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Goebel J, Schult K, Schara U, Neudorf U, Forsting M, Schlosser T, Nassenstein K. Patterns of cardiac involvement in different muscular dystrophies assessed by magnetic resonance imaging. Acta Radiol 2023; 64:605-611. [PMID: 35147046 DOI: 10.1177/02841851221077402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In muscular dystrophies, it is not only skeletal muscles that can be affected, but also the myocardium. This cardiac involvement can represent a major cause of morbidity and mortality. PURPOSE To investigate cardiac involvement in Duchenne (DMD), Becker (BMD), and limb girdle muscular dystrophy (LGMD) patients, and carriers of DMD/BMD by cardiac magnetic resonance (CMR) imaging and to search for differences in the pattern of cardiac involvement. MATERIAL AND METHODS All patients with genetically or histologically proven DMD, BMD, and LGMD, or confirmed carriers of DMD/BMD who had undergone CMR at our clinic between January 2008 and November 2018 were retrospectively included and re-evaluated for regional and global left ventricular function, increased trabecularization, and late enhancement. RESULTS A total of 26 DMD, 10 BMD, 11 LGMD, and seven DMD/BMD carriers were included. Only one carrier of DMD presented with normal CMR results; all other participants showed cardiac abnormalities. Regional wall motion abnormalities (RWMA; prevalence in LGMD patients: 55%) and late enhancement (prevalence in LGMD patients: 82%) were frequent. RWMA were accentuated basal inferolateral in DMD/BMD carriers, while in LGMD they were accentuated apical. In all groups late enhancement was located mainly subepicardial/midmyocardial with a basal inferolateral accentuation. Apart from the different RWMA distribution, no further group-specific differences were found. CONCLUSION We found a high rate of cardiac involvement not only in DMD/BMD, but also in LGMD and DMD/BMD carriers with a different RWMA accentuation (apical in LGMD and basal inferolateral in DMD/BMD) as a single group-specific difference.
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Affiliation(s)
- Juliane Goebel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, 39081University Hospital Essen, Essen, Germany
| | - Karolin Schult
- Department of Diagnostic and Interventional Radiology and Neuroradiology, 39081University Hospital Essen, Essen, Germany
| | - Ulrike Schara
- Department of Pediatric Neurology, 39081University Hospital Essen, Essen, Germany
| | - Ulrich Neudorf
- Department of Pediatric Cardiology, 39081University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, 39081University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, 39081University Hospital Essen, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, 39081University Hospital Essen, Essen, Germany
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Rinné S, Stallmeyer B, Pinggera A, Netter MF, Matschke LA, Dittmann S, Kirchhefer U, Neudorf U, Opp J, Striessnig J, Decher N, Schulze-Bahr E. Whole Exome Sequencing Identifies a Heterozygous Variant in the Cav1.3 Gene CACNA1D Associated with Familial Sinus Node Dysfunction and Focal Idiopathic Epilepsy. Int J Mol Sci 2022; 23:ijms232214215. [PMID: 36430690 PMCID: PMC9693521 DOI: 10.3390/ijms232214215] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Cav1.3 voltage-gated L-type calcium channels (LTCCs) are involved in cardiac pacemaking, hearing and hormone secretion, but are also expressed postsynaptically in neurons. So far, homozygous loss of function mutations in CACNA1D encoding the Cav1.3 α1-subunit are described in congenital sinus node dysfunction and deafness. In addition, germline mutations in CACNA1D have been linked to neurodevelopmental syndromes including epileptic seizures, autism, intellectual disability and primary hyperaldosteronism. Here, a three-generation family with a syndromal phenotype of sinus node dysfunction, idiopathic epilepsy and attention deficit hyperactivity disorder (ADHD) is investigated. Whole genome sequencing and functional heterologous expression studies were used to identify the disease-causing mechanisms in this novel syndromal disorder. We identified a heterozygous non-synonymous variant (p.Arg930His) in the CACNA1D gene that cosegregated with the combined clinical phenotype in an autosomal dominant manner. Functional heterologous expression studies showed that the CACNA1D variant induces isoform-specific alterations of Cav1.3 channel gating: a gain of ion channel function was observed in the brain-specific short CACNA1D isoform (Cav1.3S), whereas a loss of ion channel function was seen in the long (Cav1.3L) isoform. The combined gain-of-function (GOF) and loss-of-function (LOF) induced by the R930H variant are likely to be associated with the rare combined clinical and syndromal phenotypes in the family. The GOF in the Cav1.3S variant with high neuronal expression is likely to result in epilepsy, whereas the LOF in the long Cav1.3L variant results in sinus node dysfunction.
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Affiliation(s)
- Susanne Rinné
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Birgit Stallmeyer
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
| | - Alexandra Pinggera
- Department of Pharmacology and Toxicology, Center for Molecular Biosciences, University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael F. Netter
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Lina A. Matschke
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Sven Dittmann
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
| | - Uwe Kirchhefer
- Institute of Pharmacology and Toxicology, University Hospital Muenster, 48149 Muenster, Germany
| | - Ulrich Neudorf
- Zentrum für Kinder-und Jugendmedizin, Klinik für Kinderheilkunde III-Bereich Kardiologie, University Hospital Essen, 45147 Essen, Germany
| | - Joachim Opp
- Ev. Krankenhaus Oberhausen, 46047 Oberhausen, Germany
| | - Jörg Striessnig
- Department of Pharmacology and Toxicology, Center for Molecular Biosciences, University of Innsbruck, 6020 Innsbruck, Austria
| | - Niels Decher
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
- Correspondence: (N.D.); (E.S.-B.); Tel.: +49-(0)6421/28-62148 (N.D.); +49-(0)251/83-55326 (E.S.-B.)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
- Correspondence: (N.D.); (E.S.-B.); Tel.: +49-(0)6421/28-62148 (N.D.); +49-(0)251/83-55326 (E.S.-B.)
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3
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Oommen PT, Strauss T, Baltruschat K, Foeldvari I, Deuter C, Ganser G, Haas JP, Hinze C, Holzinger D, Hospach A, Huppertz HI, Illhardt A, Jung M, Kallinich T, Klein A, Minden K, Mönkemöller K, Mrusek S, Neudorf U, Dückers G, Niehues T, Schneider M, Schoof P, Thon A, Wachowsky M, Wagner N, Bloedt S, Hofer M, Tenbrock K, Schuetz C. Update of evidence- and consensus-based guidelines for the treatment of juvenile idiopathic arthritis (JIA) by the German Society of Pediatric and Juvenile Rheumatic Diseases (GKJR): New perspectives on interdisciplinary care. Clin Immunol 2022; 245:109143. [DOI: 10.1016/j.clim.2022.109143] [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] [Received: 06/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
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Vollbach K, Schuetz C, Hedrich CM, Speth F, Mönkemöller K, Brunner J, Neudorf U, Rietschel C, Hospach A, Kallinich T, Hinze C, Wagner N, Tönshoff B, Weber LT, Latta K, Thumfart J, Bald M, Wiemann D, Zappel H, Tenbrock K, Haffner D. Working Towards a Treat-to-Target Protocol in Juvenile Proliferative Lupus Nephritis - A Survey of Pediatric Rheumatologists and Nephrologists in Germany and Austria. Front Pediatr 2022; 10:851998. [PMID: 35529329 PMCID: PMC9072733 DOI: 10.3389/fped.2022.851998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To describe treatment practices for juvenile proliferative lupus nephritis (LN) class III and IV of pediatric rheumatologists and nephrologists in Germany and Austria in preparation for a treat-to-target treatment protocol in LN. METHODS Survey study by members of the Society for Pediatric and Adolescent Rheumatology (GKJR) and the German Society for Pediatric Nephrology (GPN) on diagnostics and (concomitant) therapy of LN. RESULTS Fifty-eight physicians completed the survey. Overall, there was a considerable heterogeneity regarding the suggested diagnostics and management of juvenile proliferative LN. Increased urinary protein excretion, either assessed by 24 h urine collection or spot urine (protein-creatinine ratio), and reduced estimated glomerular filtration rate were specified as important parameters for indication of kidney biopsy to diagnose proliferative LN and monitoring of therapy. Corticosteroids were generally proposed for induction and maintenance therapy, most often in conjunction with either mycophenolate mofetil (MMF) or cyclophosphamide (CP) as steroid-sparing immunosuppressants. MMF was clearly preferred over CP for induction therapy of LN class III, whereas CP and MMF were equally proposed for LN class IV. MMF was most often recommended for maintenance therapy in conjunction with oral corticosteroids and continued for at least 3 years and 1 year, respectively, after remission. Hydroxychloroquine was widely accepted as a concomitant measure followed by renin-angiotensin system inhibitors in cases of arterial hypertension and/or proteinuria. CONCLUSION The majority of pediatric rheumatologists and nephrologists in Germany and Austria propose the use of corticosteroids, most often in combination with either MMF or CP, for treatment of proliferative LN in children. The considerable heterogeneity of responses supports the need for a treat-to-target protocol for juvenile proliferative LN between pediatric rheumatologists and nephrologists.
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Affiliation(s)
- Kristina Vollbach
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian M Hedrich
- Department of Pediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.,Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Fabian Speth
- Universitätsmedizin Hamburg, Kinder- und Jugendklinik, Hamburg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Strasse, Cologne, Germany
| | - Jürgen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medizinische Universität Innsbruck, Innsbruck, and Danube Private University, Krems an der Donau, Austria
| | - Ulrich Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Christoph Rietschel
- Department of Pediatric Rheumatology, Clementine Kinderhospital, Frankfurt, Germany
| | - Anton Hospach
- Center for Pediatric Rheumatology, Olgahospital, Stuttgart, Germany
| | - Tilmann Kallinich
- German Rheumatism Research Center, Leibniz Institute, Berlin, and Charité Universitätsmedizin Berlin, Pediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Berlin, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital, Münster, Germany
| | - Norbert Wagner
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Lutz T Weber
- Division of Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, Frankfurt, Germany
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bald
- Division of Pediatric Nephrology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Dagobert Wiemann
- Division of Pediatric Diabetology/Endocrinology, University Hospital Magdeburg, Magdeburg, Germany
| | - Hildegard Zappel
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, RWTH Aachen University Hospital, Aachen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany
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5
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van Otterdijk S, Kölbel H, Schönecker A, Modler L, Marina AD, Neudorf U, Schara U. SMA CLINICAL DATA. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Schmidt A, Peters S, Knaus A, Sabir H, Hamsen F, Maj C, Fazaal J, Sivalingam S, Savchenko O, Mantri A, Holzinger D, Neudorf U, Müller A, Ludwig KU, Krawitz PM, Engels H, Nöthen MM, Bagci S. TBK1 and TNFRSF13B mutations and an autoinflammatory disease in a child with lethal COVID-19. NPJ Genom Med 2021; 6:55. [PMID: 34210994 PMCID: PMC8249618 DOI: 10.1038/s41525-021-00220-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 02/02/2021] [Accepted: 06/09/2021] [Indexed: 12/16/2022] Open
Abstract
Among children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are typically mild. Here, we describe the case of a 3.5-year-old girl with an unusually severe presentation of coronavirus disease (COVID-19). The child had an autoinflammatory disorder of unknown etiology, which had been treated using prednisolone and methotrexate, and her parents were half cousins of Turkish descent. After 5 days of nonspecific viral infection symptoms, tonic-clonic seizures occurred followed by acute cardiac insufficiency, multi-organ insufficiency, and ultimate death. Trio exome sequencing identified a homozygous splice-variant in the gene TBK1, and a homozygous missense variant in the gene TNFRSF13B. Heterozygous deleterious variants in the TBK1 gene have been associated with severe COVID-19, and the variant in the TNFRSF13B gene has been associated with common variable immunodeficiency (CVID). We suggest that the identified variants, the autoinflammatory disorder and its treatment, or a combination of these factors probably predisposed to lethal COVID-19 in the present case.
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Affiliation(s)
- Axel Schmidt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Sophia Peters
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Alexej Knaus
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Hemmen Sabir
- Neonatology and Pediatric Intensive Care, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Frauke Hamsen
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Julia Fazaal
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Sugirthan Sivalingam
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
- Core Unit for Bioinformatics Data Analysis, Medical Faculty, University of Bonn, Bonn, Germany
| | - Oleksandr Savchenko
- Department of Diagnostic and Interventional Radiology, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Aakash Mantri
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Neudorf
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Andreas Müller
- Neonatology and Pediatric Intensive Care, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Kerstin U Ludwig
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Peter M Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Hartmut Engels
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany.
| | - Soyhan Bagci
- Neonatology and Pediatric Intensive Care, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
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7
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Lainka E, Baehr M, Raszka B, Haas JP, Hügle B, Fischer N, Foell D, Hinze C, Weissbarth-Riedel E, Kallinich T, Horneff G, Windschall D, Lilienthal E, Niehues T, Neudorf U, Berendes R, Küster RM, Oommen PT, Rietschel C, Lutz T, Weller-Heinemann F, Tenbrock K, Heubner GL, Klotsche J, Wittkowski H. Experiences with IL-1 blockade in systemic juvenile idiopathic arthritis - data from the German AID-registry. Pediatr Rheumatol Online J 2021; 19:38. [PMID: 33752669 PMCID: PMC7986520 DOI: 10.1186/s12969-021-00510-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (sJIA) is a complex disease with dysregulation of the innate immune system driven by cytokines. A major role is ascribed to interleukin-1β (IL-1β), supporting the autoinflammatory character of the disease and offering an effective blocking mechanism for treatment. Here we present clinical practice data from the German AID-registry for patients treated with IL-1 inhibition (IL-1i). METHODS In 2009 a clinical and research consortium (AID-Net) was established, including an online AID-registry. Patients with documented sJIA diagnosis were identified. Data for this retrospective IL-1i study were recorded by 17 centers. Response to treatment was evaluated according to Wallace criteria and additionally by an own classifying clinical response system. RESULTS In 6 years, 202 patients with confirmed sJIA were recorded in the AID-registry. Out of these, 111 children received therapy with Anakinra (ANA) (n = 84, 39 f) and/or Canakinumab (CANA) (n = 27, 15 f) at a median age of 8.7 y (range 0.6-19.1). During the first 12 months 75/111 (ANA 55, CANA 20) patients were evaluated according to Wallace criteria (achievement of inactive disease 28/55 and 17/20, remission over 6 months under medication 13/55 and 7/20 cases). Over the whole period of time, clinical response was preserved in the majority of patients (ANA 54/80, CANA 20/27). Arthritis mostly persisted in polyarticular (PA) courses. During treatment with IL-1i concomitant medication could be tapered in about 15%. IL-1i was discontinued in 59/111 patients. 45 (15) adverse events (AE)s in ANA (CANA) treated patients (19.7 (26.6) AE/100 ANA (CANA) exposure years, 95%CI: 14.4-26.4 (14.9-43.9)) were reported. CONCLUSION In a large cohort of sJIA patients from Germany, we can confirm an overall favorable clinical response to both available IL-1 blocking agents. IL-1i was well tolerated with acceptable safety and effectiveness in a real-life clinical setting.
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Affiliation(s)
- Elke Lainka
- Department of Pediatric Rheumatology, University Children's Hospital Essen, Essen, Germany.
| | - Melanie Baehr
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Bernadette Raszka
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Johannes-Peter Haas
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Boris Hügle
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Nadine Fischer
- grid.500039.fGerman Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Dirk Foell
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Claas Hinze
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Elisabeth Weissbarth-Riedel
- grid.13648.380000 0001 2180 3484Pediatric Rheumatology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilmann Kallinich
- grid.6363.00000 0001 2218 4662Department of Pediatric Pneumology, Immunology and Intensive Medicine and Center for Chronically Sick Children, Charité University Medicine Berlin and German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Gerd Horneff
- grid.6190.e0000 0000 8580 3777Department of Pediatrics, Asklepios Clinic, Centre for Pediatric Rheumatology, St. Augustin and Medical Faculty, University of Cologne, Cologne, Germany
| | - Daniel Windschall
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | - Eggert Lilienthal
- grid.5570.70000 0004 0490 981XDepartment of Pediatrics, Ruhr-University Bochum, Bochum, Germany
| | - Tim Niehues
- HELIOS Children’s Hospital, Pediatric Immunology and Rheumatology, Krefeld, Germany
| | - Ulrich Neudorf
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Essen, Germany
| | - Rainer Berendes
- Department of Pediatric Rheumatology, St. Marien’s Children’s Hospital Landshut, Landshut, Germany
| | | | - Prasad Thomas Oommen
- grid.411327.20000 0001 2176 9917Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christoph Rietschel
- Department of Pediatrics, Clementine Children’s Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Lutz
- grid.5253.10000 0001 0328 4908Center for Pediatric and Adolescent Medicine/Pediatric Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Klaus Tenbrock
- grid.1957.a0000 0001 0728 696XDepartment of Pediatric Pneumology, Allergology and Immunology, RWTH Aachen, Aachen, Germany
| | | | - Jens Klotsche
- grid.418217.90000 0000 9323 8675German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Helmut Wittkowski
- grid.5949.10000 0001 2172 9288Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
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Rassaf T, Totzeck M, Backs J, Bokemeyer C, Hallek M, Hilfiker-Kleiner D, Hochhaus A, Lüftner D, Müller OJ, Neudorf U, Pfister R, von Haehling S, Lehmann LH, Bauersachs J. Onco-Cardiology: Consensus Paper of the German Cardiac Society, the German Society for Pediatric Cardiology and Congenital Heart Defects and the German Society for Hematology and Medical Oncology. Clin Res Cardiol 2020; 109:1197-1222. [PMID: 32405737 PMCID: PMC7515958 DOI: 10.1007/s00392-020-01636-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 30 new therapies are approved each year with only incompletely characterised side effects. This consensus paper discusses the risk factors that contribute to the development of a potentially adverse reaction to tumour therapy and, in addition, defines specific side effect profiles for different treatment groups. The focus is on novel therapeutics and recommendations for the surveillance and treatment of specific patient groups.
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Affiliation(s)
- Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Johannes Backs
- Institute for Experimental Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, Centre for Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology ABCD, University Hospital of Cologne, Cologne, Germany
| | | | - Andreas Hochhaus
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - Diana Lüftner
- Department of Haematology, Oncology and Tumour Immunology, Charité, Humboldt University Berlin, Berlin, Germany
| | - Oliver J Müller
- Department of Internal Medicine III (Cardiology, Angiology and Internal Intensive Care Medicine), University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Ulrich Neudorf
- Department of Pediatrics III, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Roman Pfister
- Clinic III for Internal Medicine, General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Internal Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Lorenz H Lehmann
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Neudorf U. Heilung ist nicht alles – Vermeidung der Kardiotoxizität gehört dazu. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Michel L, Mincu RI, Mrotzek SM, Korste S, Neudorf U, Rassaf T, Totzeck M. Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer-a meta-analysis. ESC Heart Fail 2020; 7:423-433. [PMID: 32069386 PMCID: PMC7160486 DOI: 10.1002/ehf2.12589] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 01/04/2023] Open
Abstract
AIMS Childhood cancer therapy is associated with a significant risk of therapy-related cardiotoxicity. This meta-analysis aims to evaluate cardiac biomarkers for the detection of cancer therapy-related left ventricular (LV) dysfunction in childhood cancer patients. METHODS AND RESULTS PubMed, Cochrane Library, Wiley Library, and Web of Science were screened for studies investigating brain natriuretic peptide (BNP)/N-terminal proBNP (NT-proBNP) or cardiac troponin in childhood cancer patients. The odds ratios (OR) for elevation of cardiac biomarkers and association with LV dysfunction were calculated using a random-effects model. Data from 27 studies with 1651 subjects were included. BNP/NT-proBNP levels were higher post-treatment compared with controls or pre-treatment values [standardized mean difference = 1.0; 95% confidence interval (CI) = 0.6-1.4; n = 320; P < 0.001]. LV dysfunction was present in 11.76% of included patients, and risk for LV dysfunction was increased in patients with elevated BNP/NT-proBNP (OR = 7.1; 95% CI = 2.0-25.5; n = 350; P = 0.003). The sensitivity of BNP/NT-proBNP for the detection of LV dysfunction was 33.3%, and the specificity was 91.5%. Sensitivity increased when selecting for studies that assessed patients < 5 years after anthracycline exposure and for studies including high cumulative anthracycline doses. Anthracycline chemotherapy was associated with an increased frequency of elevated troponin (OR = 3.7; 95% CI = 2.1-6.5; n = 348; P < 0.001). The available evidence on the association between elevated troponin and LV dysfunction was insufficient for an adequate analysis. In five included studies, the frequency of LV dysfunction was not increased in patients with elevated troponin (OR = 2.5; 95% CI = 0.5-13.2; n = 179; P = 0.53). CONCLUSIONS BNP/NT-proBNP is associated with cardiotoxicity in paediatric cancer patients receiving anthracycline therapy, but owing to low sensitivity, BNP/NT-proBNP has to be evaluated in the context of further parameters including clinical assessment and echocardiography. Future studies are needed to determine whether troponin serves as a marker for cardiotoxicity in children. Standardized recommendations for the application of cardiac biomarkers in children undergoing cardiotoxic cancer therapy may benefit management and clinical outcome.
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Affiliation(s)
- Lars Michel
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Raluca I Mincu
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Simone M Mrotzek
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sebastian Korste
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ulrich Neudorf
- Department of Pediatrics, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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11
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Michel L, Mincu RI, Mrotzek SM, Neudorf U, Rassaf T, Totzeck M. P693Cardiac biomarkers for the detection of anthracycline cardiotoxicity in childhood cancer - a meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0298] [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
Introduction
Heart failure is the most concerning cardiovascular side effect of anthracycline chemotherapy. Pediatric cancer patients and survivors of childhood cancer are particularly vulnerable to cancer therapy-related cardiotoxicity. Cardiac biomarkers may be beneficial for screening and diagnosis of anthracycline-related heart failure in pediatric cancer patients and survivors of childhood cancer but systematic data is not yet available.
Purpose
To evaluate (N-terminal pro) brain natriuretic peptide (BNP/NT-proBNP) and cardiac troponin for screening and prediction of cancer therapy-related cardiotoxicity in pediatric cancer patients and survivors of childhood cancer.
Methods
Cochrane, PubMed, Web of Science, and Wiley Library were screened for studies investigating cardiac troponin or BNP/NT-proBNP in pediatric cancer patients receiving anthracycline therapy or survivors of childhood cancer. The primary endpoint was left ventricular (LV) dysfunction as defined by decreased ejection fraction (EF) or fractional shortening (FS). The study was registered at the International prospective register of systematic reviews (PROSPERO) (CRD42018106616).
Results
A total of 1643 subjects from 27 studies were included. BNP/NT-proBNP levels were higher in patients post-treatment compared to control subjects or pre-treatment values (standardized mean difference = 1.0; 95% CI: 0.6–1.4; n=239). The risk for left ventricular (LV) dysfunction was increased in patients with elevated BNP/NT-proBNP (OR=5.5; 95% CI: 2.0–15.2; n=357). This was demonstrated for acute cardiotoxicity (OR=22.3; 95% CI: 3.3–151.1; n=88) and in survivors of childhood cancer (OR=3.2; 95% CI: 1.0–10.0; n=269). Sensitivity for the prediction of acute or subacute LV dysfunction was 28.9% and specificity was at 91.7%. The frequency of troponin elevations was increased after anthracycline therapy (OR=3.6; 95% CI: 2.0–6.5; n=305) but troponin was not associated with LV dysfunction (OR=0.2; 95% CI: −0.2 to 0.5; n=273).
Conclusion
BNP/NT-proBNP is elevated in pediatric patients receiving anthracycline chemotherapy and serves as a marker for the prediction of cardiotoxicity and screening for late cardiotoxicity in survivors of childhood cancer. So far, there is no systematic evidence on a benefit of cardiac troponin for the detection of anthracycline cardiotoxicity in children. Standardized recommendations on the role of cardiac biomarkers are needed for the optimal detection of anthracycline cardiotoxicity in childhood cancer patients.
Acknowledgement/Funding
IFORES research grant of the Medical Faculty, University Duisburg-Essen, Essen, Germany
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Affiliation(s)
- L Michel
- University of Duisburg-Essen, West German Heart Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - R I Mincu
- University of Duisburg-Essen, West German Heart Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - S M Mrotzek
- University of Duisburg-Essen, West German Heart Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - U Neudorf
- University Hospital Essen, Department of Pediatrics, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen, West German Heart Center, Department of Cardiology and Vascular Medicine, Essen, Germany
| | - M Totzeck
- University of Duisburg-Essen, West German Heart Center, Department of Cardiology and Vascular Medicine, Essen, Germany
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12
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Dittrich S, Graf E, Trollmann R, Neudorf U, Schara U, Heilmann A, von der Hagen M, Stiller B, Kirschner J, Pozza RD, Müller-Felber W, Weiss K, von Au K, Khalil M, Motz R, Korenke C, Lange M, Wilichowski E, Pattathu J, Ebinger F, Wiechmann N, Schröder R. Effect and safety of treatment with ACE-inhibitor Enalapril and β-blocker metoprolol on the onset of left ventricular dysfunction in Duchenne muscular dystrophy - a randomized, double-blind, placebo-controlled trial. Orphanet J Rare Dis 2019; 14:105. [PMID: 31077250 PMCID: PMC6509833 DOI: 10.1186/s13023-019-1066-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 04/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND X-linked Duchenne muscular dystrophy (DMD), the most frequent human hereditary skeletal muscle myopathy, inevitably leads to progressive dilated cardiomyopathy. We assessed the effect and safety of a combined treatment with the ACE-inhibitor enalapril and the β-blocker metoprolol in a German cohort of infantile and juvenile DMD patients with preserved left ventricular function. METHODS TRIAL DESIGN Sixteen weeks single-arm open run-in therapy with enalapril and metoprolol followed by a two-arm 1:1 randomized double-blind placebo-controlled treatment in a multicenter setting. INCLUSION CRITERIA DMD boys aged 10-14 years with left ventricular fractional shortening [LV-FS] ≥ 30% in echocardiography. Primary endpoint: time from randomization to first occurrence of LV-FS < 28%. Secondary: changes of a) LV-FS from baseline, b) blood pressure, c), heart rate and autonomic function in ECG and Holter-ECG, e) cardiac biomarkers and neurohumeral serum parameters, f) quality of life, and g) adverse events. RESULTS From 3/2010 to 12/2013, 38 patients from 10 sites were centrally randomized after run-in, with 21 patients continuing enalapril and metoprolol medication and 17 patients receiving placebo. Until end of study 12/2015, LV-FS < 28% was reached in 6/21 versus 7/17 patients. Cox regression adjusted for LV-FS after run-in showed a statistically non-significant benefit for medication over placebo (hazard ratio: 0.38; 95% confidence interval: 0.12 to 1.22; p = 0.10). Analysis of secondary outcome measures revealed a time-dependent deterioration of LV-FS with no statistically significant differences between the two study arms. Blood pressure, maximal heart rate and mean-NN values were significantly lower at the end of open run-in treatment compared to baseline. Outcome analysis 19 months after randomization displayed significantly lower maximum heart rate and higher noradrenalin and renin values in the intervention group. No difference between treatments was seen for quality of life. As a single, yet important adverse event, the reversible deterioration of walking abilities of one DMD patient during the run-in period was observed. CONCLUSIONS Our analysis of enalapril and metoprolol treatment in DMD patients with preserved left ventricular function is suggestive to delay the progression of the intrinsic cardiomyopathy to left ventricular failure, but did not reach statistical significance, probably due to insufficient sample size. CLINICAL TRIAL REGISTRATION DRKS-number 00000115, EudraCT-number 2009-009871-36.
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Affiliation(s)
- Sven Dittrich
- Department Pediatric Cardiology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg, Loschgestraße 15, 91054, Erlangen, Germany. .,German Competence Network for Congenital Heart Defects partner site, Berlin, Germany.
| | - Erika Graf
- Institute of Medical Biometry and Statistics, Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Erlangen University Hospital, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Ulrike Schara
- Department of Neuropediatrics, University Hospital Essen, Essen, Germany
| | - Antje Heilmann
- Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maja von der Hagen
- Department of Neurological Surgery, University Hospital Carl-Gustav-Carus, Technical University of Dresden, Dresden, Germany
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Wolfgang Müller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians- University of Munich, Munich, Germany
| | - Katja Weiss
- Pediatric Cardiology and Congenital Heart Disease, University Hospital Charité, Berlin, Germany
| | - Katja von Au
- Department of Pediatrics, Division of Neurology, University Hospital Charité, Berlin, Germany
| | - Markus Khalil
- Division of Pediatric Heart Surgery, Pediatric Heart Center, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Reinald Motz
- Department of Pediatric Cardiology, Elisabeth Children's Hospital, Oldenburg, Germany
| | | | - Martina Lange
- Department of Pediatric Cardiology and Intensive Care Medicine, Heart Center, University Medical Center Göttingen, Göttingen, Germany
| | - Ekkehard Wilichowski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Nicola Wiechmann
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - Rolf Schröder
- Institute of Neuropathology, Erlangen University Hospital, Erlangen, Germany
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13
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Hinrichs L, Horacek M, Neudorf U, Schlosser T, Rassaf T, Totzeck M. Diagnostic Work-Up of Pulmonary Hypertension - Think About Shunt Flow! A Case Report. Am J Case Rep 2019; 20:154-158. [PMID: 30718448 PMCID: PMC6369654 DOI: 10.12659/ajcr.912191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The diagnostic work-up and treatment of pulmonary hypertension can be complex. Pulmonary arterial hypertension (PAH), pulmonary hypertension second to lung or heart diseases and thromboembolic pulmonary hypertension, and other rare causes of pulmonary hypertension such as congenital heart diseases must be considered in the differential diagnostic work-up. CASE REPORT We report on a patient who has been treated for PAH over many years. At the age of 65, progressive symptoms required a complete re-evaluation. Here, a complex shunt vitium with a partial anomalous pulmonary venous return (PAPVR) and a sinus venosus defect (SVD) was diagnosed. CONCLUSIONS PAPVR is a rare congenital heart disease that is often associated with an SVD. It is usually diagnosed during childhood but may also be detected in adult patients who develop pulmonary hypertension and dyspnea as primary symptoms. The initial predominant left-to-right shunting associated with this disease may be undetected for years, with a slow development of right heart failure with right heart volume overload and pulmonary hypertension. Early detection is important, with a subsequent surgical intervention.
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Affiliation(s)
- Lena Hinrichs
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Michael Horacek
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulrich Neudorf
- Department of Paediatrics, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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14
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Heiligenhaus A, Minden K, Tappeiner C, Baus H, Bertram B, Deuter C, Foeldvari I, Föll D, Frosch M, Ganser G, Gaubitz M, Günther A, Heinz C, Horneff G, Huemer C, Kopp I, Lommatzsch C, Lutz T, Michels H, Neß T, Neudorf U, Pleyer U, Schneider M, Schulze-Koops H, Thurau S, Zierhut M, Lehmann HW. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 49:43-55. [PMID: 30595409 DOI: 10.1016/j.semarthrit.2018.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. CONCLUSIONS An interdisciplinary, evidence-based treatment guideline for JIAU is presented.
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Affiliation(s)
- A Heiligenhaus
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany.
| | - K Minden
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Tappeiner
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H Baus
- The Participation of the Following Bodies: Parents' Group for Children with Uveitis and their Families, Germany
| | - B Bertram
- Professional Association of Ophthalmologists (BVA), Germany
| | - C Deuter
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - I Foeldvari
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - D Föll
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Frosch
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - G Ganser
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Gaubitz
- German Society of Rheumatology (DGRh), Germany
| | - A Günther
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Heinz
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - G Horneff
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Huemer
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - I Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Germany
| | - C Lommatzsch
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - T Lutz
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - H Michels
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - T Neß
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - U Neudorf
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - U Pleyer
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Schneider
- German Society of Rheumatology (DGRh), Germany
| | | | - S Thurau
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Zierhut
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H W Lehmann
- The Society for Paediatric Rheumatology (GKJR), Germany
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Abstract
The number of pediatric cancer survivors is growing, and they are getting older. Therapy-induced cardiotoxicity therefore is debated as an ongoing problem. Recognition of the side effects in the use of anthracyclines and radiation as well as the patients' clinical condition and comorbidities leads back as far as the beginning of systematic cancer treatment in children in the 1980s. Since, numerous case reports, meta-analyses and retrospective surveys were published worldwide. However, randomized clinical trials with standardized protocols yet fail to be designed. This article gives an overview of the recent reports and emphasizes on the heterogeneity of the different approaches. A standardized work-up which may identify the patient at risk-including the patient's history and condition, individual genetic dispositions, dosage and method of drug application, consideration of co-medication, radiation therapy and dose, standardized imaging methods-is the main proposition of our report. The fusion of already established sources, e.g., data of different registries or study centers, might help to create preventive strategies for and a better understanding of patients with therapy induced cardiomyopathy.
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Affiliation(s)
- Ulrich Neudorf
- Clinic of Pediatrics III, University Hospital Essen, D-45122 Essen, Germany
| | - Anne Schönecker
- Clinic of Pediatrics III, University Hospital Essen, D-45122 Essen, Germany
| | - Dirk Reinhardt
- Clinic of Pediatrics III, University Hospital Essen, D-45122 Essen, Germany
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16
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Hinze CH, Oommen PT, Dressler F, Urban A, Weller-Heinemann F, Speth F, Lainka E, Brunner J, Fesq H, Foell D, Müller-Felber W, Neudorf U, Rietschel C, Schwarz T, Schara U, Haas JP. Development of practice and consensus-based strategies including a treat-to-target approach for the management of moderate and severe juvenile dermatomyositis in Germany and Austria. Pediatr Rheumatol Online J 2018; 16:40. [PMID: 29940960 PMCID: PMC6019723 DOI: 10.1186/s12969-018-0257-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in childhood and a major cause of morbidity among children with pediatric rheumatic diseases. The management of JDM is very heterogeneous. The JDM working group of the Society for Pediatric Rheumatology (GKJR) aims to define consensus- and practice-based strategies in order to harmonize diagnosis, treatment and monitoring of JDM. METHODS The JDM working group was established in 2015 consisting of 23 pediatric rheumatologists, pediatric neurologists and dermatologists with expertise in the management of JDM. Current practice patterns of management in JDM had previously been identified via an online survey among pediatric rheumatologists and neurologists. Using a consensus process consisting of online surveys and a face-to-face consensus conference statements were defined regarding the diagnosis, treatment and monitoring of JDM. During the conference consensus was achieved via nominal group technique. Voting took place using an electronic audience response system, and at least 80% consensus was required for individual statements. RESULTS Overall 10 individual statements were developed, finally reaching a consensus of 92 to 100% regarding (1) establishing a diagnosis, (2) case definitions for the application of the strategies (moderate and severe JDM), (3) initial diagnostic testing, (4) monitoring and documentation, (5) treatment targets within the context of a treat-to-target strategy, (6) supportive therapies, (7) explicit definition of a treat-to-target strategy, (8) various glucocorticoid regimens, including intermittent intravenous methylprednisolone pulse and high-dose oral glucocorticoid therapies with tapering, (9) initial glucocorticoid-sparing therapy and (10) management of refractory disease. CONCLUSION Using a consensus process among JDM experts, statements regarding the management of JDM were defined. These statements and the strategies aid in the management of patients with moderate and severe JDM.
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Affiliation(s)
- Claas H. Hinze
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany
| | - Prasad T. Oommen
- 0000 0000 8922 7789grid.14778.3dDepartment of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Frank Dressler
- 0000 0000 9529 9877grid.10423.34Department of Pediatric Pulmonology, Allergy and Neonatology, Hanover Medical School, Hanover, Germany
| | - Andreas Urban
- Department of Pediatrics, St. Mary’s Hospital, Amberg, Germany
| | | | - Fabian Speth
- 0000000121858338grid.10493.3fDivision of Pediatric Rheumatology, University Medicine, Rostock, Germany ,grid.410712.1Division of Immunology, Bone Marrow Transplantation and Rheumatology, University Hospital Ulm, Ulm, Germany
| | - Elke Lainka
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | - Jürgen Brunner
- 0000 0000 8853 2677grid.5361.1Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Heike Fesq
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen Department of Dermatology, Oberammergau Center for Rheumatic Diseases, Oberammergau, Germany
| | - Dirk Foell
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building D3, 48149 Münster, Germany
| | - Wolfgang Müller-Felber
- 0000 0004 0477 2585grid.411095.8Department of Pediatric Neurology, University Hospital Munich, Munich, Germany
| | - Ulrich Neudorf
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | - Christoph Rietschel
- Department of Pediatrics, Clementine Children’s Hospital, Frankfurt, Germany
| | - Tobias Schwarz
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | - Ulrike Schara
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatric Neurology, University Hospital Essen, Essen, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen Department of Dermatology, Oberammergau Center for Rheumatic Diseases, Oberammergau, Germany
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Bielak M, Husmann E, Weyandt N, Haas JP, Hügle B, Horneff G, Neudorf U, Lutz T, Lilienthal E, Kallinich T, Tenbrock K, Berendes R, Niehues T, Wittkowski H, Weißbarth-Riedel E, Heubner G, Oommen P, Klotsche J, Foell D, Lainka E. IL-6 blockade in systemic juvenile idiopathic arthritis - achievement of inactive disease and remission (data from the German AID-registry). Pediatr Rheumatol Online J 2018; 16:22. [PMID: 29622022 PMCID: PMC5887199 DOI: 10.1186/s12969-018-0236-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (sJIA) is a complex disease with an autoinflammatory component of unknown etiology related to the innate immune system. A major role in the pathogenesis has been ascribed to proinflammatory cytokines like interleukin-6 (IL-6), and effective drugs inhibiting their signaling are being developed. This study evaluates sJIA patients treated with the IL-6 inhibitor tocilizumab (TCZ) concerning clinical response rate, disease course and adverse effects in a real-life clinical setting. METHODS In 2009 a clinical and research consortium was established, including an online registry for autoinflammatory diseases (AID) ( https://aid-register.de ). Data for this retrospective TCZ study were documented by 13 centers. RESULTS From 7/2009 to 4/2014, 200 patients with sJIA were recorded in the AID-registry. Out of these, 46 (19 m, 27 f, age 1-18 years) received therapy with TCZ. Long term treatment (median 23 months) has been documented in 24/46 patients who were evaluated according to Wallace criteria (active disease 6/24, inactive disease 5/24, remission 13/24 cases). Under observation co-medication were used in 40/46 cases. Adverse events were reported in 11/46 patients. The clinical response rate (no clinical manifestation, no increased inflammation parameters) within the first 12 weeks of treatment was calculated to be 35%. CONCLUSION Out of 200 sJIA children reported in the German AID-registry, 46 were treated with TCZ, showing a clinical response rate of 35% during the first 12 weeks, and inactive disease and/or remission under medication in 75% after one year. Adverse events were seen in 24% and severe adverse events in 4%. TRIAL REGISTRATION The AID-Registry is funded by the BMBF (01GM08104, 01GM1112D, 01GM1512D).
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Affiliation(s)
- M. Bielak
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - E. Husmann
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - N. Weyandt
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - J.-P. Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - B. Hügle
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - G. Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin, Centre for Pediatric Rheumatology, Sankt Augustin, Germany ,0000 0000 8852 305Xgrid.411097.aDepartment of Pediatric and Adolescents medicine, Medical faculty, University Hospital of Cologne, Cologne, Germany
| | - U. Neudorf
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - T. Lutz
- 0000 0001 0328 4908grid.5253.1Center for Pediatric and Adolescent Medicine/Pediatric Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - E. Lilienthal
- 0000 0004 0490 981Xgrid.5570.7Department of Pediatrics, Ruhr-University Bochum, Bochum, Germany
| | - T. Kallinich
- 0000 0001 2218 4662grid.6363.0Department of Pediatric Pneumology and Immunology and Center for Chronically Sick Children of the Charité, Charité University Medicine Berlin, Berlin, Germany
| | - K. Tenbrock
- 0000 0001 0728 696Xgrid.1957.aDepartment of Pediatric Pneumology, Allergology and Immunology, RWTH Aachen University, Aachen, Germany
| | - R. Berendes
- Department of Pediatric Rheumatology, St. Marien’s Children’s Hospital Landshut, Landshut, Germany
| | - T. Niehues
- HELIOS Children’s Hospital Krefeld, Pediatric Immunology and Rheumatology, Krefeld, Germany
| | - H. Wittkowski
- 0000 0001 2172 9288grid.5949.1Department of Pediatric Rheumatology and Immunology, University of Münster, Münster, Germany
| | - E. Weißbarth-Riedel
- 0000 0001 2180 3484grid.13648.38Department of Pediatric Rheumatology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - G. Heubner
- Children’s Hospital Dresden-Neustadt, Dresden, Germany
| | - P. Oommen
- 0000 0001 2176 9917grid.411327.2Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - J. Klotsche
- 0000 0000 9323 8675grid.418217.9German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Dirk Foell
- 0000 0001 2172 9288grid.5949.1Department of Pediatric Rheumatology and Immunology, University of Münster, Münster, Germany
| | - E. Lainka
- Department of Pediatric Rheumatology, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
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Zartner PA, Neudorf U, Bierbach B, Hart C, Schneider MB. First follow-up of a breakable stent for implantation in infants dedicated for a life-long stay. Catheter Cardiovasc Interv 2018; 91:1119-1124. [PMID: 29469968 DOI: 10.1002/ccd.27543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/10/2017] [Revised: 01/17/2018] [Accepted: 01/27/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE AND METHODS The use of conventional metal stents in infants is severely limited by subsequent somatic growth. The use of a breakable balloon expandable stent (BS) designed for initial implant at small diameters but with properties that allow unlimited dilation in line with growth has potential advantages in this patient group. This study reports our experience with this stent between 2010 and 2014. A total of 17 BS were implanted in 14 infants (mean age 4.8 months). All but one stent was placed into the aorta to treat coarctation. RESULTS All implantations were successful and initial gradients dropped from a mean of 25-6 mm Hg (range from 1-50 down to 0-24 mm Hg). Mean follow-up was 3.3 years (range 5 days to 7 years) with a total cumulative follow-up of 46.7 patient years. Stent redilation was performed a median of 2.5 times (range 0-5). Sixteen stents in 13 patients remain in place. Following redilation beyond 10 mm, circumferential integrity of the BS was lost in 10 patients. No further stent implantation or related surgery was necessary. A 3 mm dissection occurred in one patient after redilation. CONCLUSIONS The BS performed well in terms of relief of stenosis and could be successfully dilated during the phase of the infants' most rapid growth. Mild intimal proliferation occurred in some patients early after implantation. In the course of the stepwise redilations and growth adjustments, both, planned longitudinal and transverse fractures occurred without allowing a collapse of the stented area.
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Affiliation(s)
- Peter A Zartner
- Department of Cardiology, German Paediatric Heart Centre, Sankt Augustin, Germany
| | - Ulrich Neudorf
- Department of Cardiology, University Essen, Essen, Germany
| | - Benjamin Bierbach
- Department of Cardiothoracic Surgery, German Paediatric Heart Centre, Sankt Augustin, Germany
| | - Chris Hart
- Department of Cardiology, German Paediatric Heart Centre, Sankt Augustin, Germany
| | - Martin B Schneider
- Department of Cardiology, German Paediatric Heart Centre, Sankt Augustin, Germany
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Hinze CH, Holzinger D, Lainka E, Haas JP, Speth F, Kallinich T, Rieber N, Hufnagel M, Jansson AF, Hedrich C, Winowski H, Berger T, Foeldvari I, Ganser G, Hospach A, Huppertz HI, Mönkemöller K, Neudorf U, Weißbarth-Riedel E, Wittkowski H, Horneff G, Foell D. Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany. Pediatr Rheumatol Online J 2018; 16:7. [PMID: 29357887 PMCID: PMC5778670 DOI: 10.1186/s12969-018-0224-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/12/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (SJIA) is an autoinflammatory disease associated with chronic arthritis. Early diagnosis and effective therapy of SJIA is desirable, so that complications are avoided. The PRO-KIND initiative of the German Society for Pediatric Rheumatology (GKJR) aims to define consensus-based strategies to harmonize diagnostic and therapeutic approaches in Germany. METHODS We analyzed data on patients diagnosed with SJIA from 3 national registries in Germany. Subsequently, via online surveys and teleconferences among pediatric rheumatologists with a special expertise in the treatment of SJIA, we identified current diagnostic and treatment approaches in Germany. Those were harmonized via the formulation of statements and, supported by findings from a literature search. Finally, an in-person consensus conference using nominal group technique was held to further modify and consent the statements. RESULTS Up to 50% of patients diagnosed with SJIA in Germany do not fulfill the International League of Associations for Rheumatology (ILAR) classification criteria, mostly due to the absence of chronic arthritis. Our findings suggest that chronic arthritis is not obligatory for the diagnosis and treatment of SJIA, allowing a diagnosis of probable SJIA. Malignant, infectious and hereditary autoinflammatory diseases should be considered before rendering a diagnosis of probable SJIA. There is substantial variability in the initial treatment of SJIA. Based on registry data, most patients initially receive systemic glucocorticoids, however, increasingly substituted or accompanied by biological agents, i.e. interleukin (IL)-1 and IL-6 blockade (up to 27.2% of patients). We identified preferred initial therapies for probable and definitive SJIA, including step-up patterns and treatment targets for the short-term (resolution of fever, decrease in C-reactive protein by 50% within 7 days), the mid-term (improvement in physician global and active joint count by at least 50% or a JADAS-10 score of maximally 5.4 within 4 weeks) and the long-term (glucocorticoid-free clinically inactive disease within 6 to 12 months), and an explicit treat-to-target strategy. CONCLUSIONS We developed consensus-based strategies regarding the diagnosis and treatment of probable or definitive SJIA in Germany.
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Affiliation(s)
- Claas H. Hinze
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
| | - Dirk Holzinger
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany ,0000 0001 2187 5445grid.5718.bDepartment of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| | - Elke Lainka
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Fabian Speth
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Tilmann Kallinich
- 0000 0001 2218 4662grid.6363.0Department of Pediatric Pulmonology and Immunology, Charité, Berlin, Germany
| | - Nikolaus Rieber
- Department of Pediatrics, StKM GmbH and Technical University Muenchen, Munich, Germany ,0000 0001 2190 1447grid.10392.39The Department of Pediatrics I, University of Tuebingen, Tuebingen, Germany
| | - Markus Hufnagel
- 0000 0000 9428 7911grid.7708.8Department of Pediatrics, University Hospital Freiburg, Freiburg, Germany
| | - Annette F. Jansson
- 0000 0004 0477 2585grid.411095.8Division of Pediatric Rheumatology & Immunology, Dr. von Hauner Children’s Hospital, University Hospital Munich, Munich, Germany
| | - Christian Hedrich
- 0000 0001 1091 2917grid.412282.fDepartment of Pediatrics, University Hospital Dresden, Dresden, Germany ,0000 0004 1936 8470grid.10025.36Department of Women’s & Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK ,0000 0004 0421 1374grid.417858.7Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool, UK
| | - Hanna Winowski
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | | | - Ivan Foeldvari
- Hamburg Center for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Gerd Ganser
- grid.416438.cDepartment of Pediatric Rheumatology, St. Josef Hospital, Sendenhorst, Germany
| | - Anton Hospach
- Department of Pediatrics, Olga Hospital, Stuttgart, Germany
| | - Hans-Iko Huppertz
- Department of Pediatrics, Prof. Hess Children’s Hospital, Bremen, Germany
| | | | - Ulrich Neudorf
- 0000 0001 0262 7331grid.410718.bDepartment of Pediatrics, University Hospital Essen, Essen, Germany
| | | | - Helmut Wittkowski
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Hospital, St. Augustin, Germany ,0000 0000 8580 3777grid.6190.eUniversity of Cologne, Cologne, Germany
| | - Dirk Foell
- 0000 0004 0551 4246grid.16149.3bDepartment of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Albert-Schweitzer-Campus 1, Building W30, 48149 Münster, Germany
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Dittrich S, Graf E, Neudorf U, Heilmann A, Schara U, Kirschner J, Stiller B. Effect and Safety of Treatment with ACE-Inhibitor Enalapril and β-Blocker Metoprolol on the Onset of Left Ventricular Dysfunction in Duchenne Muscular Dystrophy: Results from a Six Years, Double-blind, Randomized Placebo-controlled Trial. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628322] [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: 10/28/2022]
Affiliation(s)
- S. Dittrich
- Pediatric Cardiology, Erlangen University Hospital, Erlangen, Germany
| | - E. Graf
- Clinical Trials Unit of the Medical Center, University of Freiburg, Freiburg, Germany
| | - U. Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - A. Heilmann
- Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
| | - U. Schara
- Pediatric Neurology, University Hospital Essen, Essen, Germany
| | - J. Kirschner
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - B. Stiller
- Congenital Heart Defects and Pediatric Cardiology, Heart Center Freiburg University, Freiburg, Germany
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21
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Knieper AM, Klotsche J, Lainka E, Berger T, Dressler F, Jansson AF, Rietschel C, Oommen PT, Berendes R, Niehues T, Neudorf U, Foell D, Wittkowski H, Kallinich T. Familial Mediterranean fever in children and adolescents: factors for colchicine dosage and predicting parameters for dose increase. Rheumatology (Oxford) 2017; 56:1597-1606. [PMID: 28859329 DOI: 10.1093/rheumatology/kex222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim was to analyse factors influencing the individual colchicine dose in children with FMF, to evaluate the impact of dose adjustment on the clinical course and inflammation and to identify clinical parameters and biomarkers that predict dose increase in the near future. Methods Data from 409 paediatric FMF patients (4566 visits) derived from the national auto-inflammatory diseases registry were analysed. Serum concentrations of S100 molecules were determined by ELISA. Results The age-dependent colchicine dose is influenced by the present genotype. The body surface area is the anthropometric parameter that correlates best with the applied dosages. Colchicine introduction and dose increase lead to significant reduction of clinical symptoms and inflammation. During established colchicine therapy, an increase of one single biomarker increases the likelihood of a dose increment in the next 12 months with a factor of 1.62-1.94. A combination of biomarkers including S100 molecules increases this odds ratio up to 4.66 when analysing all patients and up to 7.27 when analysing patients with a high risk of severe disease. Conclusion Colchicine therapy is currently guided mainly by the occurrence of clinical symptoms and serological inflammation. Other factors, such as the genotype, the body surface area and biomarkers, will help to manage colchicine therapy in a more individualized fashion. The additional analysis of S100 molecules as sensitive biomarkers will help to identify patients at risk for dose increases in the near future.
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Affiliation(s)
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Leibniz Institute.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin
| | - Elke Lainka
- Pediatric Rheumatology, Department of Paediatrics, University of Duisburg-Essen, Essen
| | - Thomas Berger
- Pediatric Neurology, Vestische Kinderklinik Datteln, Datteln
| | - Frank Dressler
- Centre for Paediatrics and Adolescent Medicine, Hannover Medical School, Hannover
| | - Annette F Jansson
- Department of Rheumatology and Immunology, Hauner Children's Hospital, Ludwig Maximilians University, Munich
| | - Christoph Rietschel
- Clementine Kinderhospital, Verein Frankfurter Stiftungskrankenhäuser, Frankfurt
| | - Prasad T Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center of Child and Adolescent Health, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf
| | - Rainer Berendes
- Pediatric Rheumatology, Children's Hospital St Marien, Landshut
| | - Tim Niehues
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld
| | - Ulrich Neudorf
- Pediatric Rheumatology, Department of Paediatrics, University of Duisburg-Essen, Essen
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University of Münster, Münster
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University of Münster, Münster
| | - Tilmann Kallinich
- Pediatric Pneumology and Immunology, Charité University Medicine Berlin.,Social Pediatric Center, Charité University Medicine Berlin, Berlin, Germany
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22
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Gohar F, Orak B, Kallinich T, Jeske M, Lieber M, von Bernuth H, Giese A, Weissbarth-Riedel E, Haas JP, Dressler F, Holzinger D, Lohse P, Neudorf U, Lainka E, Hinze C, Masjosthusmann K, Kessel C, Weinhage T, Foell D, Wittkowski H. Correlation of Secretory Activity of Neutrophils With Genotype in Patients With Familial Mediterranean Fever. Arthritis Rheumatol 2017; 68:3010-3022. [PMID: 27333294 DOI: 10.1002/art.39784] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is an autoinflammatory disorder caused by pyrin-encoding MEFV mutations. Patients present with recurrent but self-limiting episodes of acute inflammation and often have persistent subclinical inflammation. The pathophysiology is only partially understood, but neutrophil overactivation is a hallmark of the disease. S100A12 is a neutrophil-derived proinflammatory danger signal that is strongly elevated in active FMF. This study was undertaken to characterize the secretory activity of neutrophils in vitro and investigate the association of S100A12 with disease activity and genotype in patients with FMF. METHODS Neutrophils from FMF patients carrying the p.M694V mutation (1 compound heterozygous and 5 homozygous) and neutrophils from 4 healthy control subjects were purified and stimulated in vitro. Neutrophil secretion of S100A12, interleukin-18 (IL-18), IL-1β, and caspase 1 was determined. Based on these in vitro analyses, serum concentrations of S100A12, IL-18, and IL-1β were also analyzed in 128 clinically and genetically characterized patients with FMF. RESULTS In vitro, unstimulated neutrophils from p.M694V-positive patients spontaneously secreted more S100A12, IL-18, and caspase 1 compared to neutrophils from healthy controls. Serum concentrations of S100A12 correlated with disease activity and genotype, with the levels being highest in homozygous patients and with compound heterozygotes displaying higher levels than heterozygotes. Compared to individuals negative for the p.M694V mutation, heterozygous, compound heterozygous, or homozygous p.M694V-positive patients had higher serum levels of S100A12 and IL-18 during inactive and subclinical disease. CONCLUSION The FMF phenotype is known to be more severe in patients carrying the p.M694V mutation. This report describes 2 molecules secreted by unconventional secretory pathways, S100A12 and IL-18, whose concentrations correlated with clinical disease activity and genotype in patients with FMF. In this clinically and genetically heterogeneous disease, management of these surrogate markers might help to improve patient care and outcomes.
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Affiliation(s)
- Faekah Gohar
- University Children's Hospital, Muenster, Germany
| | - Banu Orak
- Charité University Medicine, Berlin, Germany
| | | | | | | | - Horst von Bernuth
- Labor Berlin-Charité Vivantes GmbH and Charité University Medicine, Berlin, Germany
| | - Arnd Giese
- St. Josef-Hospital, Ruhr University, Bochum, Germany
| | | | - Johannes-Peter Haas
- German Centre for Child and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | | | | | - Peter Lohse
- Center for Genomics and Transcriptomics, Tuebingen, Germany
| | | | - Elke Lainka
- University of Duisburg-Essen, Essen, Germany
| | - Claas Hinze
- University Children's Hospital, Muenster, Germany
| | | | | | | | - Dirk Foell
- University Children's Hospital, Muenster, Germany
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Osswald B, Zartner P, Müntjes C, Neudorf U. Persistent Septicemia after Complete Removal of an Infected Pacemaker System. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598993] [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: 10/20/2022]
Affiliation(s)
- B. Osswald
- Department of Cardiovascular Surgery, University of Düsseldorf, Düsseldorf, Germany
| | - P. Zartner
- Department of Pediatric Cardiology, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
| | - C. Müntjes
- Department of Pediatric Cardiology, University of Essen, Essen, Germany
| | - U. Neudorf
- Department of Pediatric Cardiology, University of Essen, Essen, Germany
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24
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Hamsen F, Müntjes C, Kampmann W, Schweiger B, Neudorf U, Lainka E. Atypical clinical presentation of a severe Tumor Necrosis Factor Receptor-associated Periodic Syndrome (TRAPS) without mutation in the TNFRSF1A gene and good response to anakinra. Case report of a ten year old girl with fever, skin edema and abdominal pain (AID-registry). Pediatr Rheumatol Online J 2015. [PMCID: PMC4597600 DOI: 10.1186/1546-0096-13-s1-p43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Bielak M, Husmann E, Weyandt N, Haas JP, Horneff G, Lutz T, Lilienthal E, Kallinich T, Tenbrock K, Berendes R, Dückers G, Wittkowski H, Weißbarth-Riedel E, Heubner G, Oommen PT, Klotsche J, Neudorf U, Föll D, Niehues T, Lainka E. Interleukin (IL)- 6 inhibition - Follow-up data of the German AID-registry1. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599838 DOI: 10.1186/1546-0096-13-s1-p63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schelhorn J, Neudorf U, Schemuth H, Nensa F, Nassenstein K, Schlosser TW. Volumetric measurements in patients with corrected tetralogy of Fallot: comparison of short-axis versus axial cardiac MRI and echocardiography. Acta Radiol 2015; 56:1315-22. [PMID: 25348475 DOI: 10.1177/0284185114556017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with corrected tetralogy of Fallot (cToF) are prone to develop pulmonary regurgitation and right ventricular enlargement resulting in long-term complications, thus correct right ventricular volumetric monitoring is crucial. However, it remains controversial which cardiovascular magnetic resonance imaging (CMRI) slice orientation is most appropriate in cToF for the analysis of the right ventricular volume. PURPOSE To investigate which slice orientation is most suited for right ventricular volumetry in cToF we compared short-axis and axial slices, and furthermore we compared right ventricular data between CMRI and echocardiography. MATERIAL AND METHODS Thirty CMRI examinations of 27 patients with cToF were included retrospectively. Right ventricular end-diastolic (EDV) and end-systolic volume (ESV) were derived from short-axis and axial cine CMRI planes. Furthermore, pulmonary trunk forward flow in phase-contrast CMRI and right ventricular inner diastolic diameter in echocardiography (R VIDdiast) were measured. By Bland-Altman and variance analysis intra- and inter-observer agreement were assessed for cine CMRI data. By Pearson correlation CMRI cine and phase-contrast data and CMRI cine and echocardiographic data were compared. RESULTS Intra- and inter-observer variability for right ventricular EDV were significantly lower in axial slices (P = 0.016, P = 0.010). For right ventricular ESV a trend towards a lower intra- and inter-observer variability in axial slices was found (P = 0.063, P = 0.138). Right ventricular stroke volume in short-axis (r = 0.872, P < 0.001) and in axial (r = 0.914, P < 0.001) planes correlated highly, respectively very highly with pulmonary trunk forward flow in phase-contrast CMRI. R VIDdiast correlated highly with right ventricular EDV assessed by short-axis and axial CMRI (P < 0.001, P < 0.001). CONCLUSION Due to lower intra- and inter-observer variability, axial slices are recommended for right ventricular volumetry in cToF.
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Affiliation(s)
- Juliane Schelhorn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Neudorf
- Clinic for Pediatrics III, University Hospital Essen, Essen, Germany
| | - Haemi Schemuth
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Thomas W Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Gohar F, Orak B, Jeske M, Lieber M, von Bernuth H, Giese A, Weissbarth-Riedel E, Haas P, Dressler F, Holzinger D, Lohse P, Neudorf U, Lainka E, Kallinich T, Foell D, Wittkowski H. FRI0515 Neutrophil-Specific S100A12 Phenotype Correlates to Genotype in Familial Mediterranean Fever. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3467] [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: 11/04/2022]
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Schelhorn J, Schönecker A, Neudorf U, Naßenstein K, Schara U, Schlosser T. Kernspintomografisch detektierte kardiale Auffälligkeiten bei heterozygoten Trägern der Muskeldystrophie Duchenne. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550945] [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: 10/23/2022]
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Neudorf U, Lilienthal E, Hospach T. Erratum zu: Handlungsempfehlung nach der Leitlinie „Vaskulitiden – Kawasaki-Syndrom“. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3236-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schönecker A, Schelhorn J, Schlosser T, Neudorf U, Schara U. Evaluation of cardiologic status in Carriers of Duchenne Muscular Dystrophy (DMD Carriers). Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394026] [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: 10/24/2022]
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Hoerning A, Raub S, Neudorf U, Müntjes C, Kathemann S, Lainka E, Stehling F, Hoyer PF, Gerner P. Pulse oximetry is insufficient for timely diagnosis of hepatopulmonary syndrome in children with liver cirrhosis. J Pediatr 2014; 164:546-52.e1-2. [PMID: 24321540 DOI: 10.1016/j.jpeds.2013.10.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/17/2013] [Accepted: 10/24/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prospectively investigate the prevalence of hepatopulmonary syndrome (HPS), the importance of pulse oximetry in diagnosing HPS, and the longitudinal course after liver transplantation in children with cirrhosis referred for liver transplantation. STUDY DESIGN Fifty-six patients aged 1-17 years (mean age, 4.6 ± 5.0 years) with liver cirrhosis were screened for HPS by hyperemic capillary blood gas (CBG) analysis and contrast-enhanced transthoracic echocardiography. Eleven patients were excluded owing to conditions that can produce cardiopulmonary dysfunction, including 5 with cystic fibrosis, 1 with pulmonary arterial hypertension, and 5 with an intracardial shunt. HPS was classified in accordance with the European Respiratory Society Task Force criteria on pulmonary-hepatic disorders. Patient groups were compared for biochemical and clinical characteristics. RESULTS Eighteen children (40%) with cirrhosis were intrapulmonary vasodilatation (IPVD)-positive and had a pulse oximetry oxygen saturation level >98%. Two of these patients (11%) exhibited moderate HPS with an elevated alveolar arterial oxygen gradient >15 mm Hg and PaO2 <70 mm Hg; they died before undergoing liver transplantation. The sensitivity and specificity of CBG analysis for detecting elevated alveolar arterial oxygen gradient in children with IPVD was 94% and 53%, respectively. HPS was associated with late hepatoportoenterostomy (P < .04). Liver transplantation led to resolution of HPS in all patients. CONCLUSION IPVD is frequent in children with liver cirrhosis (40%). Pulse oximetry is insufficient for timely HPS diagnosis. Pathological CBG analysis data indicate IPVD in the majority of cases, but are imprecise in children aged <2 years. Contrast-enhanced transthoracic echocardiography and CBG analysis are recommended for evaluation of HPS in children with cirrhosis, regardless of liver synthesis capacity and clinical chemistry data.
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Affiliation(s)
- André Hoerning
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Simon Raub
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Neudorf
- Clinic for Pediatrics III, Department of Pediatric Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carsten Müntjes
- Clinic for Pediatrics III, Department of Pediatric Cardiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Simone Kathemann
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elke Lainka
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Clinic for Pediatrics III, Department of Pediatric Pulmonology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter F Hoyer
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrick Gerner
- Clinic for Pediatrics II, Department of Pediatric Nephrology, Gastroenterology, Endocrinology, and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Gohar F, Husmann E, Haas PJ, Horneff G, Wittkowski H, Holzinger D, Kallinich T, Neudorf U, Niehues T, Lainka E, Foell D. PReS-FINAL-2216: Biomarkers MRP8/14 and S100A12 correspond with flare and remission clinical status in Sojia patients in the AID-NET register. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044789 DOI: 10.1186/1546-0096-11-s2-p206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Gohar F, Jeske M, Lohse P, Kallinich T, Neudorf U, Niehues T, Wittkowski H, Lainka E, Foell D. PReS-FINAL-2215: Genotype-phenotype correlations in children with Familial Mediterranean Fever in Germany. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043328 DOI: 10.1186/1546-0096-11-s2-p205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Jeske M, Lohse P, Kallinich T, Berger T, Rietschel C, Holzinger D, Kamlah C, Lankisch P, Berendes R, Dückers G, Horneff G, Lilienthal E, Haas JP, Giese A, Dressler F, Berrang J, Pütter C, Braunewell L, Neudorf U, Niehues T, Lainka E. P01-008 – FMF genotype-phenotype correlations in Germany. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952118 DOI: 10.1186/1546-0096-11-s1-a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jeske M, Lohse P, Kallinich T, Berger T, Rietschel C, Holzinger D, Kamlah C, Lankisch P, Berendes R, Dueckers G, Horneff G, Lilienthal E, Haas J, Giese A, Dressler F, Berrang J, Braunewell L, Neudorf U, Niehues T, Föll D, Lainka E. Genotype-Phenotype and Genotype-Origin Correlations in Children with Mediterranean Fever in Germany – an AID-Net Study. Klin Padiatr 2013; 225:325-30. [DOI: 10.1055/s-0033-1355372] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Jeske
- Pediatric Rheumatology, University Children′s Hospital, Essen, Germany
| | - P. Lohse
- Human Genetics, Laboratory Medicine and Human Genetics, Singen, Germany
| | - T. Kallinich
- Pediatric Pneumology and Immunology, Charité University Medicine Berlin, Germany
| | - T. Berger
- Pediatric Rheumatology, Witten/Herdecke University Children’s Hospital, Datteln, Germany
| | - C. Rietschel
- Pediatric Rheumatology, Clementine Children’s Hospital, Frankfurt/Main, Germany
| | - D. Holzinger
- Pediatric Rheumatology and Immunology, University Children’s Hospital, Muenster, Germany
| | - C. Kamlah
- Pediatric Rheumatology, University Children’s Hospital, Hamburg, Germany
| | - P. Lankisch
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center of Child and Adolescent Health, Heinrich-Heine-University Duesseldorf, Germany
| | - R. Berendes
- Pediatric Rheumatology, St. Marien’s Children’s Hospital, Landshut, Germany
| | - G. Dueckers
- Pediatric Immunology and Rheumatology, HELIOS Klinikum’s Hospital, Krefeld, Germany
| | - G. Horneff
- Centre of Pediatric Rheumatology, Asklepios Clinic, St. Augustin, Germany
| | - E. Lilienthal
- Pediatric Rheumatology, Ruhr-University Children’s Hospital, Bochum, Germany
| | - J. Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - A. Giese
- Central Patient Admission/Emergency Department, Marienhospital, Herne, Germany
| | - F. Dressler
- Pediatric Rheumatology Clinic, Hannover Medical School, Hannover, Germany
| | - J. Berrang
- Pediatric Rheumatology, Westfaelisches Kinderzentrum, Dortmund, Germany
| | - L. Braunewell
- Pediatric Rheumatology, University Children′s Hospital, Essen, Germany
| | - U. Neudorf
- Pediatric Rheumatology, University Children′s Hospital, Essen, Germany
| | - T. Niehues
- Pediatric Immunology and Rheumatology, HELIOS Klinikum’s Hospital, Krefeld, Germany
| | - D. Föll
- Pediatric Rheumatology and Immunology, University Children’s Hospital, Muenster, Germany
| | - E. Lainka
- Pediatric Rheumatology, University Children′s Hospital, Essen, Germany
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Webinger J, Abdul-Khaliq H, Apitz C, Berger F, Dalla-Pozza R, Eichhorn J, Gravenhorst V, v d Hagen M, Kehl H, Lange M, Motz R, Neudorf U, Stiller B, Dittrich S. Evaluation einer Multizentrischen Studie nach dem Arzneimittelgesetz im Kindesalter (Eudra-CT Nummer: 2009-009871-36). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Neudorf U, Müntjes C, Konorza T, Kälsch H, Kahlert P, Kaiser G, Wissmann A, Krüger C, Kästner M, Sigler M, Schneider M. Ein „Baby-Stent“ für Neugeborene und das weitere Leben - Ergebnisse der Tierversuche. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lainka E, Bielak M, Lohse P, Timmann C, Stojanov S, von Kries R, Niehues T, Neudorf U. Familial Mediterranean fever in Germany: epidemiological, clinical, and genetic characteristics of a pediatric population. Eur J Pediatr 2012; 171:1775-85. [PMID: 22903357 DOI: 10.1007/s00431-012-1803-8] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 12/18/2022]
Abstract
UNLABELLED Familial Mediterranean fever (FMF) is an autoinflammatory disease and belongs to the heterogeneous group of hereditary recurrent fever syndromes (HRFs). AIMS The aims of the study were to determine the incidence of FMF in Germany and to describe the spectrum of pyrin mutations and the clinical characteristics in children. A prospective surveillance of children with HRF including FMF was conducted in Germany during a time period of 3 years by the German paediatric surveillance unit for rare paediatric diseases (ESPED). Monthly inquiries were sent to 370 children's hospitals (Clinic-ESPED, n1) and to 23 laboratories (Laboratory-ESPED, n2). Inclusion criteria were children ≤ 16 years of age, disease-associated pyrin mutations, and more than three self-limiting episodes of fever >38.5 °C with increased inflammation markers. In n1, 122 patients with FMF and 225 pyrin mutations were identified. Ninety-two of 122 (75 %) children were of Turkish origin. The minimum incidence of FMF was estimated to be 3 (95 % CI: 2.48-3.54) per 10(6) person-years in the whole children population and 55 (95 % CI: 46-66) per 10(6) person-years in Turkish children living in Germany. N1 U n2 amounted to 593 asymptomatic and symptomatic carriers of 895 mutations (overlap of 73 cases with 134 mutations). p.Met694Val (45 %), p.Met680Ile (14 %), p.Val726Ala (12 %), and p.Glu148Gln (11.5 %) were the most common pyrin mutations. CONCLUSIONS Despite FMF being the most frequent of the HRFs, its incidence in Germany is low. Twenty-five to 50 FMF patients ≤ 16 years are newly diagnosed per year. The disease is most commonly observed in individuals of Turkish ancestry.
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Affiliation(s)
- E Lainka
- Department of Paediatric Rheumatology, Children's Hospital, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
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Hunold P, Michna D, Theysohn JM, Neudorf U, Barkhausen J, Vogt FM, Quick HH. Zeitaufgelöste 4D TWIST MR-Angiographie bei angeborenen Herz- und Gefäßanomalien: Bildqualität und zusätzliche diagnostische Aussagekraft im Vergleich zur 3D MRA. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Kawasaki disease (KD) is a systemic vasculitis of unknown etiology. The diagnostic criteria are fulfilled with fever of unknown origin and 4 of the following 5 criteria: bilateral conjunctival injection, cervical lymphadenopathy, polymorphous rash, oral mucous membrane changes (injected lips, strawberry tongue) and peripheral extremity changes (erythema, edema, desquamation). If less than 4 criteria are found incomplete KD can be diagnosed. The therapy is 2 g/kg body weight single dose intravenous immunoglobulin and acetylsalicylic acid (ASS). In the long-term follow-up the main focus is on the coronary arteries because coronary changes play a key role in the intensity of long-term management. There is some evidence that KD is a risk factor for cardiovascular diseases in adults.
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Affiliation(s)
- U Neudorf
- Klinik für Kinderheilkunde III - Bereiche Kardiologie und Rheumatologie, Zentrum für Kinder- und Jugendmedizin, Essen, Deutschland.
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Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, Baus H, Becker M, Bertram B, Dannecker G, Deuter C, Foeldvari I, Frosch M, Ganser G, Gaubitz M, Gerdes G, Horneff G, Illhardt A, Mackensen F, Minden K, Pleyer U, Schneider M, Wagner N, Zierhut M. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 2011; 32:1121-33. [DOI: 10.1007/s00296-011-2126-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/22/2011] [Indexed: 12/14/2022]
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Lainka E, Bielak M, Hilger V, Basu O, Neudorf U, Wittkowski H, Holzinger D, Roth J, Niehues T, Foell D. Translational research network and patient registry for auto-inflammatory diseases. Rheumatology (Oxford) 2011; 50:237-42. [PMID: 21148158 DOI: 10.1093/rheumatology/keq270] [Citation(s) in RCA: 22] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Auto-inflammatory diseases (AIDs) are characterized by recurrent self-limiting systemic inflammation. In a multicentre effort, we set out to register genetic, epidemiological and clinical features as well as prognostic factors of these diseases by prospective longitudinal and long-term documentation, in order to define novel AIDs and to better understand treatment responses and outcome. METHODS In 2009, a federally funded clinical and research consortium (AID-Net) was established, including an online registry for AIDs (http://www.aid-register.uk-essen.de). Inclusion criteria are disease-associated mutations for hereditary periodic fever syndromes [FMF, hyperimmunoglobulinaemia D and periodic fever syndrome (HIDS), TNF receptor 1-associated periodic syndrome (TRAPS) and cryopyrin-associated periodic syndrome (CAPS)], or, alternatively, clinically confirmed AID, systemic-onset JIA (SoJIA) and periodic fever, aphthous stomatitis, pharyngitis and adenopathy (PFAPA) syndrome with unknown genetic background. Patients were recruited to the registry and patient material was deposited in biomaterial banks (DNA/serum). In addition, basic research projects were initiated that focus on molecular mechanisms of AID. RESULTS During the first 9 months, 117 patients (65 males, 52 females; age 1-21 years) have been recorded and classified as FMF (n=84), HIDS (n=1), TRAPS (n=3) and CAPS (n=1); clinically confirmed AID (n=5); SoJIA (n=22); and PFAPA (n=1). One hundred and fifty blood samples of 18 patients were included in biomaterial banks. CONCLUSION Recruitment and follow-up of patients with AID will enable us to comprehensively address the correlation between clinical and epidemiological data, genetics and biomarkers. The translational approach may help to identify genetic or inflammatory markers relevant for the course and outcome of diseases.
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Affiliation(s)
- Elke Lainka
- Department of Paediatric Rheumatology, Children's Hospital, University Duisburg-Essen, Essen, Germany.
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Hauffa BP, Knaup K, Lehmann N, Neudorf U, Nagel B. Effects of growth hormone therapy on cardiac dimensions in children and adolescents with Prader-Willi syndrome. Horm Res Paediatr 2011; 75:56-62. [PMID: 20924154 DOI: 10.1159/000319612] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 07/12/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Growth hormone (GH) secretory status and GH therapy influence cardiac muscle mass and function. Most patients with Prader-Willi syndrome (PWS) are GH-deficient (GHD), and are at risk to develop obesity-related cardiac problems. Few data exist on the development of cardiac dimensions under GH treatment in PWS. STUDY DESIGN in a retrospective study, cardiac dimensions measured echocardiographically in 26 children with PWS before and after 22.9 ± 11.0 months of GH therapy (0.035 mg/kg/day) were compared to those of 13 GHD children treated with GH (0.025-0.035 mg/kg/day) over 13.5 ± 4.2 months. RESULTS low-normal left ventricular end-systolic [diastolic] diameter SDS increased in PWS patients (1.41, p < 0.0001 [1.23, p < 0.0001]) and in controls (0.61, p = 0.04 [0.78, p = 0.013]), becoming elevated above normal in 2/26 PWS patients. There was a trend for a higher GH effect on left ventricular end-systolic diameter in PWS (p = 0.071). Mean values of all echocardiographic dimensions remained in the normal range in both PWS patients and controls, before and under GH therapy. CONCLUSION the response of cardiac dimensions to GH treatment is similar in PWS patients and GHD controls, with a trend towards more elevated left ventricular parameters in PWS. Therefore, regular echocardiographic assessment may be considered in PWS children with longer treatment duration.
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Affiliation(s)
- Berthold P Hauffa
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Essen, Germany.
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Lainka E, Neudorf U, Lohse P, Timmann C, Bielak M, Stojanov S, Huss K, Kries RV, Niehues T. Analysis of Cryopyrin-Associated Periodic Syndromes (CAPS) in German Children: Epidemiological, Clinical and Genetic Characteristics. Klin Padiatr 2010; 222:356-61. [DOI: 10.1055/s-0030-1265181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Arbeiter AK, Kranz B, Wingen AM, Bonzel KE, Dohna-Schwake C, Hanssler L, Neudorf U, Hoyer PF, Büscher R. Continuous venovenous haemodialysis (CVVHD) and continuous peritoneal dialysis (CPD) in the acute management of 21 children with inborn errors of metabolism. Nephrol Dial Transplant 2009; 25:1257-65. [PMID: 19934086 DOI: 10.1093/ndt/gfp595] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Newborns with inborn errors of metabolism often present with hyperammonaemic coma, requiring prompt diagnosis and specific medical therapy, nutritional support and efficient toxin removal. Little information regarding the efficacy and safety of continuous venovenous haemodialysis (CVVHD) as an option for extracorporal ammonia detoxification in children is available. METHODS Twenty-one patients with hyperammonaemia [19 neonates (mean age 4.1 +/- 2.4 days) and two children 1 and 7 years of age, respectively] were admitted to our hospital for dialysis between 1996 and 2008. Seventeen children (15 neonates), received CVVHD. Four neonates received continuous peritoneal dialysis (CPD). All started medical treatment with sodium benzoate, l-arginine hydrochloride and carnitine as well as protein-restricted parenteral diets with high caloric intake before dialysis. RESULTS Plasma ammonia levels (range 464-7267 microg/dl before dialysis and 27-3317 microg/dl after dialysis) were significantly reduced by 50% within 4.7 +/- 2.5 h with CVVHD compared with 13.5 +/- 6.2 h with CPD (P < 0.0001). Plasma ammonia levels <200 microg/dl critical range were achieved within 22.4 +/- 18.1 h in CVVHD patients compared with 35.0 +/- 24.1 h with CPD. Depending on the weight and blood pressure stability of the patients, mean blood flow velocities of 9.8 +/- 3.4 ml/kg/min and mean dialysate flow rates of 3925 +/- 2398 ml/min/1.73 m(2) were employed. Blood and dialysate flows significantly correlated with ammonia clearance and decay of ammonia in vivo. Because of the severe underlying disease, 18% of CVVHD patients died compared with 50% undergoing CPD. In total, 82% of CVVHD patients survived the first 6 months after dialysis. Among these, 43% were without sequelae, 43% developed moderate mental retardation, and two (14%) developed severe mental retardation. CONCLUSION CVVHD effectively and quickly eliminates plasma ammonia. To optimize long-term mental outcome, rapid identification and appropriate treatment of the underlying disease as well as starting dialysis early are of enormous therapeutic value.
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Affiliation(s)
- Anja K Arbeiter
- Children's Hospital, University of Duisburg-Essen, Department of Paediatrics II, Hufelandstr. 55, 45122 Essen, Germany.
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Lainka E, Neudorf U, Lohse P, Timmann C, Stojanov S, Huss K, von Kries R, Niehues T. Incidence of TNFRSF1A mutations in German children: epidemiological, clinical and genetic characteristics. Rheumatology (Oxford) 2009; 48:987-91. [PMID: 19541728 DOI: 10.1093/rheumatology/kep140] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE TNF receptor 1-associated periodic syndrome (TRAPS) is a rare disease belonging to the heterogeneous group of hereditary periodic fever (HPF) syndromes. By their monogenic origins, the HPF syndromes are clearly differentiated from other periodic inflammatory episodes occurring in autoimmune, neoplastic and infectious diseases. We aim to determine the incidence of TRAPS and the spectrum of mutations in the TNFRSF1A gene, and to give a brief survey of clinical signs. METHODS A prospective surveillance of children with TRAPS was conducted in Germany during a time period of 3 years (2003-06). Monthly inquiries were sent to 370 children's hospitals by the German Pediatric Surveillance Unit (Clinic-ESPED, n1) and to 23 laboratories (Laboratory-ESPED, n2). Inclusion criteria were TNFRSF1A mutation-positive patients < or =16 years of age, more than three self-limiting episodes of fever >38.5 degrees C, and increased inflammation markers. Clinical, epidemiological and genetic data were evaluated via questionnaires. RESULTS Of the 23 cases included, 19 were identical in 20 clinical and 22 laboratory reports. The incidence of TRAPS in German children was estimated to be approximately 5.6 per 10(7) person-years. In 20 TRAPS patients of the Clinic-ESPED, median age of onset and duration of fever periods were 6 (range 1-16) years and 6.3 (range 2-24) days, respectively. Main symptoms were arthralgia, abdominal pain, lymphadenopathy, headache and skin involvement. The R92Q substitution was found in 19 (83%) of 23 cases. CONCLUSION The incidence of TRAPS is low and corresponds to 6-10 newly diagnosed patients < or =16 years per year in Germany.
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Affiliation(s)
- Elke Lainka
- Department of Paediatric Rheumatology, Children's Hospital, University Duisburg-Essen, Essen, Germany.
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Abstract
Infectious uveitis caused by Borrelia, tuberculosis or syphilis is a rare condition, even in childhood. Because these diseases can be treated successfully, knowledge of their diagnosis and therapy is highly important. The clinical aspects vary from simple conjunctivitis to endophthalmitis or neuro-ophthalmological diseases. The diagnosis of and therapy for borreliosis depend on the stage of the disease. The involvement of different organ systems or positive indirect tests (tuberculin skin test, interferon gamma assays) are important factors in the diagnosis of tuberculosis as the cause of a uveitis. Serology is essential for the diagnosis and monitoring of syphilis.
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Affiliation(s)
- T Ness
- Universitäts-Augenklinik Freiburg.
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Abstract
BACKGROUND Intraocular inflammation in children differs considerably from that found in adults. Therefore the diagnostic work-up has to be adapted to the age and specific diseases. MATERIALS AND METHODS The published literature was reviewed for results of clinical trials and consensus meetings. In addition, the authors have incorporated their own experience. RESULTS Recommendations for a systematic and complete diagnostic work-up are given using tables where possible. CONCLUSIONS A close cooperation between ophthalmologists and paediatricians is very important.
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Kallinich T, Haffner D, Niehues T, Huss K, Lainka E, Neudorf U, Schaefer C, Stojanov S, Timmann C, Keitzer R, Ozdogan H, Ozen S. Colchicine use in children and adolescents with familial Mediterranean fever: literature review and consensus statement. Pediatrics 2007; 119:e474-83. [PMID: 17242135 DOI: 10.1542/peds.2006-1434] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The daily application of colchicine is the standard therapy for prophylaxis of attacks and amyloid deposition in familial Mediterranean fever. However, because of many issues (eg, dosage, time of introduction, etc), no standardized treatment recommendations have been established. In this work we review the available literature on colchicine use with respect to its indication, efficacy, mode of application, and safety in children and adolescents with familial Mediterranean fever. On the basis of this analysis, a consensus statement on the application of colchicine in children and adolescents with familial Mediterranean fever was developed by caregivers from Germany, Austria, and Turkey.
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Affiliation(s)
- Tilmann Kallinich
- Department of Pediatric Pneumology and Immunology, Charite-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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