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Lang M, Tabari A, Polak D, Ford J, Clifford B, Lo WC, Manzoor K, Splitthoff DN, Wald LL, Rapalino O, Schaefer P, Conklin J, Cauley S, Huang SY. Clinical Evaluation of Scout Accelerated Motion Estimation and Reduction Technique for 3D MR Imaging in the Inpatient and Emergency Department Settings. AJNR Am J Neuroradiol 2023; 44:125-133. [PMID: 36702502 PMCID: PMC9891324 DOI: 10.3174/ajnr.a7777] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE A scout accelerated motion estimation and reduction (SAMER) framework has been developed for efficient retrospective motion correction. The goal of this study was to perform an initial evaluation of SAMER in a series of clinical brain MR imaging examinations. MATERIALS AND METHODS Ninety-seven patients who underwent MR imaging in the inpatient and emergency department settings were included in the study. SAMER motion correction was retrospectively applied to an accelerated T1-weighted MPRAGE sequence that was included in brain MR imaging examinations performed with and without contrast. Two blinded neuroradiologists graded images with and without SAMER motion correction on a 5-tier motion severity scale (none = 1, minimal = 2, mild = 3, moderate = 4, severe = 5). RESULTS The median SAMER reconstruction time was 1 minute 47 seconds. SAMER motion correction significantly improved overall motion grades across all examinations (P < .005). Motion artifacts were reduced in 28% of cases, unchanged in 64% of cases, and increased in 8% of cases. SAMER improved motion grades in 100% of moderate motion cases and 75% of severe motion cases. Sixty-nine percent of nondiagnostic motion cases (grades 4 and 5) were considered diagnostic after SAMER motion correction. For cases with minimal or no motion, SAMER had negligible impact on the overall motion grade. For cases with mild, moderate, and severe motion, SAMER improved the motion grade by an average of 0.3 (SD, 0.5), 1.1 (SD, 0.3), and 1.1 (SD, 0.8) grades, respectively. CONCLUSIONS SAMER improved the diagnostic image quality of clinical brain MR imaging examinations with motion artifacts. The improvement was most pronounced for cases with moderate or severe motion.
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Affiliation(s)
- M Lang
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - A Tabari
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - D Polak
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Siemens Healthcare GmbH (D.P., D.N.S.), Erlangen, Germany
| | - J Ford
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - B Clifford
- Siemens Medical Solutions (B.C., W.-C.L.), Boston, Massachusetts
| | - W-C Lo
- Siemens Medical Solutions (B.C., W.-C.L.), Boston, Massachusetts
| | - K Manzoor
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - D N Splitthoff
- Siemens Healthcare GmbH (D.P., D.N.S.), Erlangen, Germany
| | - L L Wald
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (L.L.W.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - O Rapalino
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - P Schaefer
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - J Conklin
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - S Cauley
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - S Y Huang
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
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Schaefer P, Casadaban L, Rabkin D. Abstract No. 57 Hypertension following renal artery embolization for renal angiomyolipoma: a single-center retrospective review. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.138] [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: 10/18/2022] Open
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Rapalino O, Pourvaziri A, Maher M, Jaramillo-Cardoso A, Edlow BL, Conklin J, Huang S, Westover B, Romero JM, Halpern E, Gupta R, Pomerantz S, Schaefer P, Gonzalez RG, Mukerji SS, Lev MH. Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy. AJNR Am J Neuroradiol 2021; 42:632-638. [PMID: 33414226 DOI: 10.3174/ajnr.a6966] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. MATERIALS AND METHODS Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. RESULTS The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m2, P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001). CONCLUSIONS Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.
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Affiliation(s)
- O Rapalino
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Pourvaziri
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - M Maher
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Jaramillo-Cardoso
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J Conklin
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Huang
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J M Romero
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - E Halpern
- Institute for Technology Assessment (E.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - R Gupta
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Pomerantz
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - P Schaefer
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - R G Gonzalez
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - M H Lev
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
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Stiermaier T, Schaefer P, Saad M, Meyer-Saraei R, De Waha-Thiele S, Fuernau G, Langer H, Barkhausen J, Desch S, Thiele H, Eitel I. Impact of morphine treatment with and without metoclopramide co-administration on myocardial and microvascular injury in acute myocardial infarction: insights from a randomized trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Intravenous morphine administration in patients with acute myocardial infarction (AMI) can adversely affect platelet inhibition induced by P2Y12 receptor antagonists, potentially resulting in an increased risk of adverse clinical events. In contrast, some evidence suggests that opioid agonists may have cardioprotective effects on the myocardium. Currently available data in this regard are, however, sparse, inconsistent, and methodologically limited.
Purpose
The aim of this study was to investigate the impact of morphine with or without metoclopramide (MCP) co-administration on myocardial and microvascular injury after AMI assessed by cardiac magnetic resonance (CMR).
Methods
This prospective, randomized, single-center study assigned 138 patients with AMI in a 1:1:1 ratio to (a) ticagrelor 180 mg plus intravenous morphine 5 mg (morphine group); (b) ticagrelor 180 mg plus intravenous morphine 5 mg and MCP 10 mg (morphine + MCP group); or (c) ticagrelor 180 mg plus intravenous placebo (control group). Study drugs were administered before primary percutaneous coronary intervention. CMR was performed in 101 patients on day 1–4 after the index event to assess infarct size, microvascular obstruction, and left ventricular ejection fraction.
Results
Infarct size was significantly smaller in the morphine only group as compared to controls (15.5%LV [IQR 5.0 to 21.4%LV] vs. 17.9%LV [IQR 12.3 to 32.9%LV]; p=0.047). Furthermore, the number of patients with microvascular obstruction was significantly lower after morphine administration (10/36 [28%] versus 21/39 [54%]; p=0.022) and the extent of microvascular obstruction was smaller (0%LV [0 to 1.40%LV] versus 0.74%LV [0 to 3.10%LV]; p=0.037). In multivariable regression analysis, morphine administration was independently associated with a reduced risk for the occurrence of microvascular obstruction (odds ratio 0.37; 95% confidence interval 0.14 to 0.93; p=0.035). Left ventricular ejection fraction did not differ significantly between the morphine and the control group (p=0.970) and there was no significant difference in left ventricular ejection fraction (p=0.790), infarct size (p=0.491), and extent (p=0.753) or presence (p=0.914) of microvascular obstruction when comparing the morphine + MCP group to the control group.
Conclusions
In this randomized study, intravenous administration of morphine prior to primary percutaneous coronary intervention resulted in a significant reduction of myocardial and microvascular damage following AMI. This potential cardioprotective effect of morphine requires further evaluation in well-designed future trials with clinical endpoints.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Stiermaier
- University Heart Center Luebeck, Luebeck, Germany
| | - P Schaefer
- University Heart Center Luebeck, Luebeck, Germany
| | - M Saad
- University Heart Center Luebeck, Luebeck, Germany
| | | | | | - G Fuernau
- University Heart Center Luebeck, Luebeck, Germany
| | - H Langer
- University Heart Center Luebeck, Luebeck, Germany
| | - J Barkhausen
- University hospital Schleswig-Holstein Campus Lübeck, Luebeck, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center Luebeck, Luebeck, Germany
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Fagundes J, Longo MG, Huang SY, Rosen BR, Witzel T, Heberlein K, Gonzalez RG, Schaefer P, Rapalino O. Diagnostic Performance of a 10-Minute Gadolinium-Enhanced Brain MRI Protocol Compared with the Standard Clinical Protocol for Detection of Intracranial Enhancing Lesions. AJNR Am J Neuroradiol 2017; 38:1689-1694. [PMID: 28705816 DOI: 10.3174/ajnr.a5293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of new MR imaging scanners with stronger gradients and improvement in coil technology, allied with emerging fast imaging techniques, has allowed a substantial reduction in MR imaging scan times. Our goal was to develop a 10-minute gadolinium-enhanced brain MR imaging protocol with accelerated sequences and to evaluate its diagnostic performance compared with the standard clinical protocol. MATERIALS AND METHODS Fifty-three patients referred for brain MR imaging with contrast were scanned with a 3T scanner. Each MR image consisted of 5 basic fast precontrast sequences plus standard and accelerated versions of the same postcontrast T1WI sequences. Two neuroradiologists assessed the image quality and the final diagnosis for each set of postcontrast sequences and compared their performances. RESULTS The acquisition time of the combined accelerated pre- and postcontrast sequences was 10 minutes and 15 seconds; and of the fast postcontrast sequences, 3 minutes and 36 seconds, 46% of the standard sequences. The 10-minute postcontrast axial T1WI had fewer image artifacts (P < .001) and better overall diagnostic quality (P < .001). Although the 10-minute MPRAGE sequence showed a tendency to have more artifacts than the standard sequence (P = .08), the overall diagnostic quality was similar (P = .66). Moreover, there was no statistically significant difference in the diagnostic performance between the protocols. The sensitivity, specificity, and accuracy values for the 10-minute protocol were 100.0%, 88.9%, and 98.1%. CONCLUSIONS The 10-minute brain MR imaging protocol with contrast is comparable in diagnostic performance with the standard protocol in an inpatient motion-prone population, with the additional benefits of reducing acquisition times and image artifacts.
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Affiliation(s)
- J Fagundes
- From the Clínica de Diagnóstico por Imagem (J.F.), Rio de Janeiro, Brazil
| | - M G Longo
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - S Y Huang
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - B R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging (B.R.R., T.W.), Charlestown, Massachusetts
| | - T Witzel
- Athinoula A. Martinos Center for Biomedical Imaging (B.R.R., T.W.), Charlestown, Massachusetts
| | - K Heberlein
- Siemens Medical Solutions (K.H.), Malvern, Pennsylvania
| | - R G Gonzalez
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - P Schaefer
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - O Rapalino
- Department of Radiology (M.G.L., S.Y.H., R.G.G., P.S., O.R.), Massachusetts General Hospital, Boston, Massachusetts
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Cristescu I, Cristescu I, Dörr L, Hellriegel G, Michling R, Murdoch D, Schaefer P, Welte S, Wurster W. Experiments on Water Detritiation and Cryogenic Distillation at TLK; Impact on ITER Fuel Cycle Subsystems Interfaces. Fusion Science and Technology 2017. [DOI: 10.13182/fst08-a1849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- I. Cristescu
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - I.R. Cristescu
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - L. Dörr
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - G. Hellriegel
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - R. Michling
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - D. Murdoch
- EFDA CSU, MPI fuer Plasmaphysik, Garching, Germany
| | - P. Schaefer
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - S. Welte
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
| | - W. Wurster
- Forschungszentrum Karlsruhe, Institute for Technical Physics, Tritium Laboratory Karlsruhe P.O. Box 3640, D- 76021Karlsruhe, Germany,(+49) 7247 82 3537, e-mail:
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Cristescu I, Bükki-Deme A, Carr R, Gramlich N, Groessle R, Melzer C, Schaefer P, Welte S. Review of the TLK Activities Related to Water Detritiation, Isotope Separation Based on Cryogenic Distillation and Development of Barriers Against Tritium Permeation. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1288057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ion Cristescu
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - A. Bükki-Deme
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - R. Carr
- DBD Ltd, Chadwick House, Birchwood Park, Warrington Cheshire WA3 6AEH, United Kingdom
| | - N. Gramlich
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - R. Groessle
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - C. Melzer
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - P. Schaefer
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
| | - Stefan Welte
- Karlsruhe Institute for Technology, Institute for Technical Physics, Tritium Laboratory Karlsruhe, Herrmann von-Helmholtz-Platz 1, Eggenstein - Leopoldshafen D-76344, Germany
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Branchi V, Schaefer P, Semaan A, Kania A, Lingohr P, Kalff JC, Schäfer N, Kristiansen G, Dietrich D, Matthaei H. Promoter hypermethylation of SHOX2 and SEPT9 is a potential biomarker for minimally invasive diagnosis in adenocarcinomas of the biliary tract. Clin Epigenetics 2016; 8:133. [PMID: 27999621 PMCID: PMC5153824 DOI: 10.1186/s13148-016-0299-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/29/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Biliary tract carcinoma (BTC) is a fatal malignancy which aggressiveness contrasts sharply with its relatively mild and late clinical presentation. Novel molecular markers for early diagnosis and precise treatment are urgently needed. The purpose of this study was to evaluate the diagnostic and prognostic value of promoter hypermethylation of the SHOX2 and SEPT9 gene loci in BTC. METHODS Relative DNA methylation of SHOX2 and SEPT9 was quantified in tumor specimens and matched normal adjacent tissue (NAT) from 71 BTC patients, as well as in plasma samples from an independent prospective cohort of 20 cholangiocarcinoma patients and 100 control patients. Receiver operating characteristic (ROC) curve analyses were performed to probe the diagnostic ability of both methylation markers. DNA methylation was correlated to clinicopathological data and to overall survival. RESULTS SHOX2 methylation was significantly higher in tumor tissue than in NAT irrespective of tumor localization (p < 0.001) and correctly identified 71% of BTC specimens with 100% specificity (AUC = 0.918; 95% CI 0.865-0.971). SEPT9 hypermethylation was significantly more frequent in gallbladder carcinomas compared to cholangiocarcinomas (p = 0.01) and was associated with large primary tumors (p = 0.01) as well as age (p = 0.03). Cox proportional hazard analysis confirmed microscopic residual tumor at the surgical margin (R1-resection) as an independent prognostic factor, while SHOX2 and SEPT9 methylation showed no correlation with overall survival. Elevated DNA methylation levels were also found in plasma derived from cholangiocarcinoma patients. SHOX2 and SEPT9 methylation as a marker panel achieved a sensitivity of 45% and a specificity of 99% in differentiating between samples from patients with and without cholangiocarcinoma (AUC = 0.752; 95% CI 0.631-0.873). CONCLUSIONS SHOX2 and SEPT9 are frequently methylated in biliary tract cancers. Promoter hypermethylation of SHOX2 and SEPT9 may therefore serve as a minimally invasive biomarker supporting diagnosis finding and therapy monitoring in clinical specimens.
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Affiliation(s)
- V Branchi
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - P Schaefer
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - A Semaan
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - A Kania
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - P Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - J C Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - N Schäfer
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - G Kristiansen
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - D Dietrich
- Institute of Pathology, University Hospital Bonn, Bonn, Germany.,Department of Otolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - H Matthaei
- Department of General, Visceral, Thoracic and Vascular Surgery University Hospital Bonn, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
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Raymond S, Leslie-Mazwi T, Rost N, Schaefer P, Hirsch J, Gonzalez R, Rabinov J. E-039 Comparison of Medical Therapy vs. Intra-Arterial Therapy for Acute Vertebrobasilar Stroke. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.111] [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: 11/03/2022]
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10
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Langer C, Both M, Harders H, Lutz M, Eden M, Kühl C, Sattler B, Jansen O, Schaefer P, Frey N. Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry. Eur Radiol 2014; 25:575-84. [PMID: 25316053 DOI: 10.1007/s00330-014-3434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/22/2014] [Accepted: 09/04/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM. METHODS N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR. RESULTS The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9). CONCLUSIONS LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90% of the cases. KEY POINTS • LeMDCT of relatively low contrast allows for LV planimetry in HCM. • The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9). • LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.
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Affiliation(s)
- Christoph Langer
- Department of Cardiology, Angiology and Critical Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Schittenhelmstr. 12, 24105, Kiel, Germany,
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11
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Welte S, Cristescu I, Dittrich H, Lohr N, Melzer C, Michling R, Plusczyk C, Schaefer P. Setup and commissioning of a combined water detritiation and isotope separation experiment at the Tritium Laboratory Karlsruhe. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Langer C, Hohnhorst M, Schaefer P, Lutz M, Luedde M, Eden M, Kuehl C, Prinz C, Faber L, Frey N. Cardiac CT in hypertrophic cardiomyopathy: volumetric assessment of intramyocardial fibrosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4709] [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: 11/13/2022] Open
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13
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Williams T, George A, Regine W, Thomas D, Schaefer P, Safran H, Small W, Guha C, Ben-Josef E. Caveolin-1 Expression Correlates With Outcomes in Pancreatic Ductal Carcinoma: A Secondary Analysis of RTOG 9704. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.073] [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: 10/27/2022]
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Schaefer F, Fürst M, Schaefer P. Gynäkomastie unter Methotrexat-Einnahme bei Churg-Strauss-Syndrom. ROFO-FORTSCHR RONTG 2012; 184:59-60. [DOI: 10.1055/s-0031-1281761] [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: 10/17/2022]
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Schaefer P, Koeppe P. Semantik des Röntgenbefundes am Beispiel der Thoraxuntersuchung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229217] [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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18
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Gutensohn K, Schaefer P, Krueger W, Löliger C, Asmussen C, Geidel K, Kuehnl P. The Storage Lesion of Single Donor Platelets: Insights from Flow Cytometric Analysis and Transmission Electron Microscopy. Transfus Med Hemother 2009. [DOI: 10.1159/000223515] [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: 11/19/2022] Open
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20
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Jahnke T, Trentmann J, Charalambous N, Huemme T, Sehr D, Heller M, Mueller-Huelsbeck S, Schaefer P. Abstract No. 227: Directional Atherectomy for In-Stent Restenosis of the Femoropopliteal Artery: Results of a Pilot Study. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.220] [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: 11/15/2022] Open
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21
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Jahnke T, Jamili A, Charalambous N, Huemme T, Trentmann J, Mueller-Huelsbeck S, Heller M, Schaefer P. Abstract No. 231: Featured Abstract. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.224] [Citation(s) in RCA: 2] [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: 11/16/2022] Open
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22
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Markovic SN, Suman VJ, Schaefer P, Morton R, Rowland KM. Aerosolized sargramostim for the treatment of metastatic melanoma to the lungs. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8565 Background: Previous studies using low-dose (250 ug/dose) aerosolized sargramostim (granulocyte macrophage colony stimulating factor: aero-GM-CSF) for the treatment of metastatic melanoma, revealed anecdotal clinical responses that appeared to correlate with an increase in the number of tumor specific cytotoxic T lymphocytes (CTL) in blood. Herein, we address whether or not further dose escalation of aero-GM-CSF is safe, results in greater increase of melanoma specific CTLs, and affects clinical outcomes. Methods: A 5+5 dose escalation clinical trial was conducted to determine the dose of aero-GM-CSF that would increase in the frequency of peripheral blood melanoma specific CTLs in HLA-A2+ patients with metastatic melanoma to the lungs. Aero-GM-CSF was administered twice daily on days 1–7 and 15–21 of a 28 day cycle at doses of: 500, 750, 1,000, 1,250, 1,500, 1,750, and 2,000 ug per cohort. If at most 2 of 5 patients at a dose level reported a 5-fold increase in CTLs, dose escalation occurred. If not, 5 additional patients were treated at that dose. Dose escalation continued until =2 of 5 patients at a dose level developed severe toxicity, at least 7 of the 10 patients at a dose level reported a 5-fold increase in CTLs, or all dose levels were exhausted. Results: The study accrued 40 patients from August 2002 to July 2006. Four patients cancelled participation prior to treatment. One patient was replaced (500 ug) as he died within 13 days of registration. Among the 35 remaining patients, median age was 58 (23–84), 72% were male, and 72% had a PS=0. Dose escalation was not terminated due to toxicity. Toxicities = grade 3 (at least probably treatment related) included: grade 3 fatigue (1) at 1,000 ug; and grade 3 cough (1), and grade 4 dyspnea (1) at 1,750 ug. At the 2,000 ug dose, most patients (4 of 5) exhibited a greater than 2-fold increase in melanoma specific CTLs. Two of these patients remain on treatment: one with partial response at 14.0 months and the other with stable disease at 6.5 months. A 5-fold increase in tumor specific CTLs was not achieved in any patient. Conclusions: Aero-GM-CSF therapy administered at up to 2,000 ug/dose appears safe and seems to correlate with increased frequencies of tumor specific CTLs in a dose-dependent fashion. Further dose escalation followed by clinical efficacy testing is warranted. No significant financial relationships to disclose.
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Affiliation(s)
- S. N. Markovic
- Mayo Clinic, Rochester, MN; TCHOP, Toledo, OH; Medical Oncology and Hematology Associates, DesMoines, IA; Carle Clinic, Urbana, IL
| | - V. J. Suman
- Mayo Clinic, Rochester, MN; TCHOP, Toledo, OH; Medical Oncology and Hematology Associates, DesMoines, IA; Carle Clinic, Urbana, IL
| | - P. Schaefer
- Mayo Clinic, Rochester, MN; TCHOP, Toledo, OH; Medical Oncology and Hematology Associates, DesMoines, IA; Carle Clinic, Urbana, IL
| | - R. Morton
- Mayo Clinic, Rochester, MN; TCHOP, Toledo, OH; Medical Oncology and Hematology Associates, DesMoines, IA; Carle Clinic, Urbana, IL
| | - K. M. Rowland
- Mayo Clinic, Rochester, MN; TCHOP, Toledo, OH; Medical Oncology and Hematology Associates, DesMoines, IA; Carle Clinic, Urbana, IL
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Bouchardy C, Fioretta G, Verkooijen HM, Vlastos G, Schaefer P, Delaloye JF, Neyroud-Caspar I, Balmer Majno S, Wespi Y, Forni M, Chappuis P, Sappino AP, Rapiti E. Recent increase of breast cancer incidence among women under the age of forty. Br J Cancer 2007; 96:1743-6. [PMID: 17533391 PMCID: PMC2359920 DOI: 10.1038/sj.bjc.6603783] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Using data from the Geneva Cancer Registry, we found that in 2002–2004, breast cancer incidence in women aged 25–39 years increased by 46.7% per year (95% CI: 7.1–74.0, P=0.015), which surveillance or detection bias may not fully explain.
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Affiliation(s)
- C Bouchardy
- Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, 55, bd de la Cluse, 1205 Geneva, Switzerland.
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Buckner JC, Ballman K, Schaefer P, Furth AF, Giannini C, Scheithauer BW, Galanis E, Jaeckle KA. NCCTG 96–94–53: Clinical variables associated with overall survival (OS), progression-free survival (PFS), 6 month progression-free survival (PFS6), immediate progression (ImmProg), and response in patients enrolled in recurrent glioma clinical trials. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1520 Background: Multiple variables may impact endpoints utilized to assess efficacy of investigational therapies for pts with recurrent gliomas. Understanding the nature of these variables should aid interpretation of results. Methods: 583 pts were enrolled to 15 consecutive recurrent glioma clinical trials conducted between 1980 and 2004. Identical patient, tumor, treatment and time variables were identified for each trial. Central neuropathology review was completed and pts were grouped by WHO diagnoses. Pts alive and progression-free at 6 months after start of treatment were a PFS6 ‘success’. Pts whose outcome was progression at first evaluation were classified as “Immediate Progression (ImmProg)”. Response was defined as regression, partial regression, or complete regression in the absence of worsening neurologic symptoms or increased corticosteroid dose. Univariable and multivariable Classification and Regression Trees (CART) models were used to identify factors associated with OS, PFS, PFS6, ImmProg, and Response. Results: Variables associated with outcomes for each endpoint assessed by CART models are shown in Table below. Conclusions: In clinical trials of recurrent glioma, age, PS, duration of disease, primary and recurrent histologic diagnosis, and primary and recurrent extent of resection are associated with outcomes. These variables should be validated in additional datasets for potential inclusion in reports of future clinical trials. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. C. Buckner
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - K. Ballman
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - P. Schaefer
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - A. F. Furth
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - C. Giannini
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - B. W. Scheithauer
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - E. Galanis
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
| | - K. A. Jaeckle
- North Central Cancer Treatment Group; Mayo Clinic College of Medicine, Rochester, MN; Mayo Clinic, Rochester, MN; Toledo CCOP, Toledo, OH; Mayo Clinic Jacksonville, Jacksonville, FL
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Glugla M, Caldwell-Nichols C, Cristescu I, Doerr L, Hellriegel G, Laesser R, Murdoch D, Schaefer P. Protection of the primary circuits and effect on the design of the inner deuterium/tritium fuel cycle of ITER. Fusion Engineering and Design 2005. [DOI: 10.1016/j.fusengdes.2005.06.047] [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: 10/25/2022]
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Alberts SR, Foster NR, Morton RF, Kugler J, Schaefer P, Wiesenfeld M, Fitch TR, Steen P, Kim GP, Gill S. PS-341 and gemcitabine in patients with metastatic pancreatic adenocarcinoma: a North Central Cancer Treatment Group (NCCTG) randomized phase II study. Ann Oncol 2005; 16:1654-61. [PMID: 16085692 DOI: 10.1093/annonc/mdi324] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND PS-341 is a proteasome inhibitor with preclinical activity in pancreatic cancer tumor models and synergistic activity with gemcitabine. This randomized phase II study determined the tumor response rate (RR) for PS-341 alone and the 6-month survival and RR for the combination of gemcitabine and PS-341 in patients with metastatic pancreatic adenocarcinoma. PATIENTS AND METHODS Patients were randomized to receive 3-week cycles of either arm A: PS-341 1.5 mg/m(2) i.v. bolus (over 3--5 s) on days 1, 4, 8 and 11 or arm B: PS-341 1.0 mg/m(2) (same as arm A otherwise) plus gemcitabine 1,000 mg/m(2) i.v. on days 1 and 8. Patients progressing on arm A were allowed to receive arm B treatment. RESULTS Arm A: 42 evaluable patients were enrolled with a confirmed RR of 0% (95% CI 0% to 8%), median survival of 2.5 months (95% CI 2.0-3.3), and median time to progression (TTP) of 1.2 months (95% CI 1.1--1.3). Twelve of 43 evaluable patients (28%) experienced at least one grade 4+ AE. Arm B: 39 evaluable patients yielded a 6-month survival rate of 41% (16/39, 95% CI 29.8% to 67.0%), median survival of 4.8 months (95% CI 2.4--7.4), median TTP of 2.4 months (95% CI 1.5--3.1), and confirmed RR of 10% (4 partial responses/0 complete responses, 95% CI 3% to 24%). Eleven of 43 evaluable patients (26%) experienced at least one grade 4+ AE. One patient had grade 5 hypotension. CONCLUSION The use of PS-341 alone or in combination with gemcitabine did not result in an overall survival and RR better than that expected for gemcitabine alone. Based on the lack of efficacy and the toxicity seen in our trial, there does not appear to be a role for PS-341 in pancreatic adenocarcinoma with either of the schedules used in this trial.
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Affiliation(s)
- S R Alberts
- Mayo Clinic and Mayo Foundation, Rochester, MN 55905.
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Schwartz GK, Winter K, Minsky B, Janjan N, Schaefer P, Thomson J, Rani A, Gross H, Willett C, Kelsen D. A randomized phase II trial comparing two paclitaxel (P)-cisplatin (C) containing chemoradiation (CRT) regimens as adjuvant therapy in resected gastric cancer (RTOG Intergroup #0114). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. K. Schwartz
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - K. Winter
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - B. Minsky
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - N. Janjan
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - P. Schaefer
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - J. Thomson
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - A. Rani
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - H. Gross
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - C. Willett
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
| | - D. Kelsen
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; RTOG HQ, Philadelphia, PA; M.D. Anderson Cancer Ctr, Houston, TX; Natalie Warren Cancer Ctr, Tulsa, OK; LDS Hosp, Salt Lake City, UT; Thomas Jefferson Univ, Philadelphia, PA; Dayton CCOP, Dayton, OH; Duke Univ Comp Cancer Ctr, Durham, NC
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Tebeu PM, Pelte MF, Anguenot JL, Vlastos AT, De Pury RB, Kinkel K, Megevand E, Schaefer P. Krukenberg tumour from an appendiceal carcinoma presenting as a primary ovarian tumour. W INDIAN MED J 2004; 53:427-8. [PMID: 15816275] [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: 05/02/2023]
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Holmberg SB, Crivellari D, Zahrieh D, Forbes JF, Rey P, Dent DM, Schaefer P, Bernhard J, Campbell I, Rudenstam CMM. A randomized trial comparing axillary clearance versus no axillary clearance in older patients (≥ 60 years) with breast cancer: First results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. B. Holmberg
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - D. Crivellari
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - D. Zahrieh
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - J. F. Forbes
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - P. Rey
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - D. M. Dent
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - P. Schaefer
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - J. Bernhard
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - I. Campbell
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
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Verkooijen H, Fioretta G, Vlastos G, Schaefer P, Kurtz J, Sappino A, Schubert H, Bouchardy C. Patient's refusal of surgery strongly decreases prognosis of non metastatic breast cancer. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)91043-9] [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] Open
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Bonnefoi H, Biganzoli L, Mauriac L, Cufer T, Schaefer P, Atalay G, Piccart M. An EORTC phase I study of capecitabine (Xeloda) in combination with fixed doses of cyclophosphamide and epirubicin (cex) as primary treatment for large operable or locally advanced/inflammatory breast cancer. Eur J Cancer 2003; 39:1277-83. [PMID: 12763217 DOI: 10.1016/s0959-8049(03)00266-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/19/2022]
Abstract
In breast cancer, chemotherapy regimens that include infusional 5-fluorouracil (5-FU) lead to high response rates, but require central venous access and pumps. To avoid these inconveniences, we substituted infusional 5-FU with capecitabine. The main objective of this study was to determine the maximum tolerated dose (MTD) of capecitabine when given in combination with fixed doses of epirubicin and cyclophosphamide (100 and 600 mg/m(2) day 1 every (q) 3 weeks) as primary treatment for large operable or locally advanced/inflammatory breast cancer without distant metastasis. Capecitabine was escalated from 750 mg/m(2) twice a day (bid) to 1250 mg/m(2) bid from day 1 to day 14 in four dose levels. Dose escalation was permitted if 0/3 or 1/6 patients experienced dose-limiting toxicity (DLT). A total of 23 patients were included and 117 courses were administered. At dose level 4, 2 of 2 patients presented DLTs defining the MTD. A high rate of capecitabine treatment modification was required with capecitabine 1050 mg/m(2) bid (dose level 3). 19 patients achieved an objective response (83%). In conclusion, we believe that capecitabine 900 mg/m(2) bid (dose level 2) is the recommended dose in combination with epirubicin 100 mg/m(2) and cyclophosphamide 600 mg/m(2). The acceptable toxicity profile and encouraging activity of this regimen warrant further evaluation.
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Affiliation(s)
- H Bonnefoi
- Hôpitaux Universitaires de Genève, 30 Boulevard de la Cluse, 1211 14, Geneva, Switzerland.
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Bonnefoi H, Biganzoli L, Cufer T, Mauriac L, Hamilton A, Schaefer P, Piccart M. An EORTC phase I study of epirubicin in combination with fixed doses of cyclophosphamide and infusional 5-fu (CEF-infu) as primary treatment of large operable or locally advanced/inflammatory breast cancer. Breast Cancer Res Treat 2001; 70:55-63. [PMID: 11768362 DOI: 10.1023/a:1012530607649] [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
PURPOSE The association of continuous infusion 5-fluorouracil, epirubicin (50 mg/m2 q 3 weeks) and a platinum compound (cisplatin or carboplatin) was found to be very active in patients with either locally advanced/inflammatory (LA/I) [1, 2] or large operable (LO) breast cancer (BC) [3]. The same rate of activity in terms of response rate (RR) and response duration was observed in LA/I BC patients when cisplatin was replaced by cyclophosphamide [4]. The dose of epirubicin was either 50 mg/m2 [ 1, 2, 3] or 60 mg/m2/cycle [4]. The main objective of this study was to determine the maximum tolerated dose (MTD) of epirubicin when given in combination with fixed doses of cyclophosphamide and infusional 5-fluorouracil (CEF-infu) as neoadjuvant therapy in patients with LO or LA/I BC for a maximum of 6 cycles. PATIENTS AND METHODS Eligible patients had LO or LA/I BC, a performance status 0-1, adequate organ function and were <65 years old. Cyclophosphamide was administered at the dose of 400 mg/m2 day 1 and 8, q 4 weeks and infusional 5-fluorouracil 200 mg/m2/day was given day 1-28, q 4 weeks. Epirubicin was escalated from 30 to 45 and to 60 mg/m2 day 1 and 8; dose escalation was permitted if 0/3 or 1/6 patients experienced dose limiting toxicity (DLT) during the first 2 cycles of therapy. DLT for epirubicin was defined as febrile neutropenia, grade 4 neutropenia lasting for >7 days, grade 4 thrombocytopenia, or any non-haematological toxicity of CTC grade > or =3, excluding alopecia and plantar-palmar erythrodysesthesia (this toxicity was attributable to infusional 5-fluorouracil and was not considered a DLT of epirubicin). RESULTS A total of 21 patients, median age 44 years (range 29-63) have been treated. 107 courses have been delivered, with a median number of 5 cycles per patient (range 4-6). DLTs on cycles I and 2 on level 1, 2, 3: grade 3 (G3) mucositis occurred in 1/10 patients treated at the third dose level. An interim analysis showed that G3 PPE occurred in 5/16 pts treated with the 28-day infusional 5-FU schedule at the 3 dose levels. The protocol was subsequently amended to limit the duration of infusional 5-fluorouracil infusion from 4 to 3 weeks. No G3 PPE was detected in 5 patients treated with this new schedule. CONCLUSIONS This study establishes that epirubicin 60mg/m2 day 1 and 8, cyclophosphamide 400mg/m2 day 1 and 8 and infusional 5-fluorouracil 200 mg/m2/day day 1-21. q 4 weeks is the recommended dose level. Given the encouraging activity of this regimen (15/21 clinical responses) we have replaced infusional 5-fluorouracil by oral capecitabine in a recently activated study.
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Affiliation(s)
- H Bonnefoi
- Hĵpitaux Universitaires de Genève, Genève, Switzerland.
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Ehretsmann C, Schaefer P, Adam R. Cutaneous tolerance of baby wipes by infants with atopic dermatitis, and comparison of the mildness of baby wipe and water in infant skin. J Eur Acad Dermatol Venereol 2001; 15 Suppl 1:16-21. [PMID: 11720073 DOI: 10.1046/j.0926-9959.2001.00004.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 11/20/2022]
Abstract
To confirm the safety and cutaneous tolerability of a new brand of baby wet wipes, we conducted the following clinical studies: (i) a double-blind in-use study in 102 infants over a period of 2 weeks, to compare skin tolerance of the wipes vs. water and a cleansing material (ii) a chamber scarification test on adults to assess the skin irritation potential of the baby wipe, and (iii) a 4-week clinical in-use study in 60 babies with atopic dermatitis, to confirm safety and skin tolerability in a sensitive skin subpopulation. In the clinical comparison with water and cleansing material, skin conditions were assessed visually for presence and severity of erythema and diaper dermatitis. The overall skin condition was not different in the group using wipes and in the group using only water and a cleansing material, indicating comparable skin mildness for both regimes. The chamber scarification test confirmed that the lotion contained in the wipe has a very low irritation potential, lower than that of a currently marketed baby wipe and comparable to that of water under occlusive patch test conditions. The good skin tolerance of the wipes was supported by the observations of a dermatologist in the clinical study in babies with atopic dermatitis. These data strongly support the suitability of the baby wipes tested in these studies for daily cleansing of the diapered area, even for infants with sensitive skin. These data also provide useful information regarding the comparative skin mildness of baby wipes and water.
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Affiliation(s)
- C Ehretsmann
- Safety Department, Procter & Gamble Co., Germany.
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36
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Carrero I, Kroeger N, Krueger W, Schaefer P, Kuehnl P, Gutensohn K. A Two-Year Flow-Cytometric Immune Surveillance of Plateletpheresis Donors. Transfus Med Hemother 2000. [DOI: 10.1159/000053543] [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: 11/19/2022] Open
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37
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Gutensohn K, Beythien C, Koester R, Bau J, Fenner T, Grewe P, Padmanaban K, Schaefer P, Kuehnl P. In vitro Biocompatibility Analyses of Stents Coated with Diamond-Like Carbon by Flow Cytometry, Cell Growth Assays and Electron Microscopy. Transfus Med Hemother 2000. [DOI: 10.1159/000025268] [Citation(s) in RCA: 3] [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: 11/19/2022] Open
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39
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Schaefer P. [Correlation of radiologic and pathologic-anatomical findings in dust-induced pneumoconiosis in former coal miners]. Pneumologie 1998; 52:372-3. [PMID: 9715653] [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: 02/08/2023]
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40
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Provenzale JM, Schaefer P, Traweek ST, Ferry J, Moore JO, Friedman AH, McLendon RE. Craniocerebral plasmacytoma: MR features. AJNR Am J Neuroradiol 1997; 18:389-92. [PMID: 9111682 PMCID: PMC8338571] [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: 02/04/2023]
Abstract
We report the MR imaging findings in two patients with solitary craniocerebral plasmacytoma, a benign plasma cell tumor that can arise from the skull, the dura, or, rarely, the brain. In both patients, the lesion was extraaxial and nearly isointense with gray matter on T2-weighted MR images, and diffusely enhanced after administration of contrast material, bearing some similarities to meningioma. A diagnosis of solitary craniocerebral plasmacytoma should be considered when a mass with these imaging features is seen, because total excision may not be necessary for this radiosensitive tumor.
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Affiliation(s)
- J M Provenzale
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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41
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Harrell JS, Johnston LF, Griggs TR, Schaefer P, Carr EG, McMurray RG, Meibohm AR, Munoz S, Raines BN, Williams OD. An occupation based physical activity intervention program: improving fitness and decreasing obesity. AAOHN J 1996; 44:377-84. [PMID: 8852235] [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: 02/02/2023]
Abstract
The purpose of this quasi-experimental study was to determine the effectiveness of an occupation based health and fitness program. Subjects were 1,504 police trainees (85% male, 15% female) with an ethnic distribution of 82% white, 16% African American, and 2% other. Data were collected at 25 sites across the state of North Carolina. The sites were randomly assigned to either the experimental group (implemented the intervention) or the control group (continued usual training). As compared with controls, subjects at the experimental sites improved significantly in cardiovascular fitness (aerobic power), general muscular strength (number of sit ups per minute), and flexibility, and lowered their body fat. The intervention required minimal equipment and was taught primarily by peers who received a 1 week training program. This occupational approach to improving health could be particularly useful in occupations with many workers who seldom engage in leisure time physical activity.
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Abstract
BACKGROUND Three cases of islet cell tumors of the pancreas with hypercalcemia were studied, and 16 similar cases have been found in a 25-year review of the English-language literature. The purpose of the study was to review the cause of the hypercalcemia and the clinical characteristics of the tumors. METHODS Tumor tissue retrieved from paraffin-embedded blocks was studied immunohistochemically for both parathyroid hormone (PTH) and PTH-related protein (PTHrP). PTH was measured in the serum in each patient and the serum PTHrP was measured by immunoassay in one patient. RESULTS One of our patients had a fatal serum calcium level of 26.4 mg/dl. PTHrP stains were positive in two of our tumors, and one patient had an elevated PTHrP serum level. Serum PTH levels were normal or low in each patient. All three tumors were malignant and extremely vascular. The total group of 19 patients have in common hypercalcemia associated with a normal or low serum PTH level. Although the cause of hypercalcemia has not been proved, the tumors apparently produce PTHrP, because seven of eight tumors stained positive for PTHrP and each of the four patients tested had an elevated PTHrP serum titer. The tumors are extremely vascular, are usually malignant (17 of 18), and become large, but they are compatible with a relatively long patient survival time. CONCLUSIONS These neuroendocrine tumors associated with hypercalcemia share several characteristics, but a claim that they represent another type of "functioning islet cell tumor" should await a clearer delineation of the cause of the hypercalcemia.
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Affiliation(s)
- C Mao
- Department of Surgery, Toledo Hospital, Ohio
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43
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Breen GA, Brocavich JM, Etzel JV, Shah V, Schaefer P, Forlenza S. Evaluation of effects of altered gastric pH on absorption of dapsone in healthy volunteers. Antimicrob Agents Chemother 1994; 38:2227-9. [PMID: 7811056 PMCID: PMC284721 DOI: 10.1128/aac.38.9.2227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A prospective, randomized, crossover study was performed with seven healthy volunteers to address the effect of increased gastric pH on dapsone absorption. Subjects were randomized to receive a single 100-mg dose of dapsone or a single 100-mg dose of dapsone in addition to 30 ml of a high potency antacid 1 h before dapsone administration and hourly thereafter for a total of 10 doses. Dapsone concentrations in serum were measured periodically for 48 h. No statistical differences between the two regimens were noted when mean dapsone maximal initial concentrations, times to peak, and areas under the curve were compared. These data suggest that an increase in gastric pH has little or no effect on the absorption of dapsone in healthy subjects.
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Affiliation(s)
- G A Breen
- Department of Pharmacy, Nassau County Medical Center, East Meadow, New York
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44
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Leventhal EA, Leventhal H, Schaefer P, Easterling D. Conservation of energy, uncertainty reduction, and swift utilization of medical care among the elderly. J Gerontol 1993; 48:P78-86. [PMID: 8473701 DOI: 10.1093/geronj/48.2.p78] [Citation(s) in RCA: 44] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examined age differences in the timing of the decision to seek medical care. Two cohorts, one of middle-aged (40 to 55 years, n = 88) and one of older patients (65 and over, n = 80), who sought medical care when symptomatic were interviewed at the time of their visit. Age differences were examined with respect to total delay (the time from first noticing symptoms until calling for care), as well as its two constituent phases: appraisal delay (symptom onset until deciding one was ill) and illness delay (decision one was ill until calling for care). Older persons were expected to be more conserving of physical and psychic resources, and thus quicker in seeking care. The cohort effect was expected to be most visible for symptoms judged to be of uncertain seriousness. The delay results and ancillary findings on reasons given for delay are generally supportive of the hypotheses, with the caveat that the cohort difference also reflects higher levels of avoidance behavior by the middle-aged than by the older subjects.
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Affiliation(s)
- E A Leventhal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University
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45
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Schaefer P. [Breast screening in Geneva?]. Helv Chir Acta 1992; 59:195-202. [PMID: 1526828] [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: 12/27/2022]
Abstract
Repeated screening-mammography is the best method for an earlier diagnosis of breast cancer in women aged 50 years and more. This diagnostic tool is closely related to the factor "time" and is responsible for the modification of the TNM-groups of the cancers to be treated. An actual project has to consider the local conditions as well as the results of the large randomized trials; special efforts have to be made to ascertain the quality of the screening and its control.
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Affiliation(s)
- P Schaefer
- Clinique de gynécologie, Hôpital cantonal universitaire, Genève
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46
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Abstract
VIN III etiology is multifactorial with a predominant role held by human papillomavirus infections, especially infections with HPV type 16. Other cofactors are also involved. We reviewed our patients presenting with VIN III, focusing our attention on smoking. Out of 37 patients 29 (78%) were smokers and among those who presented with a relapse after treatment (11 patients) all were smokers. We discuss mechanisms by which tobacco could act as a cofactor in VIN III.
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Affiliation(s)
- R Friedrich
- Clinique de Gynécologie, Hôpital Cantonal Universitaire, Genève, Suisse
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47
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Abstract
Thymomas occur in 10% to 15% of patients with myasthenia gravis. Since not all patients are referred for thymectomy, a test that could reliably predict the presence or absence of a thymoma would be of great assistance in the management of these patients. We studied all patients referred for thymectomy at Walter Reed Army Medical Center from 1983 to 1989. Complete records were available for 13 patients. Computerized tomography (CT) correctly predicted the presence of a thymoma in one patient and falsely predicted a thymoma in a patient with a thymic cyst; it accurately predicted the absence of a thymoma in the remaining 11 patients. The sensitivity of CT scanning was 100%, the specificity was 92%, and the accuracy was 92%, results that are in agreement with previously published data. Compared to conventional chest roentgenography, CT scanning provided a more precise anatomic localization, and accurately predicted local invasion. We recommend a CT scan of the mediastinum in all patients with myasthenia gravis to avoid delayed diagnosis of thymoma in patients who normally would not be referred for thymectomy.
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Affiliation(s)
- D A Hale
- General Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307-5001
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48
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Halloran BP, Schaefer P, Lifschitz M, Levens M, Goldsmith RS. Plasma vitamin D metabolite concentrations in chronic renal failure: effect of oral administration of 25-hydroxyvitamin D3. J Clin Endocrinol Metab 1984; 59:1063-9. [PMID: 6333430 DOI: 10.1210/jcem-59-6-1063] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The circulating concentrations of 1,25-dihydroxyvitamin D and 24,25-dihydroxyvitamin D are abnormally low in patients with chronic renal failure (CRF). To determine the importance of substrate (25-hydroxyvitamin D) concentration in this phenomenon, five patients with end stage renal disease treated with hemodialysis were given 25-hydroxyvitamin D3 (25-OH-D3) orally for 4 weeks. The serum concentration of 25-OH-D3 increased from a mean (+/- SEM) of 26 +/- 5 ng/ml immediately before therapy to a maximum of 108 +/- 5 ng/ml 4 weeks after beginning administration of 25-OH-D3. The concentrations of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), 24,25-dihydroxyvitamin D3 (24,25(OH)2D3), and 25,26-dihydroxyvitamin D3 (25,26(OH)2D3) increased from 6.6 +/- 0.8 pg/ml, 0.29 +/- 0.10 ng/ml, and 0.36 +/- 0.06 ng/ml, respectively, immediately before 25-OH-D3 administration to 21.7 +/- 2.2 pg/ml, 0.48 +/- 0.09 ng/ml; and 0.78 +/- 0.12 ng/ml, respectively, after 4 weeks of administration of 25-OH-D3. These results suggest that substrate availability may be an important determinant of the circulating concentrations of these metabolites in patients with CRF. It seems possible that the therapeutic effects of 25-OH-D3 administration to the CRF patient may be mediated through the normal actions of 1,25-dihydroxyvitamin D3, 24,25-dihydroxyvitamin D3, and perhaps other metabolites rather than through analog effects of 25-OH-D3.
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49
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Lehmann J, Schaefer P, Ferkany JW, Coyle JT. Quinolinic acid evokes [3H]acetylcholine release in striatal slices: mediation by NMDA-type excitatory amino acid receptors. Eur J Pharmacol 1983; 96:111-5. [PMID: 6141057 DOI: 10.1016/0014-2999(83)90536-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Quinolinic acid evoked the release of [3H]acetylcholine from striatal slices with an EC50 of approximately 2 mM and an efficacy similar to that of N-methyl-D,L-aspartic acid. (+/-)-2-Amino-5-phosphonopentanoic acid and (-)-2-amino-7-phosphonoheptanoic acid antagonized quinolinic acid-evoked release, while glutamate diethylester and 2-amino-4-phosphonobutyric acid were ineffective as antagonists. Release of [3H]acetylcholine evoked by quinolinic acid was strongly attenuated by the presence of magnesium (1.2 mM) in the medium. The results are consistent with the interaction of quinolinic acid with NMDA-type excitatory amino acid receptors on the striatal cholinergic interneurons.
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50
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Schlotfeldt-Schäfer I, Schaefer P, Flatz S, Hürter P. [Congenital varicella syndrome]. Monatsschr Kinderheilkd 1983; 131:106-8. [PMID: 6843555] [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: 01/22/2023]
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