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Dutta R, Sana H, Sawhney R, El Omrani O, Ehsan A, Fallah P, Pigeolet M, Jayaram A, Riviello R, Park KB. How youth engagement can break surgery out of its silo in global health. Public Health Action 2023; 13:117. [PMID: 37736582 PMCID: PMC10446666 DOI: 10.5588/pha.23.0027] [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: 09/23/2023] Open
Affiliation(s)
- R Dutta
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - H Sana
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - R Sawhney
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low and Middle-Income Countries, Mumbai, India
| | - O El Omrani
- Plastic and Reconstructive Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| | - A Ehsan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - P Fallah
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - M Pigeolet
- Department of Pediatric Orthopedics, Húpital universitaire Necker - Enfants malades, Paris, France
| | - A Jayaram
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Riviello
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - K B Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
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Kumari D, Sanchez-Salazar A, Villa C, Herschap B, Ehsan A. Triaging of Bone Marrow for Esoteric Testing – Cost-effective and Patient-centric Approach Utilizing WHO Nomenclature for Hematolymphoid Malignancies. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Esoteric testing (ES) plays a major role in bone marrow (BM) evaluation. Providers usually order tests considering differential diagnoses based on clinical history. Hematopathologists (HP) while reviewing the BM consider modifying the standing orders. Knowledge and simple guidelines for triaging BM for ES are limited in the literature.
Methods/Case Report
Between 2015-2021, a total of 2560 BMs were selected. Initial tests that were ordered by providers were reviewed by HP considering clinical history, medical necessity, and preliminary BM morphology. Average Medicare fee schedule for 2022 was used for cost analysis. Types of ES were evaluated for Flow Cytometry (FC); Cytogenetics (CG); Fluorescence In-Situ Hybridization (FISH) and Molecular Genetics (MG). Immunostains were excluded in this study.
Results (if a Case Study enter NA)
Cases were evaluated and categorized as cytopenias, cytosis, staging, MPN, MDS, myelomas, treatment follow-up and miscellaneous indications. ES were modified based on medical necessity and blinded with insurance plans or payment status. Initial clinical orders were modified by HP as follows: FC-reduced 15%; CG-reduced 38%; FISH-modified 25%; MG-modified 40% (single assays or NGS). Overall healthcare savings by modifying tests were close to $1.2M.
Conclusion
Effective triaging of BM is a complex decision and can result in significant cost savings. Factors positively impacting these savings are: 1) expertise training in hematopathology, 2) personalized order of ES considering clinical indication, 3) peer-to- peer interaction with providers, and 4) the types of samples obtained. Collaborative efforts among pathologists and clinicians may lead to appropriate ordering of tests, cost- saving effective patient care with relevant diagnostic, therapeutic and prognostic information obtained as recommended by WHO nomenclature for hematolymphoid malignancies. In addition, established practice guidelines with personalized medicine will reduce the burden for pre-authorization when challenged with time sensitive samples obtained from cancer patients obtained thru invasive procedures.
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Affiliation(s)
- D Kumari
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - A Sanchez-Salazar
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - C Villa
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - B Herschap
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - A Ehsan
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
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Poonam F, Loos C, Wells A, Ehsan A. Molecular Solid Tumor Algorithm – Simplified Patient-Centric/Cost-Effective Approach by Pathologists. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
The process from the time the patient is diagnosed with cancer and receives their first treatment is complex and time-consuming. It requires adherence to national comprehensive cancer network (NCCN) guidelines; is challenged with limited tissue, how and when to order tests, and reimbursement timelines with pre- authorizations. We evaluated the role of the pathologists, who are an integral part of patient care, along with oncologists and surgeons.
Methods/Case Report
254 cases from various types of solid tumors (paraffin-embedded blocks) were collected from several pathology departments. Tests (two panels NGS-DNA/RNA expression, FISH, PD-L1, and IHC) were ordered as early as on the day of diagnosis to as late as 18 months following the diagnosis. Cancer cases reviewed were Colo-Rectal (72), Lung (48), Breast (24), Gastric (10), CNS (8), Melanoma (4), Head/Neck (20), GU (16), Sarcomas (8), Thyroid (6), Hepatic (8), Female Genital Tract (7) and Unknown Primary (23).
Results (if a Case Study enter NA)
We evaluated pathology reports, identified blocks, reviewed H&E slides, utilized NCCN guidelines in collaboration with oncologists. Tests were ordered using established billing criteria. Following tests were performed: PD-L1 (190 - 75%), FISH (50 - 20%), and NGS – two simple panel approach (215 - 85%). Using the aforesaid methods, our NGS results were successful in >95%. We were able to identify actionable and prognostic mutations in >80% of tumors.
Conclusion
Our algorithm has been designed considering NCCN guidelines and are updated frequently with new therapeutic targets and actionable mutations. The emphasis is to conserve diagnostic tissue and ensure timely ordering of tests as medically necessary. This can be adopted by pathologists in conjunction with clinical information, pathology reports, and be used as a part of diagnostic workups to reduce delays in treatment, avoid tissue loss, utilize current billing (inpatient/outpatient) practices, pre-authorization and eventually improving patient care as well as reduce overall healthcare costs.
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Affiliation(s)
- F Poonam
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - C Loos
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - A Wells
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
| | - A Ehsan
- Pathology, CorePath Laboratories , San Antonio, Texas , United States
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Hussain M, Liaqat I, Bukhari SM, Khan FS, Adalat R, Shafique MS, Azam SM, Ali A, Khalid M, Shahid Z, Iqbal MJ, Slahuddin, Ehsan A. The impact of cow dung augmentation on soil restoration and bio-accumulation of metals (Lead and Cadmium) in Pheretima posthuma (Annelida: Clitellata). BRAZ J BIOL 2021; 83:e247562. [PMID: 34495155 DOI: 10.1590/1519-6984.247562] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
To investigate the role of cow dung in soil reclamation and bio assimilation along with bio accumulation of heavy metals in earthworm (P. posthuma) (N=900) earthworms were used and treatment groups of CD-soil mixture of different proportion of cow dung were designed. Nonlethal doses of lead acetate and cadmium chloride were added in treatment groups. Mature P. posthuma were released in each experimental pot maintaining the favorable conditions. The pH, carbon, nitrogen, phosphorus, exchangeable cations, and heavy metal level of each mixture was evaluated. The results indicated that bio-assimilation of Pb and Cd by P. posthuma were significantly (P ˂ 0.01) higher in different soil-CD treatments compared to control. Highest bio-assimilation of both metals was observed in T1 of both groups (Pb = 563.8 mg/kg and Cd = 42.95 mg/kg). The contents of both metals were significantly (P ˂ 0.05) lowered in casting. The nutrient concentration in the final castings of all soil-CD treatments were also equally transformed from less or insoluble to more soluble and available for plants, except for carbon level which increased with CD proportion. It is concluded that cow dung as organic matter has a positive effect on soil reclamation and bio-assimilation of metals by P. posthuma.
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Affiliation(s)
- M Hussain
- GC University Lahore, Department of Zoology, Microbiology Lab, Lahore, Pakistan
| | - I Liaqat
- GC University Lahore, Department of Zoology, Microbiology Lab, Lahore, Pakistan
| | - S M Bukhari
- University of Veterinary and Animal Sciences, Department of Wildlife and Ecology, Lahore, Pakistan
| | - F S Khan
- University of Sialkot, Department of Biotechnology, Sialkot, Pakistan
| | - R Adalat
- University of Sialkot, Department of Biotechnology, Sialkot, Pakistan
| | - M Salman Shafique
- GC University, Department of Chemistry, Atomic Absorption Lab. and Functional Material Lab., Lahore, Pakistan
| | - S M Azam
- University of Education, Division of Science and Technology, Department of Zoology, Lahore, Pakistan
| | - A Ali
- The Islamia University of Bahawalpur, Department of Zoology, Bahawalpur, Pakistan
| | - M Khalid
- Government Emerson College Multan, Department of Zoology, Multan, Pakistan
| | - Z Shahid
- University of Veterinary and Animal Sciences, Department of Fisheries & Aquaculture, Lahore, Pakistan
| | - M Javed Iqbal
- Bahauddin Zakariya University, Department of Zoology, Multan, Pakistan
| | - Slahuddin
- Universityof Gujrat, Department of Zoology, Gujrat, Pakistan
| | - A Ehsan
- The University of Lahore, Department of Zoology, Institute of Molecular Biology and Biotechnology, Lahore, Pakistan
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5
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Ehsan A. Risk factors associated with mortality from Neonatal tetanus in district Naseerabad, Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.059] [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: 10/22/2022] Open
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6
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Ali H, Ehsan A, Kennedy K, Riley P, Seo A, Bajaj N, Singh A, Sellke F, Levine D, Kiernan M, Yousefzai R. The Cost and Length of Stay Associated with Biventricular Assist Devices in the United States (2009-2015). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.142] [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] Open
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7
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Ehsan A, Ehsan A, Spini D, Sommet N, Morselli D. COMMUNITY INTERVENTIONS FOR THE MENTAL HEALTH OF ELDERLY INDIVIDUALS: A SWISS CASE STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Ehsan
- University of Lausanne, NCCR LIVES, Lausanne, Vaud, Switzerl
| | - A Ehsan
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - D Spini
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - N Sommet
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - D Morselli
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
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8
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Ehsan A, Ehsan A, Spini D, Sommet N, Morselli D. COMMUNITY INTERVENTIONS FOR THE MENTAL HEALTH OF ELDERLY INDIVIDUALS: A SWISS CASE STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ehsan
- University of Lausanne, NCCR LIVES, Lausanne, Vaud, Switzerl
| | - A Ehsan
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - D Spini
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - N Sommet
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
| | - D Morselli
- University of Lausanne, Switzerland; Swiss Centre of Competence in Research LIVES. Overcoming Vulnerability: Life Course, Perspectives, Switzerl
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9
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Kostopoulou D, Casaert S, Tzanidakis N, van Doorn D, Demeler J, von Samson-Himmelstjerna G, Saratsis A, Voutzourakis N, Ehsan A, Doornaert T, Looijen M, De Wilde N, Sotiraki S, Claerebout E, Geurden T. The occurrence and genetic characterization of Cryptosporidium and Giardia species in foals in Belgium, The Netherlands, Germany and Greece. Vet Parasitol 2015; 211:170-4. [PMID: 26012855 DOI: 10.1016/j.vetpar.2015.04.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 12/08/2014] [Revised: 02/12/2015] [Accepted: 04/18/2015] [Indexed: 01/02/2023]
Abstract
Faecal samples were collected from foals between the age of 1 week and 6 months in Belgium, The Netherlands, Germany and Greece. A quantitative direct immunofluorescence assay based on the commercial MERIFLUOR Cryptosporidium/Giardia kit was performed to evaluate the presence of (oo) cysts. Parasite positive samples were genotyped, based on the 18S ribosomal DNA gene and the heat shock protein (HSP70) gene for Cryptosporidium and on the β-giardin gene and the triose phosphate isomerase (TPI) gene for Giardia. In total, 134 foals from Belgium, 44 foals from The Netherlands, 30 foals from Germany and 190 foals from Greece were examined. No Cryptosporidium oocysts were identified in faecal samples from foals in Germany and The Netherlands. In Belgium and Greece, 4.5% and 1.1% of the foals examined were Cryptosporidium positive, respectively, all with a low oocyst excretion ranging from 100 to 2450 oocysts per gram of faeces. For Giardia, 14.2%, 11.4%, 10.0% and 11.6% of the foals in Belgium, The Netherlands, Germany and Greece, respectively, were found to excrete cysts, with a range of 50 up to 4,000,000 cysts per gram of faeces. Younger animals secreted significantly more Giardia cysts than older horses (p<0.05), but no significant correlation between Giardia infection and diarrhoea was observed. Most Giardia positive samples belonged to assemblage AI and/or BIV, but also assemblage E was detected in two samples. Together with the identification of Cryptosporidium horse genotype, this suggests only a low risk for zoonotic transmission.
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Affiliation(s)
- D Kostopoulou
- Laboratory of Parasitology, Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001 Thessaloniki, Greece; Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium.
| | - S Casaert
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
| | - N Tzanidakis
- Laboratory of Parasitology, Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001 Thessaloniki, Greece
| | - D van Doorn
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584CL Utrecht, The Netherlands
| | - J Demeler
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - G von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - A Saratsis
- Laboratory of Parasitology, Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001 Thessaloniki, Greece
| | - N Voutzourakis
- Laboratory of Parasitology, Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001 Thessaloniki, Greece
| | - A Ehsan
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
| | - T Doornaert
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
| | - M Looijen
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584CL Utrecht, The Netherlands
| | - N De Wilde
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
| | - S Sotiraki
- Laboratory of Parasitology, Veterinary Research Institute, Hellenic Agricultural Organization Demeter, Thermi, 57001 Thessaloniki, Greece
| | - E Claerebout
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
| | - T Geurden
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
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Miller R, Covington S, Taranto S, Carrico R, Ehsan A, Friedman B, Green M, Ison MG, Kaul D, Kubak B, Lebovitz DJ, Lyon GM, Nalesnik MA, Pruett TL, Teperman L, Vasudev B, Blumberg E. Communication gaps associated with donor-derived infections. Am J Transplant 2015; 15:259-64. [PMID: 25376342 DOI: 10.1111/ajt.12978] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/21/2014] [Accepted: 08/04/2014] [Indexed: 01/25/2023]
Abstract
The detection and management of potential donor-derived infections is challenging, in part due to the complexity of communications between diverse labs, organ procurement organizations (OPOs), and recipient transplant centers. We sought to determine if communication delays or errors occur in the reporting and management of donor-derived infections and if these are associated with preventable adverse events in recipients. All reported potential donor-derived transmission events reviewed by the Organ Procurement and Transplantation Network Ad Hoc Disease Transmission Advisory Committee from January 2008 to June 2010 were evaluated for communication gaps between the donor center, OPO and transplant centers. The impact on recipient outcomes was then determined. Fifty-six infection events (IEs; involving 168 recipients) were evaluated. Eighteen IEs (48 recipients) were associated with communication gaps, of which 12 resulted in adverse effects in 69% of recipients (20/29), including six deaths. When IEs and test results were reported without delay, appropriate interventions were taken, subsequently minimizing or averting recipient infection (23 IEs, 72 recipients). Communication gaps in reported IEs are frequent, occur at multiple levels in the communication process, and contribute to adverse outcomes among affected transplant recipients. Conversely, effective communication minimized or averted infection in transplant recipients.
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Affiliation(s)
- R Miller
- Divisions of Infectious Diseases and Transplant Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
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Hossain MMM, Ehsan A, Rahman MA, Chowdhury MBR, Haq M. Responses of monosex nile tilapia (Oreochromis niloticus) to intraperitoneal challenge by Streptococcus iniae after vaccination with ghosts of the bacterium. ACTA ACUST UNITED AC 2012. [DOI: 10.3329/bvet.v29i1.11889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The vaccine potential of Streptococcus iniae ghosts produced by gene E mediated lysis was investigated using tilapia (Oreochromis niloticus). Tilapia immunized with S. iniae ghosts (SIG) and formalin killed S. iniae (FKC) vaccines showed significantly higher serum agglutination titres than control fish. Fish immunized with SIG showed no significant differences with fish immunized with FKC in serum agglutination titres, but showed significantly higher bactericidal activity than fish immunized with FKC. Furthermore, fish immunized with SIG showed higher protection than fish immunized with FKC. As this promising type of a non-living whole cell envelope preparation seems to be favorable over conventional vaccines, we suggest S. iniae ghosts as a new vaccine candidate DOI: http://dx.doi.org/10.3329/bvet.v29i1.11889 Bangl. vet. 2012. Vol. 29, No. 1, 31-37
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12
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Ehsan A, Taranto S, Covington S, Miller R, Taylor K, Parker K, Friedman B, Green M, Ruiz P, Blumberg E. 66 Donor-Derived Infections in Heart Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.070] [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] Open
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13
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Grit GH, Bénéré E, Ehsan A, De Wilde N, Claerebout E, Vercruysse J, Maes L, Geurden T. Giardia duodenalis cyst survival in cattle slurry. Vet Parasitol 2012; 184:330-4. [DOI: 10.1016/j.vetpar.2011.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 08/09/2011] [Accepted: 08/11/2011] [Indexed: 11/29/2022]
Affiliation(s)
- G H Grit
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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14
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Griese D, Ehsan A, Melo L. Isolation and transplantation of autologous circulating endothelial cells into denuded vessels and prosthetic grafts: Implications for cell-based vascular therapy. J Vasc Surg 2004. [DOI: 10.1016/j.jvs.2004.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Huber PE, Mann MJ, Melo LG, Ehsan A, Kong D, Zhang L, Rezvani M, Peschke P, Jolesz F, Dzau VJ, Hynynen K. Focused ultrasound (HIFU) induces localized enhancement of reporter gene expression in rabbit carotid artery. Gene Ther 2003; 10:1600-7. [PMID: 12907952 DOI: 10.1038/sj.gt.3302045] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The development of accurate, safe, and efficient gene delivery remains a major challenge towards the realization of gene therapeutic prevention and treatment of cardiovascular diseases. In this study, we investigated the ability of high-intensity focused ultrasound (HIFU), a form of mechanical wave transmission, to act as a noninvasive tool for the enhancement of in vivo gene transfer into rabbit carotid arteries. Segments of the common carotid arteries of New Zealand white rabbits were isolated and infused with plasmid DNA encoding the reporter beta-galactosidase either with or without the addition of ultrasound contrast agent consisting of small (approximately 2-5 microm) gas-filled human albumin microspheres to augment cavitation. Infused arteries were exposed to pulsed ultrasound for 1 min (frequency 0.85 MHz, burst length 50 ms, repetition frequency 1 Hz, duration 60 s, peak pressure amplitude of 15 MPa). At 6.3 MPa, HIFU enhanced gene expression eight-fold, and 17.5-fold in the presence of contrast. We found increasing amounts of beta-galactosidase expression in the carotid vessel with increasing pressure amplitude. This dose-response relation was present with and without contrast. Without contrast, no vessel damage was detected up to 15 MPa, while the addition of contrast induced side effects above a threshold of 6.3 MPa peak pressure. The entire procedure was feasible and safe for the animals, and the results suggest that HIFU has the potential to assist in the noninvasive spatial regulation of gene transfer into the vascular system.
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Affiliation(s)
- P E Huber
- Department of Radiology, Brigham and Womens' Hospital, Harvard Medical School, Boston, MA, USA
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Restrepo A, Devore P, Encarnación CE, Wholey MH, Schneider D, Callander NS, Ferral H, Postoak D, Anderson JE, Walsh T, Padayao G, Gokmen E, Ehsan A, Ochoa L, Neumon B, West G, Restrepo MI, Przykucki J, Patterson J, Freytes CO. Performance of a hybrid central venous catheter utilized for both peripheral blood stem cell harvest and transplant support of patients undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2002; 30:389-95. [PMID: 12235524 DOI: 10.1038/sj.bmt.1703647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2002] [Accepted: 04/22/2002] [Indexed: 11/09/2022]
Abstract
Patients undergoing autologous peripheral blood stem cell transplantation (PBSC) frequently require the sequential insertion of two central venous catheters, one for leukapheresis and one for transplant support. Hybrid catheters suitable for leukapheresis and long-term use have been increasingly used, but there is limited information regarding their performance and complication rate. The purpose of this study was to determine the performance of the Pheres-Flow hybrid catheter when utilized for both leukapheresis and transplant support, with particular emphasis on the incidence of infectious and occlusive complications. We prospectively analyzed the performance of 92 catheters in 82 consecutive patients who underwent autologous peripheral blood stem cell (PBSC) transplantation. Occlusion was the most frequent complication of this catheter with 29% of the patients experiencing difficulty drawing blood or infusing fluids. Infection was another frequent complication. Twenty-two percent of patients developed catheter-related bloodstream infections and 15 catheters had to be removed because of proven or suspected infection that did not respond to antibiotic therapy. Nevertheless, 77% of patients were able to complete leukapheresis and transplant support with only one catheter. We conclude that the utilization of the Pheres-Flow catheter for both leukapheresis and transplant support is feasible, but that new strategies need to be developed to decrease the incidence of occlusive and infectious complications of hybrid catheters.
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Affiliation(s)
- A Restrepo
- Department of Medicine, University of Texas Health Science Center, San Antonio, USA
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17
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Ehsan A, Sommer F, Haupt G, Engelmann U. Significance of fluorescence cystoscopy for diagnosis of superficial bladder cancer after intravesical instillation of delta aminolevulinic acid. Urol Int 2002; 67:298-304. [PMID: 11741132 DOI: 10.1159/000051007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Most lesions of superficial bladder cancer may be easily missed during conventional white light cystoscopy. The aim of this work was to evaluate the efficiency of endoscopic fluorescence diagnosis of superficial malignant bladder tumours following intravesical instillation of delta-aminoleviulenic acid. PATIENTS AND METHODS 30 patients of suspected or previously diagnosed bladder cancer were subject of evaluation. All patients received 50 ml of a 3% delta-ALA solution intravesically, 2-3 h prior to diagnostic cystoscopy. Fluorescence excitation intraoperatively was achieved by a violet-blue light from a xenon light source. RESULTS A clear strong red fluorescence colour was observed emitting from all malignant vesical lesions. A diagnostic sensitivity of 98% and specificity of 65% has been determined for this novel diagnostic modality. CONCLUSION Fluorescence cystoscopy using delta-ALA is a reliable procedure that can be offered to all patients with suspected bladder cancer lesions.
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Affiliation(s)
- A Ehsan
- Department of Urology, University of Cologne, Germany.
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18
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Sommer F, Ehsan A, Caspers HP, Klotz T, Engelmann U. Risk adjustment for evaluating the outcome of urological operative procedures. J Urol 2001; 166:968-72. [PMID: 11490257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
PURPOSE Considerable public and media attention has been directed in recent years toward comparing performance at individual hospitals. So-called death league tables have been published in the media, ranking hospitals according to crude mortality rates. Crude rates of mortality and morbidity are clearly misleading. Therefore, scoring systems comparing treatment outcomes among physicians or hospitals on an objective basis are urgently required. MATERIALS AND METHODS During a 12-month period we prospectively evaluated 651 patients at 2 urological units using a simple and well validated surgical scoring system. Patients had been admitted to the units for routine urological operations. The scoring system consists of a simple preoperative physiological score, a postoperative severity score and defined types of complications. RESULTS The morbidity and mortality rates for unit 1 were 7.4% and 1.3%, respectively. For unit 2 the morbidity and mortality rates were 14% and 8.8%, respectively. Despite the marked differences in these crude rates risk adjusted analysis revealed no significant difference (p <0.05). Receiver operating characteristics curve analysis likewise demonstrated no significant difference in mortality and morbidity for the 2 units. CONCLUSIONS Raw rates of mortality and morbidity are often inappropriately used to compare the performance of various surgical procedures, especially vascular and cardiothoracic surgery. In Great Britain at some institutions urological units are ranked according to mortality and morbidity outcome. As a consequence, important variables, such as patient physiological state at surgery and the type of procedure, are not considered. Our study shows that the scoring system applied is suitable for urological audit and may be a valuable tool for comparing performance at various units.
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Affiliation(s)
- F Sommer
- Department of Urology, University Medical Center of Cologne, Cologne, Germany
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19
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Siebert JD, Harvey LA, Fishkin PA, Knost JA, Ehsan A, Smir BN, Craig FE. Comparison of lymphoid neoplasm classification. A blinded study between a community and an academic setting. Am J Clin Pathol 2001; 115:650-5. [PMID: 11345827 DOI: 10.1309/84vg-pl1v-t547-vc2r] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The revised European-American classification of lymphoid neoplasms has been reported as reproducible among expert pathologists and feasible in a community setting. We evaluated the reproducibility of lymphoid neoplasm diagnoses between a community and an academic center. We subtyped 188 lymphoid neoplasms using revised European-American classification criteria. Clinical findings, histologic or cytologic preparations, paraffin-section immunostains, and flow cytometry data were reviewed as appropriate. Diagnoses were compared only after completion of the study. Lymphoma subtype was concordant for 167 (88.8%) of 188 cases. Discordant cases included 15 B-cell, 2 T-cell, and 4 Hodgkin lymphomas. For B-cell neoplasms, discordance was most often due to classifying diffuse large cell lymphoma as another aggressive subtype of lymphoma (n = 6), marginal zone lymphoma as another subtype (n = 4), or follicle center lymphoma grade II as grade III (n = 3). For Hodgkin disease, discordance was most often due to classifying nodular sclerosis as mixed cellularity type (n = 3). Comparison of community and academic center diagnoses demonstrated high concordance for most revised European-American classification subtypes. Some sources of discordance have been addressed in the new World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues.
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Affiliation(s)
- J D Siebert
- Department of Pathology, OSF Saint Francis Medical Center, 530 NE Glen Oak Ave, Peoria, IL 61637, USA
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20
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Abstract
OBJECTIVE In the last few years, comparative outcome quality statistics have been one of the key topics for discussion in health care. Comparative audits using overall mortality and morbidity figures can be misleading as they do not take into account variations in urological procedure and patient fitness. The purpose of our study was to compare the crude operative morbidity and mortality rates with the predicted rates using an established scoring system (POSSUM). MATERIALS AND METHODS To examine these effects, we compared 5 urological operations (transurethral resection of the prostate, transurethral resection of the bladder, radical nephrectomy, suprapubic enucleation of the prostate and radical prostatovesiculectomy) performed by 2 urologists in a prospective study during a 12-month period. POSSUM consists of a simple preoperative physiological score, a postoperative score and defined kinds of complications. RESULTS One urologist operated on 160 patients, with an operative mortality of 2.5% and morbidity of 31.3%. The other urologist operated on 144 patients, with an operative mortality of 0.7% and morbidity of 9%. At first sight, there appear to be significant differences in operative outcome between the 2 urologists. However, analysis using the POSSUM system predicts a mortality rate of 3.1% for the first urologist and 0.7% for the second urologist (morbidity rates of 35% for the first urologist and 10.4% for the second urologist). Receiver operating curve analysis demonstrated no significant difference between the 2 urologists. CONCLUSION The present study demonstrates how misleading crude mortality and morbidity figures can be when comparing different urologists. By producing a single assessment of physiological status at the time of operation and of operative severity, POSSUM analysis allows a more realistic comparison between different urologists.
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Affiliation(s)
- F Sommer
- Department of Urology, University Medical Centre of Cologne, and Paracelsus Klinik Golzheim, Düsseldorf, Germany.
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21
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Ehsan A, Mann MJ, Dell'Acqua G, Dzau VJ. Long-term stabilization of vein graft wall architecture and prolonged resistance to experimental atherosclerosis after E2F decoy oligonucleotide gene therapy. J Thorac Cardiovasc Surg 2001; 121:714-22. [PMID: 11279413 DOI: 10.1067/mtc.2001.111204] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We tested the hypothesis that a single intraoperative transfection of rabbit vein grafts with a decoy oligonucleotide that blocks cell-cycle gene transactivation by the transcription factor E2F induces long-term stable adaptation that involves medial hypertrophy and a resistance to neointimal hyperplasia and atherosclerosis. METHODS Jugular vein to carotid artery interposition vein grafts in hypercholesterolemic rabbits were treated, using pressure-mediated delivery, with either E2F decoy oligonucleotide, scrambled oligonucleotide, or vehicle alone. E2F decoy inhibition of cell-cycle gene expression was determined by measuring proliferating cell nuclear antigen upregulation and bromodeoxyuridine incorporation in vascular smooth muscle cells. Neointimal hyperplasia and atherosclerosis were compared between groups at 6 months after operation. Wall stress was derived from the ratio of luminal radius to wall thickness. Normal rabbits exposed to 6 weeks of diet-induced hypercholesterolemia starting 6 months after operation were analyzed in the same manner. RESULTS The E2F decoy oligonucleotide, but not scrambled oligonucleotide or vehicle alone, inhibited proliferating cell nuclear antigen expression and smooth muscle cell proliferation. Furthermore, this manipulation of cell-cycle gene expression yielded an inhibition of neointimal hyperplasia and atherosclerotic plaque formation throughout the 6 months of cholesterol feeding. In normocholesterolemic rabbits, vehicle-treated and scrambled oligonucleotide-treated vein grafts remain susceptible to diet-induced atherosclerosis as well, whereas resistance to this disease induction remained stable in genetically engineered grafts. CONCLUSION A single intraoperative pressure-mediated delivery of E2F decoy effectively provides vein grafts with long-term resistance to neointimal hyperplasia and atherosclerosis. These findings suggest that long-term reduction in human vein graft failure rates may be feasible with this ex vivo gene therapy approach.
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Affiliation(s)
- A Ehsan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 202115, USA
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22
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Abstract
A primary pathologic response to vascular injury is the proliferation and migration of vascular smooth muscle cells and the development of neointimal lesions. An increasing body of knowledge regarding the molecular and genetic basis of neointimal disease has created a unique opportunity for the treatment of this complex disorder. Gene therapy attempts to correct pathobiological processes by either inhibiting or correcting cellular functions at the level of gene expression. These endpoints are achieved by the delivery of either functional genes or oligonucleotides, capable of interfering with a cell's programmed machinery. Since the early 1990s, the evolution of this technology, along with an ever-expanding source of pathobiological information, has led to many novel approaches for the treatment of restenosis in arterial balloon injury as well as vein graft bypass failure. Using a variety of targets, inhibition of proliferation has predominantly been achieved through direct disruption of the cell cycle machinery. In addition, others have demonstrated successful inhibition by interfering with the signals for cellular proliferation or the enhancement of anti-proliferative stimuli. As this exciting therapeutic alternative evolves, improvements in safety, specificity and efficiency will enhance the likelihood of widespread clinical application.
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Affiliation(s)
- A Ehsan
- Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
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Affiliation(s)
- V J Dzau
- Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
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24
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Abstract
Epstein-Barr virus (EBV) infects lymphocytes, where it persists indefinitely for the life of the host; whether the virus interacts with p53 to maintain itself in these cells is unknown. Lymphoid biopsy samples from 10 patients with infectious mononucleosis (IM) were examined for expression of p53 by immunohistochemistry. Accumulation of p53 was detected in all 10 cases, primarily in large lymphocytes of the expanded paracortex. The presence of EBV was confirmed in all 10 cases by EBER1 (EBV-encoded RNA) in situ hybridization, whereas 11 non-IM control samples lacked significant EBER1 and did not express p53 in paracortical lymphocytes. Interestingly, EBV infection alone does not cause accumulation of intracellular p53, because many more cells expressed EBER1 than p53 in the IM tissues. To determine whether p53 was confined to the subset of infected cells in which viral replication was occurring, BZLF1 immunostains were performed. Viral BZLF1 was detected in 8 of 10 IM tissues; however, the paucity and small size of the BZLF1-expressing lymphocytes suggests that they are not the same cells overexpressing p53. To further examine the relationship between p53 and EBV gene expression, the tissues were studied for latent membrane protein 1 (LMP1) expression by immunohistochemistry. Viral LMP1 was observed in the large paracortical lymphocytes of all 10 cases of IM, indicating co-localization of p53 and LMP1 in these cells. Our findings confirm that p53 overexpression is not specific for nodal malignancy and that p53 accumulation is characteristic of IM. Because p53 was not coexpressed in the same cells as BZLF1, it appears that BZLF1 is not directly responsible for p53 accumulation. Nevertheless, co-localization of p53 and LMP1 in activated-appearing lymphocytes suggests that EBV infection is responsible for p53 accumulation. HUM PATHOL 31:1397-1403.
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Affiliation(s)
- A Ehsan
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
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25
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Ehsan A, Mann M. Antisense and gene therapy to prevent restenosis. Vasc Med 2000. [DOI: 10.1191/135886300668426194] [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: 11/05/2022]
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26
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Mann MJ, Whittemore AD, Donaldson MC, Belkin M, Conte MS, Polak JF, Orav EJ, Ehsan A, Dell'Acqua G, Dzau VJ. Ex-vivo gene therapy of human vascular bypass grafts with E2F decoy: the PREVENT single-centre, randomised, controlled trial. Lancet 1999; 354:1493-8. [PMID: 10551494 DOI: 10.1016/s0140-6736(99)09405-2] [Citation(s) in RCA: 308] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cell-cycle blockade by ex-vivo gene therapy of experimental vein grafts inhibits the neointimal hyperplasia and subsequent accelerated atherosclerosis that lead to human bypass-graft failure. In a prospective, randomised, controlled trial, we investigated the safety and biological efficacy of intraoperative gene therapy in patients receiving bypass vein grafts. METHODS We studied gene therapy that uses decoy oligodeoxynucleotide, which binds and inactivates the pivotal cell-cycle transcription factor E2F. 41 patients were randomly assigned untreated (16), E2F-decoy-treated (17), or scrambled-oligodeoxynucleotide-treated (eight) human infrainguinal vein grafts. Oligonucleotide was delivered to grafts intraoperatively by ex-vivo pressure-mediated transfection. The primary endpoints were safety and inhibition of target cell-cycle regulatory genes and of DNA synthesis in the grafts. Analysis was by intention to treat. FINDINGS Mean transfection efficiency was 89.0% (SD 1.9). Proliferating-cell nuclear antigen and c-myc mRNA concentrations and bromodeoxyuridine incorporation were decreased in the EF2-decoy group by medians of 73% [IQR 53-84], 70% [50-79], and 74% [56-83], respectively) but not in the scrambled-oligodeoxynucleotide group (p<0.0001). Groups did not differ for postoperative complication rates. At 12 months, fewer graft occlusions, revisions, or critical stenoses were seen in the E2F-decoy group than in the untreated group (hazard ratio 0.34 [95% CI 0.12-0.99]). INTERPRETATION Intraoperative transfection of human bypass vein grafts with E2F-decoy oligodeoxynucleotide is safe, feasible, and can achieve sequence-specific inhibition of cell-cycle gene expression and DNA replication. Application of this genetic-engineering strategy may lower failure rates of human primary bypass vein grafting.
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Affiliation(s)
- M J Mann
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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27
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Ortega AE, Peters JH, Incarbone R, Estrada L, Ehsan A, Kwan Y, Spencer CJ, Moore-Jeffries E, Kuchta K, Nicoloff JT. A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996; 183:249-56. [PMID: 8784319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In a relatively short period of time, therapeutic laparoscopy has become an everyday part of the general surgeon's life. Although laparoscopy provides distinct clinical advantages, it is not yet clear that it lessens the stress response typical of elective surgical procedures, and as such, the morbidity of surgery. The hypothesis that laparoscopic cholecystectomy produces less of a metabolic and stress hormonal response than open cholecystectomy was tested in a prospective randomized trial. STUDY DESIGN Twenty otherwise healthy women between 18 and 45 years of age with a history of uncomplicated symptomatic cholelithiasis undergoing either laparoscopic (n = 10) or open cholecystectomy (n = 10) were studied. The hormonal response of the adrenocortical (serum adrenocorticotropic hormone, cortisol, and urinary free cortisol), adrenomedullary (plasma and urinary epinephrine and norepinephrine), thyroid (thyroid-stimulating hormone, thyroxine, and triiodothyronine), pituitary (antidiuretic hormone and growth hormone), and glucose (serum glucose, glucagon, and insulin) homeostatic axes were measured serially over a 24-hour period. RESULTS No difference was seen between the laparoscopic and open groups in operative time (mean plus or minus standard error of the mean, 70 +/- 6 minutes compared with 77 +/- 6.3 minutes) or hospital stay 1.3 +/- 0.2 compared with 1.1 +/- 0.1 days). Assessment of postoperative pain using an analog pain score was less in the laparoscopic group (4.9 +/- 1.3 compared with 12.3 +/- 2.5, p = 0.01). The response of the adrenocortical, adrenomedullary, thyroid, and glucose axes were similar or identical in both groups. Antidiuretic hormone levels were greater in the laparoscopic group at one hour intraoperatively (281 +/- 79 pg/mL compared with 54 +/- 18 pg/mL, p < 0.01), and at extubation (122 +/- 18 pg/mL compared with 36 +/- 7 pg/mL, p < 0.01). Serum glucose levels were greater immediately following laparoscopic cholecystectomy. Glucose and insulin levels were greater at four, 12, and 24 hours after open cholecystectomy. CONCLUSIONS Elective laparoscopic and open cholecystectomy for uncomplicated cholelithiasis result in similar degrees of perioperative hormonal stimulation. The different hormonal responses in the immediate and later postoperative periods after laparoscopic and open cholecystectomy suggest differential stressful stimuli between the two procedures.
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Affiliation(s)
- A E Ortega
- Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA
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28
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Kriegmair M, Waidelich R, Lumper W, Ehsan A, Baumgartner R, Hofstetter A. Integral photodynamic treatment of refractory superficial bladder cancer. J Urol 1995; 154:1339-41. [PMID: 7658534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Cystectomy is indicated after unsuccessful transurethral resection and intravesical treatment of superficial bladder cancer. As an alternative, whole bladder photodynamic therapy was done. MATERIALS AND METHODS In 21 patients the bladder was irradiated with laser light at a wavelength of 630 nm. after intravenous injection of a synthetic porphyrin mixture. RESULTS Of the 21 patients 12 attained complete remission with a mean disease-free interval of 18.0 months (range 3 to 42), 3 with partial remission were rendered disease-free with transurethral resection or neodymium:YAG laser coagulation and 6 underwent cystectomy. CONCLUSIONS In patients with refractory superficial bladder cancer the bladder can be preserved by use of photodynamic therapy.
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Affiliation(s)
- M Kriegmair
- Department of Urology, University of Munich, Germany
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Affiliation(s)
- M.* Kriegmair
- Department of Urology, University of Munich, Munich, Germany
| | - R. Waidelich
- Department of Urology, University of Munich, Munich, Germany
| | - W. Lumper
- Department of Urology, University of Munich, Munich, Germany
| | - A. Ehsan
- Department of Urology, University of Munich, Munich, Germany
| | - R. Baumgartner
- Department of Urology, University of Munich, Munich, Germany
| | - A. Hofstetter
- Department of Urology, University of Munich, Munich, Germany
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30
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Kriegmair M, Stepp H, Steinbach P, Lumper W, Ehsan A, Stepp HG, Rick K, Knüchel R, Baumgartner R, Hofstetter A. Fluorescence cystoscopy following intravesical instillation of 5-aminolevulinic acid: a new procedure with high sensitivity for detection of hardly visible urothelial neoplasias. Urol Int 1995; 55:190-6. [PMID: 8588264 DOI: 10.1159/000282784] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Methods have been sought for the in vivo marking of tiny papillary tumors of the bladder and flat urothelial lesions such as dysplasia or carcinoma in situ, which can easily be missed during conventional endoscopy under white light. A new procedure is reported for the fluorescence detection of urothelial dysplasia and early bladder cancer. The method is based on intravesical application of 5-aminolevulinic acid (ALA). ALA if applied exogenously induces accumulation of protoporphyrin IX (PPIX) in the urothelium of the bladder. PPIX is an intensively red fluorescing agent. The mean ratio of fluorescence intensity between urothelial cancer and normal epithelium was found to be 17:1. Fluorescence excitation was achieved by violet light from a krypton ion laser (lambda = 406.7 nm) or from a xenon arc lamp with a bandpass filter system (lambda = 375-440 nm). Both light sources proved to be of equal suitability for fluorescence excitation. Fluorescence microscopy revealed that the PPIX fluorescence is strictly limited to the urothelium. It could not be detected from the submucosa or muscle of the bladder. Bladder wall biopsies were taken from 90 patients with suspicion of bladder cancer under fluorescence view. The fluorescence detection proved to be of high sensitivity (98%). No serious side effects which would preclude further clinical testing, especially no cutaneous photoreaction, were observed. Tumor-associated fluorescence induced by topical ALA application offers new perspectives in the diagnosis and treatment of bladder cancer. In case of suspicious or positive urine cytologic findings, ALA fluorescence cystoscopy may be useful for detecting the precise site of the malignancy. The procedure might be helpful in complete resection or coagulation of urothelial neoplasms. Due to this, diminishing recurrence rates are expected. However, this hypothesis has to be studied in prospective clinical trials.
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Affiliation(s)
- M Kriegmair
- Urologische Klinik, Ludwig-Maximillians-Universität München, Germany
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31
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Kriegmair M, Baumgartner R, Knuechel R, Steinbach P, Ehsan A, Lumper W, Hofstädter F, Hofstetter A. Fluorescence photodetection of neoplastic urothelial lesions following intravesical instillation of 5-aminolevulinic acid. Urology 1994; 44:836-41. [PMID: 7985312 DOI: 10.1016/s0090-4295(94)80167-3] [Citation(s) in RCA: 213] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Tiny papillary tumors and flat urothelial lesions such as dysplasia or carcinoma in situ can easily be missed during routine cystoscopy. Various methods for in vivo detection of fluorescing agents (preferentially localized in malignant tissue) have been developed. Most of them are based on systemically administered synthetic porphyrin compounds and require sensitive detection devices and image processing units for fluorescence visualization. The usefulness of intracellularly accumulated endogenous protoporphyrin IX (PPIX), induced by 5-aminolevulinic acid (ALA), for diagnosis of early bladder cancer and the correlation with cystoscopic, microscopic, and fluorescence findings was investigated. METHODS ALA was instilled intravesically in 68 patients, followed by fluorescence cystoscopy with violet light from a krypton ion laser that produced fluorescence excitation. There were 299 biopsies obtained from fluorescing and nonfluorescing areas of the bladder. RESULTS ALA-induced fluorescence could be easily observed with the naked eye during cystoscopy under violet light illumination. All tumor lesions were sharply marked with brightly shining red fluorescence. Correlation of fluorescence and microscopic findings gave a sensitivity of 100% and a specificity of 68.5%. There were 26 malignant or precancerous lesions that were missed during routine cystoscopy but were detected only by ALA-induced fluorescence. CONCLUSIONS Labeling of urothelial lesions by PPIX fluorescence induced by intravesically instilled ALA seems to be a promising diagnostic procedure for malignant lesions that are difficult to visualize with standard cystoscopy.
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Affiliation(s)
- M Kriegmair
- Department of Urology, University of Munich, Germany
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32
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Clark GW, Peters JH, Ireland AP, Ehsan A, Hagen JA, Kiyabu MT, Bremner CG, DeMeester TR. Nodal metastasis and sites of recurrence after en bloc esophagectomy for adenocarcinoma. Ann Thorac Surg 1994; 58:646-53; discussion 653-4. [PMID: 7944684 DOI: 10.1016/0003-4975(94)90722-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The operative specimens from 43 patients undergoing en bloc esophagectomy for adenocarcinoma of the lower esophagus or cardia were analyzed. Depth of invasion of the tumor and extent and location of lymph node metastases were determined. Postoperative recurrence was identified from positive findings on successive 3-month computed tomographic scans. Positive nodes occurred in 33% (2/6) of intramucosal tumors, 67% (6/9) of intramural tumors, and 89% (25/28) of transmural tumors (p < 0.01). Commonly involved nodes were those in the lesser curve of the stomach (42%), parahiatal nodes (35%), paraesophageal nodes (28%), and celiac nodes (21%). Excluding perioperative deaths, follow-up was complete for 38 patients. Twenty patients had recurrence. Fifteen patients (40%, 15/38) had nodal recurrence: cervical, 7.9% (3/38); superior mediastinal, 21% (8/38); and abdominal, 24% (9/38) (retropancreatic in 7 and retrocrural in 2). Of 5 patients with nodal recurrence alone, 3 (60%) had recurrence at sites outside the margins of resection. Patients with four metastatic nodes or less had a survival advantage over those with more than four (p < 0.05). There was no difference in survival according to location of nodal metastases. Two (22.2%) of 9 patients with celiac node metastases survived longer than 4 years. Adenocarcinoma of the lower esophagus and cardia spreads widely to mediastinal and abdominal nodes, and death can occur from nodal disease. Rates of lymph node metastases increase with the depth of the primary tumor. Patients with lymphatic metastases can be cured particularly if there are fewer than four nodes involved. Curative surgical therapy necessitates wide lymph node resection to ensure removal of all metastatic nodes.
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Affiliation(s)
- G W Clark
- Department of Surgery, University of Southern California, Los Angeles
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33
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Kriegmair M, Waidelich R, Baumgartner R, Lumper W, Ehsan A, Hofstetter A. [Photodynamic therapy of superficial bladder cancer. An alternative to radical cystectomy?]. Urologe A 1994; 33:276-80. [PMID: 7941172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
If transurethral resection and intravesical treatment with BCG or chemotherapeutic agents are unsuccessful in recurrent flat multifocal superficial bladder cancer, cystectomy is considered to be indicated. A whole-bladder photodynamic therapy (PDT) was carried out in 23 patients in this worst-case situation, in 19 of whom minimum follow-up of 3 months has been possible. In 5 patients with carcinoma in situ and in 14 patients with flat papillary tumors covering nearly the whole bladder, Photofrin or Photosan-3 was applied intravesically. Irradiation of the bladder followed about 48 h, later with a light dose of 15 J/cm2 or 30 J/cm2 at a wave length of 630 nm. In 12 patients complete remission was achieved; 7 patients showed no evidence of disease over a follow-up period of 3-31 months (median 16.3 months). One patient was lost to follow-up. In 7 patients recurrent disease or residual tumor was observed following PDT, but these were easily managed by transurethral resection or Nd:YAG laser coagulation. In 4 patients PDT failed and cystectomy was carried out. Systemic progression was not observed. PDT has to be regarded as an alternative to cystectomy in the treatment of refractory superficial bladder cancer.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma in Situ/drug therapy
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/surgery
- Combined Modality Therapy
- Cystectomy
- Cystoscopy
- Female
- Follow-Up Studies
- Humans
- Laser Therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Photochemotherapy
- Urinary Bladder/pathology
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/surgery
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Affiliation(s)
- M Kriegmair
- Klinikum Grosshadern, Klinik für Urologie, Universität München
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Kriegmair M, Baumgartner R, Knüchel R, Ehsan A, Steinbach P, Lumper W, Hofstädter F, Hofstetter A. [Photodynamic diagnosis of urothelial neoplasms after intravesicular instillation of 5-aminolevulinic acid]. Urologe A 1994; 33:270-5. [PMID: 7941171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Following transurethral resection of bladder cancer, the fate of patients is clearly related to the presence or absence of precancerous or malignant lesions in the remaining mucosa. We report on a new procedure for in situ diagnosis of these flat, hardly visible urothelial lesions. The method is based on tumor-selective accumulation of endogenous protoporphyrin IX following intravesical instillation of 5-aminolevulinic acid. On excitation with violet light even tiny papillary tumors, dysplastic lesions and carcinoma in situ are bright fluorescing red. In 15 patients 26 neoplastic lesions had been diagnosed only by protoporphyrin IX fluorescence. False-negative results have not yet been observed. In 84% of 285 evaluable specimens the fluorescence findings corresponded correctly with the microscopic findings. It is expected that photodynamic diagnosis will become a matter of routine in detection of bladder cancer.
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Schmeller N, Ehsan A, Kriegmair M, Muschter R, Liedl B, Hofstetter A. [Laser lithotripsy of ureteral calculi]. Urologe A 1994; 33:308-11. [PMID: 7941178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A total of 149 patients with 152 ureteral stones were treated with intraureteral lithotripsy by Dye-laser (83.55%), Alexandrite-laser (41.27%), electrohydraulic lithotripsy adapted for use in the ureter (25.16%) or neodymium: YAG laser with optomechanic coupling (3.2%). The Dye-laser has an automatic pulse shut-off mechanism with spectral analysis of the reflected laser beam, so that effective laser pulses can only be released by contact with a stone. Most (127 of 83.5%) of the stones could be completely fragmented, so that no further treatment was necessary. In 16 cases (10.5%) the stone was too hard for fragmentation and had to be removed by alternative techniques. Intraureteral lithotripsy is a save and effective method of treating ureteral stones that cannot be reached or have not been treated successfully by shockwave lithotripsy. No significant differences in outcome were found between the different lasers or electrohydraulic lithotripsy. In selected cases endoscopic treatment may be recommended as treatment of first choice.
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Affiliation(s)
- N Schmeller
- Urologische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität München
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Costantini M, Crookes PF, Bremner RM, Hoeft SF, Ehsan A, Peters JH, Bremner CG, DeMeester TR. Value of physiologic assessment of foregut symptoms in a surgical practice. Surgery 1993. [PMID: 8211694 DOI: 10.1023/a:1016656812095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the reliability of symptoms in the diagnosis of gastroesophageal reflux disease and esophageal motility disorders as assessed by functional tests. METHODS In 365 patients referred for suspected esophageal functional disease, symptomatic assessment was compared with the results of esophageal manometry and ambulatory 24-hour pH monitoring of the distal esophagus. RESULTS Based on the patients' chief complaint, the symptomatic diagnosis was gastroesophageal reflux (44%), esophageal motor disorder (26%), chest pain of esophageal origin (9%), reflux and aspiration (8%), and abdominal pathology (12%). The symptomatic diagnosis was considerably altered by the results of the esophageal function tests: gastroesophageal reflux and motility disorders were found in all symptomatic diagnostic groups and a large number of patients in each group tested normal. The sensitivity and specificity of symptom-based diagnoses for functional disease were low. CONCLUSIONS The results of this study showed that symptoms are an unreliable guide of esophageal abnormality, illustrating the need for objective testing in these patients, particularly to avoid inappropriate medical or surgical therapy.
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Affiliation(s)
- M Costantini
- Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612
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Costantini M, Crookes PF, Bremner RM, Hoeft SF, Ehsan A, Peters JH, Bremner CG, DeMeester TR. Value of physiologic assessment of foregut symptoms in a surgical practice. Surgery 1993; 114:780-6; discussion 786-7. [PMID: 8211694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the reliability of symptoms in the diagnosis of gastroesophageal reflux disease and esophageal motility disorders as assessed by functional tests. METHODS In 365 patients referred for suspected esophageal functional disease, symptomatic assessment was compared with the results of esophageal manometry and ambulatory 24-hour pH monitoring of the distal esophagus. RESULTS Based on the patients' chief complaint, the symptomatic diagnosis was gastroesophageal reflux (44%), esophageal motor disorder (26%), chest pain of esophageal origin (9%), reflux and aspiration (8%), and abdominal pathology (12%). The symptomatic diagnosis was considerably altered by the results of the esophageal function tests: gastroesophageal reflux and motility disorders were found in all symptomatic diagnostic groups and a large number of patients in each group tested normal. The sensitivity and specificity of symptom-based diagnoses for functional disease were low. CONCLUSIONS The results of this study showed that symptoms are an unreliable guide of esophageal abnormality, illustrating the need for objective testing in these patients, particularly to avoid inappropriate medical or surgical therapy.
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Affiliation(s)
- M Costantini
- Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033-4612
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Abdel-Salam E, Ehsan A. Cystoscopic picture of Schistosoma haematobium in Egyptian children correlated to intensity of infection and morbidity. Am J Trop Med Hyg 1978; 27:774-8. [PMID: 686243 DOI: 10.4269/ajtmh.1978.27.774] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cystoscopy was done on 45 children, 5--12 yr old, infected with Schistosoma haematobium. On the basis of urinary egg output, the children were classifed as having mild, moderate, or heavy infection and the cystoscopic picture was correlated with their egg output and with their signs and symptoms. Lesions reported, in descending order of frequency, were: hyperemia, sandy patches, tubercles, ulcers, nodules, and polyps. Multiple schistosomal lesions were present in some patients and the frequency and severity of lesions correlated with the heaviness of infection. Individual variation in the severety of response to S. haematobium was observed.
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Hashmi MH, Adil AS, Viegas A, Ali S, Ahmad I, Ehsan A. Colorimetric determination of gold(III) using 3-methyl-4-vanillidine isoxazolone-5. Mikrochim Acta 1970. [DOI: 10.1007/bf01215957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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