children's Oncology Group institutions between 1997 and 2002. DS controls (N=173) were selected from the cases' primary care clinics and frequency matched on age at leukaemia diagnosis. Data were collected on demographics, child's medical history, mother's medical history, and other factors by maternal interview. Analyses were conducted using unconditional logistic regression adjusted for potential confounders. A significant negative association was observed between acute leukaemia and any infection in the first 2 years of life (adjusted odds ratio (OR)=0.55, 95% confidence interval (CI) (0.33–0.92); OR=0.53, 95% CI (0.29–0.97); and OR=0.59, 95% CI (0.28–1.25) for acute leukaemia combined, ALL, and AML respectively). The association between acute leukaemia and maternal infections during pregnancy was in the same direction but not significant. This study offers support for the hypothesis that early-life infections may play a protective role in the aetiology of acute leukaemia in children with DS.
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Affiliation(s)
- K N Canfield
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - L G Spector
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - L L Robison
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - D Lazovich
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
- University of Minnesota Cancer Center, USA
| | - M Roesler
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - A F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - F O Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - N A Heerema
- Department of Pathology, The Ohio State University, Columbus, OH 43210, USA
| | | | - C K Blair
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
| | - J A Ross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- University of Minnesota Cancer Center, USA
- Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, MMC 422, 420 Delaware St SE, Minneapolis, MN 55455, USA. E-mail:
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Abstract
This qualitative study was conducted to determine cultural influences in end-of-life care among Jewish people. The conceptual framework for this study was drawn from Leininger's culture care theory. Informants consisted of 16 professional caregivers, family members, and rabbis who had experience with end-of-life care for Jewish patients. Interviews using open-ended and focused questions were used to gather informants' descriptions of their generic values, beliefs, and practices. Findings revealed the strong influence of religious, cultural, and historical factors in caring. Sanctity of life and life promotion are central to Judaism. Caring is a communal obligation that unites the family and community into a cohesive unit. Attitudes toward death are influenced by beliefs about afterlife and suffering. The value put on expert knowledge influences patients' and family members' expectations of professional caregivers. Similarities and differences were noted among different groups of informants.
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Affiliation(s)
- D Bonura
- Hackensack University Hospital and Medical Center
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Strawn EY, Roesler M, Rinke M, Aiman EJ. Minimal precycle testing and ongoing cycle monitoring for in vitro fertilization and fresh pre-embryo transfer do not compromise fertilization, implantation, or ongoing pregnancy rates. Am J Obstet Gynecol 2000; 182:1623-8. [PMID: 10871488 DOI: 10.1067/mob.2000.107434] [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: 11/22/2022]
Abstract
OBJECTIVE We sought to assess the fertilization, implantation, and ongoing pregnancy rates with a minimal precycle and ongoing cycle monitoring protocol for in vitro fertilization and embryo transfer. STUDY DESIGN Retrospective review was conducted of 103 consecutive cycles of fresh in vitro fertilization and embryo transfer from 1996 to 1998. Precycle screening included semen analysis without strict morphologic analysis, and hysterosalpingography-sonohysterography within the last year. Serum prolactin, serum thyroid-stimulating hormone, reactive plasma reagin, human immunodeficiency virus, rubella titer, blood type, hepatitis B surface antigen, and hepatitis C antibody testing was performed on all patients within 3 months of cycle initiation. Women > or =37 years old underwent clomiphene challenge testing. The monitoring protocol included the following: baseline transvaginal ultrasonography after 12 to 14 days of midluteal gonadotropin-releasing hormone agonist down-regulation to assess endometrial thickness and adnexal appearance, transvaginal ultrasonography for follicle evaluation at 7 and 10 days, serum estradiol assay if > or =20 follicles, quantitative beta-human chorionic gonadotropin 12 to 14 days after pre-embryo transfer, repeat quantitative beta-human chorionic gonadotropin 3 to 5 days later, and transvaginal ultrasonography for intrauterine gestational sac confirmation 7 to 9 days after the initial positive pregnancy test result. The dose of gonadotropin used remained constant unless the sonogram obtained on day 7 indicated a suboptimal response (<3 follicles each, with an average diameter of 10 to 12 mm) or hyperresponse (> or =15 follicles with an average diameter of 10 to 12 mm). RESULTS The per embryo implantation rate (fetal cardiac activity) was 13.1%, and the live birth rate per 100 pre-embryo transfers was 31.5 for patients < or =40 years old. The average number of pre-embryos transferred was 3.1. The singleton pregnancy rate was 71%, and there were no multiple gestations greater than twins. The mean number of oocytes fertilized was 66%. There was 1 case of failed fertilization with intracytoplasmic sperm injection. There were two other cases of failed fertilization. One case of severe ovarian hyperstimulation occurred in spite of cryopreservation of all embryos. CONCLUSIONS In vitro fertilization and embryo transfer can be accomplished with minimal precycle testing and ongoing cycle monitoring without compromising fertilization, implantation, and ongoing pregnancy rates. This results in reduced overall costs for couples.
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Affiliation(s)
- E Y Strawn
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee 53226-3596, USA
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Fallgatter AJ, Roesler M, Sitzmann L, Heidrich A, Mueller TJ, Strik WK. Loss of functional hemispheric asymmetry in Alzheimer's dementia assessed with near-infrared spectroscopy. Brain Res Cogn Brain Res 1997; 6:67-72. [PMID: 9395850 DOI: 10.1016/s0926-6410(97)00016-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In a total of 10 patients with dementia of the Alzheimer-type (DAT) and in 10 healthy controls near-infrared spectroscopy (NIRS), a new non-invasive optical method, was used to measure the changes of concentrations of oxy- (O2HB) and deoxyhemoglobin (HHB) in left and right hemispheric prefrontal brain tissue areas during performance of the Verbal Fluency Test (VFT). On a neuropsychological level, the healthy subjects performed better in the VFT than patients with DAT. Statistical analysis of the relative concentrations of O2HB and HHB measured with NIRS during performance of the VFT revealed a significant interaction of the hemispheric effects with the diagnosis. A possible interpretation of this finding is that a good performance in the VFT relies on a predominantly left hemispheric activation observed in controls, whereas a low number of correct responses is associated with a loss of this asymmetric activation in patients with DAT. Although both, patients and controls, performed better in the category version of the VFT, the metabolic effects of this task were significantly less pronounced than in the letter version. This indicates that different energy demands, according to the type of access to the memory stores, may be interpreted as the result of a less energy-demanding access to categorically stored information and adds further evidence to the view that memory departments in humans are organized according to categorical principles.
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Affiliation(s)
- A J Fallgatter
- Department of Psychiatry, University Hospital of Wuerzburg, Germany
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Fallgatter A, Roesler M, Sitzmann L, Heidrich A, Mueller TJ, Strik WK. Loss of Functional Hemispheric Asymmetry in Alzheimer's Dementia. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80505-6] [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: 10/27/2022] Open
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Katayama KP, Stehlik E, Roesler M, Pentimalli C, Gunnarson C, Jagusch S, Meyer M. Cryopreservation of human embryos as a useful tool for infertile couples. Asia Oceania J Obstet Gynaecol 1990; 16:97-100. [PMID: 2378597 DOI: 10.1111/j.1447-0756.1990.tb00008.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In order to improve the pregnancy rate per oocyte retrieval while reducing the chance of multiple-gestations, a technique of cryopreservation of human embryos was used for our initial study consisting of 100 infertile patients undergoing in vitro fertilization (IVF) procedure. These patients combined a "fresh" embryo transfer with cryopreservation. The embryos were cryopreserved with 1,2-propanediol. Twenty-nine (29%) patients achieved ongoing pregnancies from the fresh embryo transfer. Thirty patients received a transfer of thawed embryos in a natural cycle. Nine of these patients achieved ongoing pregnancies. Combining these 2 transfers results in a 38% ongoing pregnancy rate. Forty-one patients have yet to receive their frozen embryos. The current success rate in this study indicates that over 50% of the patients in this group can expect to become pregnant by the time all the cryopreserved embryos have been transferred.
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Affiliation(s)
- K P Katayama
- Advanced Institute of Fertility, Sinai-Samaritan Medical Center, Milwaukee, Wisconsin 53233
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Katayama KP, Stehlik E, Roesler M, Jeyendran RS, Holmgren WJ, Zaneveld LJ. Treatment of human spermatozoa with an egg yolk medium can enhance the outcome of in vitro fertilization. Fertil Steril 1989; 52:1077-9. [PMID: 2591568 DOI: 10.1016/s0015-0282(16)53181-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [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: 01/01/2023]
Abstract
In at least 4 of 7 cases, fertilization of intact human oocytes was more successful when spermatozoa were pretreated with TEST yolk medium at 5 degrees C for 2 hours as compared with the standard treatment with Ham's F-10 only. Both pregnancies that were obtained after the transfer of the fertilized oocytes resulted from oocytes fertilized by TEST yolk-treated spermatozoa. No decrease in fertilization occurred in any of the cases after TEST yolk treatment. If these results hold true for a larger series of patients, it may be worthwhile for the standard IVF incubation system of spermatozoa to include TEST yolk.
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Affiliation(s)
- K P Katayama
- Advanced Institute of Fertility, Sinai Samaritan Medical Center, Milwaukee, Wisconsin
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28
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Abstract
Pregnancies achieved by IVF and resulting in blighted ovum were karyotyped. The rate of aneuploidy was found to be 38% (5/13). In vitro fertilization does not appear to be a risk factor for chromosome anomaly in live births or miscarriages, and the data reported so far may suggest that aneuploid rates are actually lower for pregnancies achieved by IVF.
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Affiliation(s)
- M Roesler
- Advanced Institute of Fertility, Milwaukee, Wisconsin 53233
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De Gasperis C, Penta De Peppo A, Piccinino C, Di Bella I, Roesler M, Sarasso G. [Doppler echocardiographic analysis of the short-term results of surgical repair of mitral valve prolapse in myxomatous degeneration]. G Ital Cardiol 1989; 19:35-9. [PMID: 2744312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ten consecutive patients with pure mitral regurgitation due to floppy valve underwent valve repair operations. Postoperative mitral continence or regurgitation and diastolic flow across the valve were evaluated by Doppler echocardiography. Mean follow-up was 6.4 months. Four patients showed minimal and 3 mild regurgitation; no regurgitation was detected in 3. A significant peak diastolic atrioventricular gradient (10 mmHg) was observed in only one patient. All patients showed symptomatic improvement and a decrease in ventricular diameters. Repair of floppy mitral valves is feasible and gives good results. Doppler echocardiography is a useful technique for monitoring postoperative valve function.
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Affiliation(s)
- C De Gasperis
- Reparto di Cardiochirurgia, Ospedale Maggiore della Carità, Novara
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Katayama KP, Roesler M, Gunnarson C, Stehlik E, Jagusch S. Short-term use of gonadotropin-releasing hormone agonist (leuprolide) for in vitro fertilization. J In Vitro Fert Embryo Transf 1988; 5:332-4. [PMID: 3146612 DOI: 10.1007/bf01129568] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A common problem encountered by in vitro fertilization (IVF) programs is the premature occurrence of the spontaneous luteinizing hormone (LH) surge during ovarian stimulation cycles. Administration of gonadotropin-releasing hormone agonists (GnRH-a) for 2 to 3 weeks produces a state of hypogonadotropic hypogonadism, thus allowing ovarian stimulation to proceed uncomplicated by a spontaneous LH surge. We have elected to treat seven patients with GnRH-a in a "short-term" protocol, with GnRH-a initiated on cycle day 3 along with exogenous gonadotropins. In this series, we found that the spontaneous LH surge was abolished, while ovarian responsiveness seemed to be improved. These results suggest that the initial surge of gonadotropins elicited by GnRH-a administration may enhance ovarian stimulation and that spontaneous LH surge is blocked when GnRH-a and exogenous gonadotropins are initiated concomitantly.
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Katayama KP, Roesler M, Gunnarson C, Stehlik E, Jagusch S, Meyer MA. Ultrasound-guided transvaginal needle aspiration of follicles for in vitro fertilization. Obstet Gynecol 1988; 72:271-4. [PMID: 2969085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In search of a simpler and less traumatic method of oocyte retrieval for in vitro fertilization (IVF), 37 infertile patients underwent ultrasound-guided transvaginal needle aspiration of the follicles instead of the conventional laparoscopic aspiration. Although only intravenous analgesics and sedatives were used, patients experienced little discomfort. There were no infections or bleeding complications after the procedure. Eleven patients (30%) achieved ongoing pregnancies; this rate of success is comparable to that with our laparoscopic method. Considering this reasonable pregnancy rate, lack of substantial morbidity, and good patient acceptance, laparoscopic oocyte retrieval for IVF can be largely replaced by the ultrasound-guided transvaginal needle aspiration technique.
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Affiliation(s)
- K P Katayama
- Advanced Institute of Fertility, Sinai Samaritan Medical Center, Milwaukee, Wisconsin
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Katayama KP, Roesler M, Gunnarson C, Halverson GM, Meyer MA. In vitro fertilization and embryo transfer. Wis Med J 1985; 84:9-11. [PMID: 4082623] [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: 01/08/2023]
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Abstract
Airway obstruction in children has many causes. Although vascular rings may have early onset of symptoms there was considerable delay in establishing the correct diagnosis. Barium swallow is diagnostic. Other tests, such as angiocardiography, bronchoscopy, bronchography, and lung scan are usually unnecessary. Pulmonary sling is a less common cause of vascular obstruction. Barium swallow showing anterior indentation at the level of the pulmonary hilum is diagnostic. Cysts and tumors are other causes of severe airway obstruction. The diagnostic and operative problems in three patients are discussed as examples. It is concluded that barium swallow is the most important single investigation in the evaluation of airway obstruction.
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Berkowitz RS, Lahey SJ, Steele G, Rayner AA, Rodrick ML, Goldstein DP, Harahap R, Pattillo RA, Sasaki S, Katayama KP, Roesler M, Mattingly RF, Goldstein DP, Berkowitz RS, Zucker PK, Bernstein MR, Salari H, Partovie V, Shin MW, Rao CV, Hussa RO, Carman FR, Rinke ML, Cook CL, Yussman MA, Zakut H, Ludomirsky A, Cole LA, Sutphen SK, Hussa RO, Pattillo RA, Kim SJ, Kang BC, Jung JK, Lee JW, Sekadde-Kigondu CB, Mati JKG, Mokohka AE, Fongoh FB, Lequin RM, Tanaka T, Ito H, Hosokawa T, Elegbe RA, Hussa RO, Pattillo RA, Damole IO, Hoffmann RG, Finlayson W, Jones WB, Stanimir GW, Lewis JL, Berkowitz RS, Goldstein DP, Birnholz J, Goldstein DP, Berkowitz RS, Bernstein MR, Hsu CT, Sarram M, Baja-Panlilio H, Lopez AM, Huy IC, Aartsen EJ, Lammes FB, ten Kate Booy MJ, Ng HT, Partovi V, Salari H, Nassirai GH, Martaadisoebrata D. First World Congress on Trophoblast Neoplasms. Human Trophoblast Neoplasms 1984. [DOI: 10.1007/978-1-4684-4811-5_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Between 1968 and 1980, 51 children had an operation for various forms of vascular ring. Additional cardiac malformations were present in five patients, and six had noncardiac congenital anomalies. Although symptoms started within the first month of life in 39 infants, only 16 came to operation under three months of age, and a delay of more than six months occurred in 15. Stridor, often life-threatening, and recurrent infections were the most common symptoms, but dysphagia was also important. The reasons for delay in diagnosis are discussed. Barium swallow provided the diagnosis in 44 patients and suggested it in a further four patients. Innominate artery compression of the trachea was not diagnosed by barium swallow. Operations of various types were performed. Accuracy in diagnosis is important because not all patients could be treated through the classic left thoracotomy. Severe tracheomalacia was responsible for the only two deaths in the series; one of these had tracheostomy performed in the referring hospital, the second child also had Fallot's tetralogy. The large majority of the patients have done well, 76% being asymptomatic at follow-up. Minimal to moderate stridor persists among the remainder to the present time.
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Sasaki S, Katayama PK, Roesler M, Pattillo RA, Mattingly RF, Ohkawa K. Cytogenetic analysis of choriocarcinoma cell lines. Nihon Sanka Fujinka Gakkai Zasshi 1982; 34:2253-6. [PMID: 7153601] [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: 01/23/2023]
Abstract
Five permanent cell lines were established in vitro from patients with gestational choriocarcinoma. Chromosome study with Q-band technique showed a modal chromosome number per cell in the hypotetraploid range in all cell lines. There were unidentifiable, structurally altered chromosomes in each cell line. BeWo cell line from choriocarcinoma following delivery of a normal male baby lost identifiable Y chromosome, whereas Jar cell line following delivery of a normal male did have a Y chromosome. One of the two cell lines following complete hydatidiform mole had a Y chromosome. The significance of this finding is discussed.
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Pattillo RA, Sasaki S, Katayama KP, Roesler M, Mattingly RF. Genesis of 46,XY hydatidiform mole. Am J Obstet Gynecol 1981; 141:104-5. [PMID: 7270611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ursini M, Roesler M. [Anesthesia in heart surgery. Prevention and therapy of renal insufficiency]. Minerva Anestesiol 1977; 43:123-8. [PMID: 854190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Six patients developed severe, unexplained, chronic bronchopulmonary disease from 3 to 13 years after the onset of nonspecific inflammatory disease of the colon. All had chronic bronchitis, bronchiectasis was diagnosed in four, and an obstructive type of pulmonary dysfunction was noted in five. Four of the six, including the two with only chronic bronchitis, had no history of smoking. There was an initial correlation between the pulmonary symptoms and the intestinal disease, except in two patients who developed overt pulmonary disease following total proctocolectomy. The frequent occurence of extraintestinal lesions has suggested that ulcerative colitis and regional enteritis are systemic disorders. Chronic unexplained bronchopulmonary disease may be another infrequent complication in such patients.
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Abstract
Six patients developed severe, unexplained, chronic bronchopulmonary disease from 3 to 13 years after the onset of nonspecific inflammatory disease of the colon. All had chronic bronchitis, bronchiectasis was diagnosed in four, and an obstructive type of pulmonary dysfunction was noted in five. Four of the six, including the two with only chronic bronchitis, had no history of smoking. There was an initial correlation between the pulmonary symptoms and the intestinal disease, except in two patients who developed overt pulmonary disease following total proctocolectomy. The frequent occurence of extraintestinal lesions has suggested that ulcerative colitis and regional enteritis are systemic disorders. Chronic unexplained bronchopulmonary disease may be another infrequent complication in such patients.
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