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Ebner R, Lohse A, Fabritius MP, Rübenthaler J, Wängler C, Wängler B, Schirrmacher R, Völter F, Schmid HP, Unterrainer LM, Öcal O, Hinterberger A, Spitzweg C, Auernhammer CJ, Geyer T, Ricke J, Bartenstein P, Holzgreve A, Grawe F. Validation of the standardization framework SSTR-RADS 1.0 for neuroendocrine tumors using the novel SSTR‑targeting peptide [ 18F]SiTATE. Eur Radiol 2024:10.1007/s00330-024-10788-3. [PMID: 38769164 DOI: 10.1007/s00330-024-10788-3] [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] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Somatostatin receptor positron emission tomography/computed tomography (SSTR-PET/CT) using [68Ga]-labeled tracers is a widely used imaging modality for neuroendocrine tumors (NET). Recently, [18F]SiTATE, a SiFAlin tagged [Tyr3]-octreotate (TATE) PET tracer, has shown great potential due to favorable clinical characteristics. We aimed to evaluate the reproducibility of Somatostatin Receptor-Reporting and Data System 1.0 (SSTR-RADS 1.0) for structured interpretation and treatment planning of NET using [18F]SiTATE. METHODS Four readers assessed [18F]SiTATE-PET/CT of 95 patients according to the SSTR-RADS 1.0 criteria at two different time points. Each reader evaluated up to five target lesions per scan. The overall scan score and the decision on peptide receptor radionuclide therapy (PRRT) were considered. Inter- and intra-reader agreement was determined using the intraclass correlation coefficient (ICC). RESULTS The ICC analysis on the inter-reader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 85%), overall scan score (ICC ≥ 90%), and the decision to recommend PRRT (ICC ≥ 85%) showed excellent agreement. However, significant differences were observed in recommending PRRT among experienced readers (ER) (p = 0.020) and inexperienced readers (IR) (p = 0.004). Compartment-based analysis demonstrated good to excellent inter-reader agreement for most organs (ICC ≥ 74%), except for lymph nodes (ICC ≥ 53%). CONCLUSION SSTR-RADS 1.0 represents a highly reproducible and consistent framework system for stratifying SSTR-targeted PET/CT scans, even using the novel SSTR-ligand [18F]SiTATE. Some inter-reader variability was observed regarding the evaluation of uptake intensity prior to PRRT as well as compartment scoring of lymph nodes, indicating that those categories require special attention during further clinical validation and might be refined in a future SSTR-RADS version 1.1. CLINICAL RELEVANCE STATEMENT SSTR-RADS 1.0 is a consistent framework for categorizing somatostatin receptor-targeted PET/CT scans when using [18F]SiTATE. The framework serves as a valuable tool for facilitating and improving the management of patients with NET. KEY POINTS SSTR-RADS 1.0 is a valuable tool for managing patients with NET. SSTR-RADS 1.0 categorizes patients with showing strong agreement across diverse reader expertise. As an alternative to [68Ga]-labeled PET/CT in neuroendocrine tumor imaging, SSTR-RADS 1.0 reliably classifies [18F]SiTATE-PET/CT.
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Affiliation(s)
- R Ebner
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - A Lohse
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - M P Fabritius
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), LMU University Hospital, LMU Munich, Munich, Germany
| | - C Wängler
- Biomedical Chemistry, Clinic of Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - B Wängler
- Biomedical Chemistry, Clinic of Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
- Molecular Imaging and Radiochemistry, Clinic of Radiology and Nuclear Medicine, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - R Schirrmacher
- Department of Oncology, Division of Oncological Imaging, University of Alberta, Edmonton, Canada
| | - F Völter
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - H P Schmid
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - L M Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - O Öcal
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - A Hinterberger
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Heidelberg, Germany
| | - C Spitzweg
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), LMU University Hospital, LMU Munich, Munich, Germany
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - C J Auernhammer
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), LMU University Hospital, LMU Munich, Munich, Germany
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - T Geyer
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - J Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), LMU University Hospital, LMU Munich, Munich, Germany
| | - P Bartenstein
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), LMU University Hospital, LMU Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - A Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - F Grawe
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Heidelberg, Germany
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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2
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Nemali A, Vockert N, Berron D, Maas A, Bernal J, Yakupov R, Peters O, Gref D, Cosma N, Preis L, Priller J, Spruth E, Altenstein S, Lohse A, Fliessbach K, Kimmich O, Vogt I, Wiltfang J, Hansen N, Bartels C, Schott BH, Maier F, Meiberth D, Glanz W, Incesoy E, Butryn M, Buerger K, Janowitz D, Pernecky R, Rauchmann B, Burow L, Teipel S, Kilimann I, Göerß D, Dyrba M, Laske C, Munk M, Sanzenbacher C, Müller S, Spottke A, Roy N, Heneka M, Brosseron F, Roeske S, Dobisch L, Ramirez A, Ewers M, Dechent P, Scheffler K, Kleineidam L, Wolfsgruber S, Wagner M, Jessen F, Duzel E, Ziegler G. Gaussian Process-based prediction of memory performance and biomarker status in ageing and Alzheimer's disease-A systematic model evaluation. Med Image Anal 2023; 90:102913. [PMID: 37660483 DOI: 10.1016/j.media.2023.102913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/15/2022] [Revised: 06/28/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023]
Abstract
Neuroimaging markers based on Magnetic Resonance Imaging (MRI) combined with various other measures (such as genetic covariates, biomarkers, vascular risk factors, neuropsychological tests etc.) might provide useful predictions of clinical outcomes during the progression towards Alzheimer's disease (AD). The use of multiple features in predictive frameworks for clinical outcomes has become increasingly prevalent in AD research. However, many studies do not focus on systematically and accurately evaluating combinations of multiple input features. Hence, the aim of the present work is to explore and assess optimal combinations of various features for MR-based prediction of (1) cognitive status and (2) biomarker positivity with a multi-kernel learning Gaussian process framework. The explored features and parameters included (A) combinations of brain tissues, modulation, smoothing, and image resolution; (B) incorporating demographics & clinical covariates; (C) the impact of the size of the training data set; (D) the influence of dimensionality reduction and the choice of kernel types. The approach was tested in a large German cohort including 959 subjects from the multicentric longitudinal study of cognitive impairment and dementia (DELCODE). Our evaluation suggests the best prediction of memory performance was obtained for a combination of neuroimaging markers, demographics, genetic information (ApoE4) and CSF biomarkers explaining 57% of outcome variance in out-of-sample predictions. The highest performance for Aβ42/40 status classification was achieved for a combination of demographics, ApoE4, and a memory score while usage of structural MRI further improved the classification of individual patient's pTau status.
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Affiliation(s)
- A Nemali
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
| | - N Vockert
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - D Berron
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - A Maas
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - J Bernal
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - R Yakupov
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - O Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany; Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Hindenburgdamm 30, 12203, Berlin, Germany
| | - D Gref
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Hindenburgdamm 30, 12203, Berlin, Germany
| | - N Cosma
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Hindenburgdamm 30, 12203, Berlin, Germany
| | - L Preis
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany; School of Medicine, Technical University of Munich; Department of Psychiatry and Psychotherapy, Munich, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - E Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - S Altenstein
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - A Lohse
- Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany
| | - K Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Venusberg-Campus 1, 53127 Bonn, Germany
| | - O Kimmich
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - I Vogt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - J Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany; Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - N Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
| | - C Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
| | - B H Schott
- Leibniz Institute for Neurobiology, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
| | - F Maier
- Department of Psychiatry, University of Cologne, Medical Faculty, Kerpener Strasse 62, 50924 Cologne, Germany
| | - D Meiberth
- Department of Psychiatry, University of Cologne, Medical Faculty, Kerpener Strasse 62, 50924 Cologne, Germany
| | - W Glanz
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany
| | - E Incesoy
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - M Butryn
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - K Buerger
- German Center for Neurodegenerative Diseases (DZNE, Munich), Feodor-Lynen-Strasse 17, 81377 Munich, Germany; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Feodor-Lynen-Strasse 17, 81377 Munich, Germany
| | - D Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Feodor-Lynen-Strasse 17, 81377 Munich, Germany
| | - R Pernecky
- German Center for Neurodegenerative Diseases (DZNE, Munich), Feodor-Lynen-Strasse 17, 81377 Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany; Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
| | - B Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - L Burow
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - S Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Psychosomatic Medicine, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - I Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Psychosomatic Medicine, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - D Göerß
- Department of Psychosomatic Medicine, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - M Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - C Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany; Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - M Munk
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany; Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - C Sanzenbacher
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - S Müller
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - A Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Department of Neurology, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - N Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - M Heneka
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Department of Psychiatry and Psychotherapy, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - F Brosseron
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - S Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - L Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - A Ramirez
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Department of Neurology, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Joseph-Stelzmann-Strasse 26, 50931 Köln, Germany; Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry & Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, TX, USA
| | - M Ewers
- German Center for Neurodegenerative Diseases (DZNE, Munich), Feodor-Lynen-Strasse 17, 81377 Munich, Germany; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Feodor-Lynen-Strasse 17, 81377 Munich, Germany
| | - P Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Goettingen, Germany
| | - K Scheffler
- Department for Biomedical Magnetic Resonance, University of Tübingen, 72076 Tübingen, Germany
| | - L Kleineidam
- University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Venusberg-Campus 1, 53127 Bonn, Germany
| | - S Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Venusberg-Campus 1, 53127 Bonn, Germany
| | - M Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; University of Bonn Medical Center, Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, Venusberg-Campus 1, 53127 Bonn, Germany
| | - F Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Department of Psychiatry, University of Cologne, Medical Faculty, Kerpener Strasse 62, 50924 Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Joseph-Stelzmann-Strasse 26, 50931 Köln, Germany
| | - E Duzel
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - G Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
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Fabritius MP, Soltani V, Cyran CC, Ricke J, Bartenstein P, Auernhammer CJ, Spitzweg C, Schnitzer ML, Ebner R, Mansournia S, Hinterberger A, Lohse A, Sheikh GT, Winkelmann M, Knösel T, Ingenerf M, Schmid-Tannwald C, Kunz WG, Rübenthaler J, Grawe F. Diagnostic accuracy of SSR-PET/CT compared to histopathology in the identification of liver metastases from well-differentiated neuroendocrine tumors. Cancer Imaging 2023; 23:92. [PMID: 37770958 PMCID: PMC10537814 DOI: 10.1186/s40644-023-00614-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Histopathology is the reference standard for diagnosing liver metastases of neuroendocrine tumors (NETs). Somatostatin receptor-positron emission tomography / computed tomography (SSR-PET/CT) has emerged as a promising non-invasive imaging modality for staging NETs. We aimed to assess the diagnostic accuracy of SSR-PET/CT in the identification of liver metastases in patients with proven NETs compared to histopathology. METHODS Histopathologic reports of 139 resected or biopsied liver lesions of patients with known NET were correlated with matching SSR-PET/CTs and the positive/negative predictive value (PPV/NPV), sensitivity, specificity, and diagnostic accuracy of SSR-PET/CT were evaluated. PET/CT reading was performed by one expert reader blinded to histopathology and clinical data. RESULTS 133 of 139 (95.7%) liver lesions showed malignant SSR-uptake in PET/CT while initial histopathology reported on 'liver metastases of NET´ in 127 (91.4%) cases, giving a PPV of 91.0%. Re-biopsy of the initially histopathologically negative lesions (reference standard) nevertheless diagnosed 'liver metastases of NET' in 6 cases, improving the PPV of PET/CT to 95.5%. Reasons for initial false-negative histopathology were inadequate sampling in the sense of non-target biopsies. The 6 (4.3%) SSR-negative lesions were all G2 NETs with a Ki-67 between 2-15%. CONCLUSION SSR-PET/CT is a highly accurate imaging modality for the diagnosis of liver metastases in patients with proven NETs. However, we found that due to the well-known tumor heterogeneity of NETs, specifically in G2 NETs approximately 4-5% are SSR-negative and may require additional imaging with [18F]FDG PET/CT.
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Affiliation(s)
- M P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - V Soltani
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - J Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - C J Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - C Spitzweg
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - M L Schnitzer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - R Ebner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Mansournia
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Hinterberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Lohse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - G T Sheikh
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Winkelmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - T Knösel
- Department of Pathology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany.
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4
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Pape S, Snijders RJALM, Gevers TJG, Chazouilleres O, Dalekos GN, Hirschfield GM, Lenzi M, Trauner M, Manns MP, Vierling JM, Montano-Loza AJ, Lohse AW, Schramm C, Drenth JPH, Heneghan MA, Alvarez F, Andrade R, Arikan C, Assis D, Bardou-Jacquet E, Biewenga M, Cancado E, Cazzagon N, Chazouillères O, Colloredo G, Cuarterolo M, Dalekos G, Debray D, Robles-Díaz M, Drenth J, Dyson J, Efe C, Engel B, Ferri S, Fontana R, Gatselis N, Gerussi A, Halilbasic E, Halliday N, Heneghan M, Hirschfield G, van Hoek B, Hørby Jørgensen M, Indolfini G, Iorio R, Jeong S, Jones D, Kelly D, Kerkar N, Lacaille F, Lammert C, Leggett B, Lenzi M, Levy C, Liberal R, Lleo A, Lohse A, Ines Lopez S, de Martin E, McLin V, Mieli-Vergani G, Milkiewicz P, Mohan N, Muratori L, Nebbia G, van Nieuwkerk C, Oo Y, Ortega A, Páres A, Pop T, Pratt D, Purnak T, Ranucci G, Rushbrook S, Schramm C, Stättermayer A, Swain M, Tanaka A, Taubert R, Terrabuio D, Terziroli B, Trauner M, Valentino P, van den Brand F, Villamil A, Wahlin S, Ytting H, Zachou K, Zeniya M. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group. J Hepatol 2022; 76:841-849. [PMID: 35066089 DOI: 10.1016/j.jhep.2021.12.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [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: 04/09/2021] [Revised: 11/18/2021] [Accepted: 12/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) has been well characterised and codified through the development of diagnostic criteria. These criteria have been adapted and simplified and are widely used in clinical practice. However, there is a need to update and precisely define the criteria for both treatment response and treatment. METHODS A systematic review was performed and a modified Delphi consensus process was used to identify and redefine the response criteria in autoimmune hepatitis. RESULTS The consensus process initiated by the International Autoimmune Hepatitis Group proposes that the term 'complete biochemical response' defined as 'normalization of serum transaminases and IgG below the upper limit of normal' be adopted to include a time point at 6 months after initiation of treatment. An insufficient response by 6 months was a failure to meet the above definition. Non-response was defined as '<50% decrease of serum transaminases within 4 weeks after initiation of treatment'. Remission is defined as liver histology with a Hepatitis Activity Index <4/18. Intolerance to treatment was agreed to stand for 'any adverse event possibly related to treatment leading to potential drug discontinuation'. CONCLUSIONS These definitions provide a simple and reproducible framework to define treatment response and non-response, irrespective of the therapeutic intervention. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable inter-study comparisons. Future prospective database studies are needed to validate these endpoints. LAY SUMMARY Consensus among international experts on response criteria and endpoints in autoimmune hepatitis is lacking. A consensus on endpoints is urgently required to set a global standard for the reporting of study results and to enable the comparison of results between clinical trials. Therefore, the International Autoimmune Hepatitis Group (IAIHG) herein presents a statement on 5 agreed response criteria and endpoints: complete biochemical response, insufficient response, non-response, remission, and intolerance to treatment, which can be used to guide future reporting.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Romée J A L M Snijders
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht 6229HX, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Oliver Chazouilleres
- Hepatology Department, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital Assistance Publique-Hôpitaux de Paris, Paris, France; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa, Greece
| | - Gideon M Hirschfield
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Marco Lenzi
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Hepatology, University of Alberta Hospital, Edmonton, Canada
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
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Quéré B, Lemelle I, Lohse A, Pillet P, Molimard J, Richer O, Sordet C, Despert V, Rossi-Semerano L, Borocco C, Koné-Paut I, Gervais E, Guellec D, Devauchelle-Pensec V. POS1314 JUVENILE IDIOPATHIC ARTHRITIS IN THE CONTEXT OF THE CORONAVIRUS DISEASE 19 PANDEMIC: IMPACT ON THE DECREASE IN TREATMENT AND THE RETURN TO SCHOOL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. In France, after the first lockdown from March to May 2020, many parents and children were then also concerned about whether reopening plans for school could ensure the safety of students, despite data concerning children with COVID-19 seem reassuring, and very few of them develop severe forms of the disease (1, 2, 3).Objectives:Our objectives were to evaluate the impact of the COVID-19 pandemic on the therapeutic management of JIA, the frequency of returning to school after the first lockdown period and the prevalence of SARS-CoV-2 infection at the time of the survey.Methods:JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. Data regarding the general characteristics of the participants, medical history, SARS-CoV-2 infection, characteristics of JIA subtypes and treatment modifications were collected.Results:A total of 173 patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants, our results reflect good adherence of the patient/parents to their immunosuppressive treatments. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases, due to anxiety of the patient/parents regarding COVID-19. Two patients were diagnosed positive for SARS-CoV-2 infection.Conclusion:This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic. In contrast, parents’ reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed.References:[1]Filocamo G, et al. “Absence of severe complications from SARS-CoV-2 infection in children with rheumatic diseases treated with biologic drugs.” J Rheumatol. 25 avr 2020;[2]Tagarro A, et al. “Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain.” JAMA Pediatr. 8 avr 2020;[3]Lu X, et al. « SARS-CoV-2 Infection in Children”. N Engl J Med. 23 avr 2020;382(17):1663-5.Acknowledgements:We would like to thank all the participants involved in this clinical research and six medical students who helped completing the forms: Margaux Blondel, Alice Bonnod, Marie Desval, Béatrice Dordain, Gabrielle Fagnet, and Madouc De Saint Martin Pernot.Disclosure of Interests:None declared
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Dietz J, Spengler U, Müllhaupt B, Schulze Zur Wiesch J, Piecha F, Mauss S, Seegers B, Hinrichsen H, Antoni C, Wietzke-Braun P, Peiffer KH, Berger A, Matschenz K, Buggisch P, Backhus J, Zizer E, Boettler T, Neumann-Haefelin C, Semela D, Stauber R, Berg T, Berg C, Zeuzem S, Vermehren J, Sarrazin C, Giostra E, Berning M, Hampe J, De Gottardi A, Rauch A, Semmo N, Discher T, Trauth J, Fischer J, Gress M, Günther R, Heinzow H, Schmidt J, Herrmann A, Stallmach A, Hilgard G, Deterding K, Lange C, Ciesek S, Wedemeyer H, Hoffmann D, Klinker H, Schulze P, Kocheise F, Müller-Schilling M, Kodal A, Kremer A, Ganslmayer M, Siebler J, Lammert F, Rissland J, Löbermann M, Götze T, Canbay A, Lohse A, von Felden J, Jordan S, Maieron A, Moradpour D, Chave JP, Moreno C, Müller T, Muche M, Epple HJ, Port K, von Hahn T, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Rockstroh J, Schattenberg J, Sprinzl M, Galle P, Roeb E, Steckstor M, Schmiegel W, Brockmeyer N, Seufferlein T, Stremmel W, Strey B, Thimme R, Teufel A, Vogelmann R, Ebert M, Tomasiewicz K, Trautwein C, Tacke F, Koenen T, Weber T, Zachoval R, Mayerle J, Raziorrouh B, Angeli W, Beckebaum S, Doberauer C, Durmashkina E, Hackelsberger A, Erhardt A, Garrido-Lüneburg A, Gattringer H, Genné D, Gschwantler M, Gundling F, Hametner S, Schöfl R, Hartmann C, Heyer T, Hirschi C, Jussios A, Kanzler S, Kordecki N, Kraus M, Kullig U, Wollschläger S, Magenta L, Beretta-Piccoli BT, Menges M, Mohr L, Muehlenberg K, Niederau C, Paulweber B, Petrides A, Pinkernell M, Piso R, Rambach W, Reiser M, Riecken B, Rieke A, Roth J, Schelling M, Schlee P, Schneider A, Scholz D, Schott E, Schuchmann M, Schulten-Baumer U, Seelhoff A, Stich A, Stickel F, Ungemach J, Walter E, Weber A, Winzer T, Abels W, Adler M, Audebert F, Baermann C, Bästlein E, Barth R, Barthel K, Becker W, Behrends J, Benninger J, Berger F, Berzow D, Beyer T, Bierbaum M, Blaukat O, Bodtländer A, Böhm G, Börner N, Bohr U, Bokemeyer B, Bruch H, Bucholz D, Burkhard O, Busch N, Chirca C, Delker R, Diedrich J, Frank M, Diehl M, Dienethal A, Dietel P, Dikopoulos N, Dreck M, Dreher F, Drude L, Ende K, Ehrle U, Baumgartl K, Emke F, Glosemeyer R, Felten G, Hüppe D, Fischer J, Fischer U, Frederking D, Frick B, Friese G, Gantke B, Geyer P, Schwind H, Glas M, Glaunsinger T, Goebel F, Göbel U, Görlitz B, Graf R, Gruber H, Härter G, Herder M, Heuchel T, Heuer S, Höffl KH, Hörster H, Sonne JU, Hofmann W, Holst F, Hunstiger M, Hurst A, Jägel-Guedes E, John C, Jung M, Kallinowski B, Kapzan B, Kerzel W, Khaykin P, Klarhof M, Klüppelberg U, Klugewitz K, Knapp B, Knevels U, Kochsiek T, Körfer A, Köster A, Kuhn M, Langekamp A, Künzig B, Link R, Littman M, Löhr H, Lutz T, Knecht G, Lutz U, Mainz D, Mahle I, Maurer P, Mayer C, Meister V, Möller H, Heyne R, Moritzen D, Mroß M, Mundlos M, Naumann U, Nehls O, Ningel K, Oelmann A, Olejnik H, Gadow K, Pascher E, Petersen J, Philipp A, Pichler M, Polzien F, Raddant R, Riedel M, Rietzler S, Rössle M, Rufle W, Rump A, Schewe C, Hoffmann C, Schleehauf D, Schmidt K, Schmidt W, Schmidt-Heinevetter G, Schmidtler-von Fabris J, Schnaitmann E, Schneider L, Schober A, Niehaus-Hahn S, Schwenzer J, Seidel T, Seitel G, Sick C, Simon K, Stähler D, Stenschke F, Steffens H, Stein K, Steinmüller M, Sternfeld T, Strey B, Svensson K, Tacke W, Teuber G, Teubner K, Thieringer J, Tomesch A, Trappe U, Ullrich J, Urban G, Usadel S, von Lucadou A, Weinberger F, Werheid-Dobers M, Werner P, Winter T, Zehnter E, Zipf A. Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections. Clin Gastroenterol Hepatol 2021; 19:195-198.e2. [PMID: 31706062 DOI: 10.1016/j.cgh.2019.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.8 However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.
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Affiliation(s)
- Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, and German Center for Infection Research (DZIF), Partner Site, Cologne-Bonn, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Barbara Seegers
- Gastroenterologisch-Hepatologisches Zentrum Kiel, Kiel, Germany
| | | | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany
| | | | - Kai-Henrik Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Johanna Backhus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Eugen Zizer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Semela
- Division of Gastroenterology and Hepatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany; Medizinische Klinik 2, St Josefs-Hospital, Wiesbaden, Germany.
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Kadiane-Oussou N, Klopfenstein T, Toko L, Royer P, Lohse A, Conrozier T, Gendrin V, Zayet S. Pneumopathies graves liées au COVID-19 : facteurs prédictifs de mortalité après traitement par tocilizumab. Med Mal Infect 2020. [PMCID: PMC7442012 DOI: 10.1016/j.medmal.2020.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Matériels et méthodes Résultats Conclusion
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Nawka MT, Lohse A, Bester M, Fiehler J, Buhk JH. Residual Flow Inside the Woven EndoBridge Device at Follow-Up: Potential Predictors of the Bicêtre Occlusion Scale Score 1 Phenomenon. AJNR Am J Neuroradiol 2020; 41:1232-1237. [PMID: 32586965 DOI: 10.3174/ajnr.a6605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) device is an established technique for the treatment of intracranial aneurysms. Occasionally, persistent opacification inside the WEB lumen can be observed at follow-up (previously described as Bicêtre Occlusion Scale Score 1). We evaluated potential risk factors of this phenomenon, hypothesizing that initial deviation of the WEB device from the aneurysm axis, size of the aneurysmal neck surface, or inappropriate WEB sizing correlates with Bicêtre Occlusion Scale Score 1 findings. MATERIALS AND METHODS We systematically reviewed all patients treated with the WEB device between February 2014 and December 2018 in our neurointerventional center. Patients with midterm follow-up DSA available were considered for aneurysm evaluation applying the Bicêtre Occlusion Scale Score. WEB angle deviation from the aneurysm axis, neck widths, and WEB sizes were collected. RESULTS We included 65 patients with 67 intracranial aneurysms. Eleven of 67 (16.4%) intracranial aneurysms showed the Bicêtre Occlusion Scale Score 1 phenomenon at follow-up. Anterior-posterior projections of WEB axis deviation (angles measured in degrees) were significantly different between the Bicêtre Occlusion Scale Score 1 cohort (median ± interquartile range, 17 ± 17) and all other Bicêtre Occlusion Scale Scores (median ± interquartile range, 7 ± 11; P = .023), whereas in lateral projections, no significant difference was observed (median ± interquartile range, 10 ± 10 versus 8 ± 9; P = .169). Neck or aneurysm recurrence, but not the Bicêtre Occlusion Scale Score 1 phenomenon, occurred significantly more often in patients with inappropriate WEB sizing compared with appropriate WEB sizing (median ± interquartile range, 1 ± 1.3 versus 0 ± 0; P < .001/P = .664). CONCLUSIONS The Bicêtre Occlusion Scale Score 1 phenomenon is associated with an initial deviation of the WEB device from the aneurysm axis but does not correlate with aneurysmal neck surface measurements or WEB sizing.
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Affiliation(s)
- M T Nawka
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - A Lohse
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Bester
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J-H Buhk
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Klopfenstein T, Zayet S, Lohse A, Balblanc JC, Badie J, Royer PY, Toko L, Mezher C, Kadiane-Oussou NJ, Bossert M, Bozgan AM, Charpentier A, Roux MF, Contreras R, Mazurier I, Dussert P, Gendrin V, Conrozier T. Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients. Med Mal Infect 2020; 50:397-400. [PMID: 32387320 PMCID: PMC7202806 DOI: 10.1016/j.medmal.2020.05.001] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [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: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.
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Affiliation(s)
- T Klopfenstein
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France.
| | - S Zayet
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France.
| | - A Lohse
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - J-C Balblanc
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - J Badie
- Intensive Care Unit Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - P-Y Royer
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - L Toko
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - C Mezher
- Intensive Care Unit Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - N J Kadiane-Oussou
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - M Bossert
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - A-M Bozgan
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - A Charpentier
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - M-F Roux
- Pharmacology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - R Contreras
- Pharmacology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - I Mazurier
- Biological Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - P Dussert
- Biological Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - V Gendrin
- Infectious Disease Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
| | - T Conrozier
- Rheumatology Department, Nord Franche-Comté Hospital, 90400 Trévenans, France
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10
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Rolvien T, Creutzfeldt AM, Lohse AW, Amling M. Stress fractures in systemic lupus erythematosus after long-term MTX use successfully treated by MTX discontinuation and individualized bone-specific therapy. Lupus 2019; 28:790-793. [PMID: 30947618 DOI: 10.1177/0961203319841434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the case of a 64-year-old woman with systemic lupus erythematosus (SLE) and recurrent bilateral stress fractures of the calcaneus due to long-term methotrexate (MTX) use. A detailed skeletal assessment pointed to osteoporomalacia with pronounced trabecular thinning and increased bone resorption. After years of unsuccessful treatment with bisphosphonates, a combined bone-specific denosumab-teriparatide treatment was initiated, and additional belimumab treatment was started to avoid intermittent steroid usage. As these measures did not lead to a significant improvement of the bone situation, MTX was eventually discontinued. This was followed by a rapid clinical improvement. In a follow-up MRI scan after 18 months, the stress fractures had almost disappeared. Furthermore, the bone density and microarchitecture markedly improved. In conclusion, this case demonstrates that MTX discontinuation/replacement in combination with an individualized and state-of-the-art bone-specific therapy is effective in SLE patients with stress fractures after long-term MTX use.
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Affiliation(s)
- T Rolvien
- 1 Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,2 Department of Orthopaedics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A M Creutzfeldt
- 3 First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- 3 First Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Amling
- 1 Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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11
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Fischer T, Spohn M, Olearo F, Zinser ME, Kasonta R, Stubbe HC, Rechtien A, Ly ML, Schmiedel S, Lohse AW, Grundhoff A, Addo MM, Dahlke C. Dynamic changes of circulating miRNAs induced by the Ebola virus vaccine VSV-EBOV. Vaccine 2018; 36:7083-7094. [PMID: 30244872 DOI: 10.1016/j.vaccine.2018.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/05/2018] [Revised: 09/02/2018] [Accepted: 09/08/2018] [Indexed: 12/18/2022]
Abstract
VSV-EBOV is a replication-competent Ebola virus (EBOV) vaccine, which was tested in clinical trials as response to the Ebola virus disease (EVD) outbreak 2013-2016. It is the most advanced EBOV candidate currently in the licensure process. The experimental vaccine was again administered as response to outbreaks in the Democratic Republic of Congo. However, underlying molecular mechanisms that convey protection remain incompletely understood. MicroRNAs (miRNAs) are known key regulators that influence gene expression on a post-transcriptional level. The miRNA-mediated control has emerged as a critical regulatory principle in the immune system, which strongly influences the balance of innate and adaptive immune responses by modulation of signaling pathways critical for differentiation of immune cells. We investigated expression levels of circulating miRNAs (c-miRNAs) in plasma from healthy vaccinees, as they may reflect cellular dynamics following VSV-EBOV immunization and additionally may serve as potential biomarkers for vaccine efficacy. As part of the WHO-led VEBCON consortium, we investigated safety and immunogenicity of VSV-EBOV in a phase I trial. A comprehensive analysis of expression levels on c-miRNAs from plasma samples following VSV-EBOV immunization (day 0, 1, 3 post vaccination) was conducted using RT-qPCR assays. Potential biological relevance was assessed using in silico analyses. Additionally, we correlated dynamics of miRNA expressions with our previously reported data on vaccine-induced antibody and cytokine responses and finally evaluated the prognostic power by generating ROC curves. We identified four promising miRNAs (hsa-miR-146a, hsa-miR-126, hsa-miR-199a, hsa-miR-484), showing a strong association with adaptive immune responses, exhibited favourable prognostic performance and are implicated in immunology-related functions. Our results provide evidence that miRNAs may serve as useful biomarkers for prediction of vaccine-induced immunogenicity. Furthermore, our unique data set provides insight into molecular mechanisms that underlie VSV-EBOV-mediated protective immune responses, which may help to decipher VSV-EBOV immune signature and accelerate strategic vaccine design or personalized approaches.
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Affiliation(s)
- T Fischer
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - M Spohn
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - F Olearo
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - M E Zinser
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Rahel Kasonta
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - H C Stubbe
- Division of Infectious Diseases, Department of Medicine II, LMU, Munich, Germany
| | - A Rechtien
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - M L Ly
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; University Medical Center Hamburg-Eppendorf (UKE), Division of Infectious Diseases, Hamburg, Germany
| | - S Schmiedel
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; University Medical Center Hamburg-Eppendorf (UKE), Division of Infectious Diseases, Hamburg, Germany
| | - A W Lohse
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - A Grundhoff
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | | | - M M Addo
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; University Medical Center Hamburg-Eppendorf (UKE), Division of Infectious Diseases, Hamburg, Germany.
| | - C Dahlke
- University Medical Center Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany; University Medical Center Hamburg-Eppendorf (UKE), Division of Infectious Diseases, Hamburg, Germany.
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12
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Keller S, Sedlacik J, Schuler T, Buchert R, Avanesov M, Zenouzi R, Lohse AW, Kooijman H, Fiehler J, Schramm C, Yamamura J. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol 2018; 29:818-828. [PMID: 30014204 DOI: 10.1007/s00330-018-5614-9] [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] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/26/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference. MATERIAL AND METHODS Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure. RESULTS Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume. CONCLUSION DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI. KEY POINTS • Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01). • The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09). • DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).
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Affiliation(s)
- S Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany. .,Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany.
| | - J Sedlacik
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Schuler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - R Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A W Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - H Kooijman
- Philips Medical Systems, MR Clinical Science, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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13
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Zenouzi R, Liwinski T, Yamamura J, Weiler-Normann C, Sebode M, Keller S, Lohse AW, Schramm C. Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret. Aliment Pharmacol Ther 2018; 48:169-178. [PMID: 29741240 DOI: 10.1111/apt.14797] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 02/05/2018] [Revised: 02/19/2018] [Accepted: 04/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. AIM To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. METHODS Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss' kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. RESULTS Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants' recommendations contrasted the real-life management and outcome. CONCLUSIONS In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.
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Affiliation(s)
- R Zenouzi
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - T Liwinski
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Weiler-Normann
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Sebode
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Schramm
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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14
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Huebener P, Sterneck MR, Bangert K, Drolz A, Lohse AW, Kluge S, Fischer L, Fuhrmann V. Stabilisation of acute-on-chronic liver failure patients before liver transplantation predicts post-transplant survival. Aliment Pharmacol Ther 2018; 47:1502-1510. [PMID: 29611203 DOI: 10.1111/apt.14627] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/17/2017] [Revised: 01/16/2018] [Accepted: 03/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute-on-chronic liver failure (ACLF) is a severe complication of liver cirrhosis associated with excess short-term mortality rates. Orthotopic liver transplantation (OLT) is a potentially life-saving therapeutic modality for acute-on-chronic liver failure patients, but selection of transplant candidates with an acceptable post-transplant outcome is difficult. AIM To assess the risk of liver transplantation in patients with ACLF, and to determine parameters that predict post-transplant survival in this patient cohort. METHODS We retrospectively analysed all 250 patients with cirrhosis who underwent their first liver transplantation between 2009 and 2014 at our institution, and assessed post-transplant outcomes. RESULTS Of 250 cirrhotic liver transplant recipients, 98 patients fulfilled the diagnostic criteria for acute-on-chronic liver failure in the 3-month pre-transplant period. Compared to non-ACLF patients, ACLF was associated with significantly higher short-term morbidity and mortality after liver transplantation (90-day patient survival 96.1% non-ACLF vs 72.4% ACLF patients, P < 0.0001). Clinical improvement in the pre-transplant period, as defined by recovery of at least one previously failed organ system, was observed in 37 of 98 acute-on-chronic liver failure patients, mostly within several days after diagnosis. Most notably, clinical improvement prior to liver transplantation was associated with excellent post-transplant survival rates that approximated non-ACLF transplant recipients. Following the 90-day post-transplant period, patient survival and long-term graft functions were comparable between ACLF and non-ACLF liver transplant recipients for up to 5 years. CONCLUSIONS Acute-on-chronic liver failure predicts adverse outcome after orthotopic liver transplantation. Given the dismal prognosis without transplantation, however, our results indicate that ACLF patients can be transplanted with comparably good outcomes, in particular patients who improve under conservative therapeutic measures.
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Affiliation(s)
- P Huebener
- Department of Internal Medicine, I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M R Sterneck
- Department of Internal Medicine, I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Bangert
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Drolz
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Internal Medicine, I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Fuhrmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Horvatits T, Westhölter D, Peine S, Schulze Zur Wiesch J, Lohse AW, Lütgehetmann M, Pischke S. Lack of evidence for human serum albumin as major source of HEV infections. Transfus Med 2018; 28:470-471. [PMID: 29707836 DOI: 10.1111/tme.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Affiliation(s)
- T Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Westhölter
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Peine
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Schulze Zur Wiesch
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - A W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
| | - M Lütgehetmann
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany.,Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Germany
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16
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von Felden J, Scheurich C, Yamamura J, Brainard DM, Mogalian E, Lohse AW, Schulze Zur Wiesch J. Successful treatment of chronic hepatitis C with ground ledipasvir/sofosbuvir in a patient with Crohn's disease and short bowel syndrome. J Viral Hepat 2018; 25:214-215. [PMID: 28783205 DOI: 10.1111/jvh.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J von Felden
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Scheurich
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Yamamura
- Department for Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - E Mogalian
- Gilead Sciences Inc, Foster City, CA, USA
| | - A W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Schulze Zur Wiesch
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Horvatits T, Pischke S, Proske VM, Fischer L, Scheidat S, Thaiss F, Fuhrmann V, Lohse AW, Nashan B, Sterneck M. Outcome and natural course of renal dysfunction in liver transplant recipients with severely impaired kidney function prior to transplantation. United European Gastroenterol J 2017; 6:104-111. [PMID: 29435320 DOI: 10.1177/2050640617707089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/09/2016] [Accepted: 04/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Since introduction of the MELD score in the liver allograft allocation system, renal insufficiency has emerged as an increasing problem. Here we evaluated the course of kidney function in patients with advanced renal insufficiency prior to liver transplantation (LT). Methods A total of 254 patients undergoing LT at the University Medical Centre Hamburg-Eppendorf (2011-2015) were screened for renal impairment (GFR < 30 ml/min) prior to LT in this observational study. Results Eighty (32%) patients (median 60 years; M/F: 48/32) had significant renal impairment prior to LT. Median follow-up post-LT was 619 days. Patient survival at 90 days, one year and two years was 76%, 66% and 64%, respectively. Need for dialysis postoperatively but not preoperatively was associated with increased mortality (p < 0.05). Renal function improved in 75% of survivors, but 78% of patients had chronic kidney disease ≥ stage 3 at end of follow-up. Of eight (16%) survivors remaining on long-term dialysis, so far only four patients have received a kidney transplant. Conclusion Postoperative dialysis affected long-term mortality. In 75% of survivors renal function improved, but still the majority of patients had an impaired renal function (CKD stage 3-5) at end of follow-up. Future studies should elucidate the impact of kidney dysfunction and dialysis on recipients' long-term survival.
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Affiliation(s)
- T Horvatits
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - V M Proske
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - L Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Scheidat
- Transplant Outpatient Clinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - F Thaiss
- Transplant Outpatient Clinic, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - V Fuhrmann
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - B Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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18
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Hopf-Jensen S, Lohse A, Lehrke D, Preiß M, Börm P, Müller-Hülsbeck P. Normvarianten der basalen Hirnvenen als Blutungsquelle bei der angiografisch negativen perimesencephalen und präpontinen Subarachnoidalblutung: Evaluation der Wertigkeit von SWI Sequenzen. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600387] [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: 10/19/2022]
Affiliation(s)
- S Hopf-Jensen
- Diakonissenkrankenhaus Flensburg, Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Flensburg
| | - A Lohse
- Diakonissenkrankenhaus Flensburg, Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Flensburg
| | - D Lehrke
- Diakonissenkrankenhaus Flensburg, Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Flensburg
| | - M Preiß
- Diakonissenkrankenhaus Flensburg, Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Flensburg
| | - P Börm
- Diakonissenkrankenhaus Flensburg, Neurochirurgische Klinik, Flensburg
| | - P Müller-Hülsbeck
- Diakonissenkrankenhaus Flensburg, Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Flensburg
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19
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Liberal R, de Boer YS, Andrade RJ, Bouma G, Dalekos GN, Floreani A, Gleeson D, Hirschfield GM, Invernizzi P, Lenzi M, Lohse AW, Macedo G, Milkiewicz P, Terziroli B, van Hoek B, Vierling JM, Heneghan MA. Expert clinical management of autoimmune hepatitis in the real world. Aliment Pharmacol Ther 2017; 45:723-732. [PMID: 28004405 DOI: 10.1111/apt.13907] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/12/2016] [Accepted: 11/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND High-quality data on the management of autoimmune hepatitis (AIH) are scarce. Despite published guidelines, management of AIH is still expert based rather than evidence based. AIM To survey expert hepatologists, asking each to describe their practices in the management of patients with AIH. METHODS A survey questionnaire was distributed to members of the International AIH Group. The questionnaire consisted of four clinical scenarios on different presentations of AIH. RESULTS Sixty surveys were sent, out of which 37 were returned. None reported budesonide as a first line induction agent for the acute presentation of AIH. Five (14%) participants reported using thiopurine S-methyltransferase measurements before commencement of thiopurine maintenance therapy. Thirteen (35%) routinely perform liver biopsy at 2 years of biochemical remission. If histological inflammatory activity is absent, four (11%) participants reduced azathioprine, whereas 10 (27%) attempted withdrawal altogether. Regarding the management of difficult-to-treat patients, mycophenolate mofetil is the most widely used second-line agent (n = ~450 in 28 centres), whereas tacrolimus (n = ~115 in 21 centres) and ciclosporin (n = ~112 in 18 centres) are less often reported. One centre reported considerable experience with infliximab, while rescue therapy with rituximab has been tried in seven centres. CONCLUSIONS There is a wide variation in the management of patients with autoimmune hepatitis even among the most expert in the field. Although good quality evidence is lacking, there is considerable experience with second-line therapies. Future prospective studies should address these issues, so that we move from an expert- to an evidence- and personalised-based care in autoimmune hepatitis.
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Giersch K, Volz T, Allweiss L, Kah J, Lohse AW, Petersen J, Sureau C, Dandri M, Lütgehetmann M. HDV-GT3 shows similar induction of innate immunity compared to HDV-GT1 in humanized mice despite its high infection efficiency and intrahepatic activity. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597515] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Giersch
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Hamburg, Germany
| | - T Volz
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Hamburg, Germany
| | - L Allweiss
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Hamburg, Germany
| | - J Kah
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Hamburg, Germany
| | - AW Lohse
- University Medical Center Hamburg-Eppendorf, I. Department of Internal Medicine, Hamburg, Germany
| | - J Petersen
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C Sureau
- Institut National de Transfusion Sanguine, Paris, Hamburg
| | - M Dandri
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Germany
| | - M Lütgehetmann
- University Medical Center Hamburg-Eppendorf, Department of Medical Microbiology, Virology and Hygiene, Hamburg, Germany
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21
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Ciesek S, Proske V, Otto B, Pischke S, Costa R, Lüthgehetmann M, Polywka S, Klempnauer J, Nashan B, Manns MP, von Hahn T, Lohse AW, Wedemeyer H, Mix H, Sterneck M. Efficacy and safety of sofosbuvir/ledipasvir for the treatment of patients with hepatitis C virus re-infection after liver transplantation. Transpl Infect Dis 2016; 18:326-32. [PMID: 26988272 DOI: 10.1111/tid.12524] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/14/2016] [Accepted: 02/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with a particularly poor outcome after liver transplantation. In December 2014, sofosbuvir/ledipasvir (SOF/LDV) fixed-dose combination (FDC) was approved for HCV genotype 1 and 4 in Europe. In orthotopic liver transplantation (OLT) recipients, the interferon-free treatment of HCV re-infection with novel direct-acting antivirals has been demonstrated to be safe and effective in clinical trials, but real-world data are missing. The aim of this study was to investigate the safety and efficacy of SOF/LDV FDC in OLT recipients in the real-life setting. METHODS All consecutive OLT patients started on SOF/LDV FDC for 12 or 24 weeks at the University Medical Center Hamburg-Eppendorf and Medical School Hannover between October 2014 and August 2015 were retrospectively analyzed (n = 30). The primary efficacy endpoint was sustained virological response (SVR), i.e., absence of viremia 12 weeks after end of treatment (SVR 12). Liver function tests, creatinine, blood count, and HCV RNA (by polymerase chain reaction assay) were determined at each visit. RESULTS SVR was achieved in 29/30 patients (96.67%) treated with SOF/LDV ± ribavirin (RBV) for 12 (n = 4) or 24 weeks (n = 25). Twenty-five patients (86.2%) received RBV. However, in 15 of the 25 patients, RBV administration had to be discontinued because of severe anemia (57.7%). One RBV-treated patient died of a myocardial infarction during antiviral therapy; this event was most likely not directly related to SOF/LDV. Aside from RBV-associated anemia, no severe side effects of the antiviral regimen were observed. CONCLUSION Antiviral treatment with SOF/LDV is highly effective, safe, and well tolerated in OLT recipients. The addition of RBV often results in severe anemia, requiring dose reduction or discontinuation.
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Affiliation(s)
- S Ciesek
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - V Proske
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Otto
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - S Pischke
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - R Costa
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - M Lüthgehetmann
- Institute for Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Institute for Medical Microbiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Klempnauer
- Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany.,General-, Visceral- and Transplant Surgery, Medical School Hannover, Hannover, Germany
| | - B Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - T von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - A W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany.,Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Mix
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.,Integrated Research and Treatment Center - Transplantation (IFB-Tx), Medical School Hannover, Hannover, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Hannover, Germany
| | - M Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
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22
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Althaus A, Broicher W, Wittkamp P, Andresen V, Lohse AW, Löwe B. Determinants and frequency of irritable bowel syndrome in a German sample. Z Gastroenterol 2016; 54:217-25. [PMID: 27043884 DOI: 10.1055/s-0041-106856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To date there is no study that has estimated the prevalence of irritable bowel syndrome (IBS) in Germany according to the current Rome III criteria. The aim of the present study was to investigate the prevalence of IBS in a non-clinical German sample. Furthermore, we investigated the association of IBS with socio-demographic and psychological risk factors. METHODS Baseline data from a prospective cohort study were analysed, including the IBS Module of the Rome III Diagnostic Questionnaires and validated psychometric scales including the Patient Health Questionnaire-15 (PHQ-15), the Big Five Inventory (BFI), the Perceived Stress Questionnaire (PSQ-5), and the Whiteley-Index (WI-7). The study population was compared to the German general population to appraise its representativeness. Multivariate logistic regression analyses were performed to identify possible risk factors associated with IBS. RESULTS Between January 2011 and September 2012, 2419 persons participated (female 54.0 %, mean age 37.4 ± 14.9 years). According to the Rome III criteria, 401 participants (16.6 %) suffered from IBS. Five predictors were independently associated with IBS: previous traveller's diarrhoea infection (OR = 1.76; 95 % CI = 1.34 to 2.31), higher somatic symptom burden (OR = 1.15; 95 % CI = 1.07 to 1.23), increased level of hypochondriasis (OR = 2.04; 95 % CI = 1.54 to 2.70), increased vulnerability to diarrhoea under stress (OR = 3.88; 95 % CI = 3.21 to 4.68) and perceived stress (OR = 1.43; 95 % CI = 1.04 to 1.99). CONCLUSIONS Our analyses yielded a relatively high IBS prevalence estimate, compared to studies published more than ten years ago. This might partially be explained by the fact that the time criterion of the Rome III criteria (at least 3 days/month in last 3 months) is more inclusive compared to the time criterion of the Rome II criteria (at least 12 weeks, which need not be consecutive, in the preceding 12 months).
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Affiliation(s)
| | | | - P Wittkamp
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - V Andresen
- Israelitisches Krankenhaus, Hamburg, Germany
| | - A W Lohse
- I. Department of Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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23
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Pischke S, Polywka S, Proske VM, Lang M, Jordan S, Nashan B, Lohse AW, Sterneck M. Course of hepatitis C virus (HCV) RNA and HCV core antigen testing are predictors for reaching sustained virologic response in liver transplant recipients undergoing sofosbuvir treatment in a real-life setting. Transpl Infect Dis 2016; 18:141-5. [PMID: 26485543 DOI: 10.1111/tid.12475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 08/09/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is associated with reduced graft survival in orthotopic liver transplant recipients. Treatment with the new direct-acting antivirals (DAAs) is safe and efficient, but no reliable predictive factors for sustained virologic response (SVR) have been identified so far. The HCV core antigen assay (HCV-core-Ag) is a new, inexpensive, and efficient method to detect viral antigens, but the value of this technique to predict treatment response in orthotopic liver transplantation (OLT) patients is still unclear. METHODS All OLT patients who were treated with a sofosbuvir-based antiviral regimen at our center between March 2014 and August 2014 were included in the analysis (n = 20). HCV-core-Ag and HCV RNA (polymerase chain reaction [PCR]) were determined at each visit. Primary endpoints of this study were SVR at 4 or 12 weeks after end of treatment (SVR 4 and SVR 12). RESULTS HCV-core-Ag tested negative after a median of 2 weeks (range 1-16 weeks) while PCR tests became negative after a median of 4 weeks (range 2-12 weeks). Time until PCR negativity and until HCV-core-Ag negativity showed a good correlation (R = 0.711, P < 0.001, Fig. ). Seventeen of 20 patients (85%) achieved SVR 12. SVR 12 was associated with a short time interval between treatment start and HCV PCR negativity (P = 0.005) or HCV-core-Ag negativity (P = 0.003, Mann-Whitney test). No severe side effects were observed. CONCLUSIONS DAA treatment is safe and well tolerated in OLT. The time points of HCV-core-Ag loss and PCR negativity were predictors of SVR 12.
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Affiliation(s)
- S Pischke
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V M Proske
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lang
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Jordan
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
We report a case of an extracutaneous involvement of pyoderma gangrenosum. The patient initially presented with multiple sterile abscesses of the skin, heart, prostate, and kidney. Extracutaneous involvement in pyoderma gangrenosum is very rare. Confirmation of the diagnosis was only possible after exclusion of other relevant differential diagnoses. Continuous search for microbes proved negative and after an empiric therapeutic attempt with prednisolone, the patient improved quickly. However, each time we reduced the steroids even in combination with methotrexate or with azathioprine the patient relapsed. Only after therapy with the tumor necrosis factor-α-inhibitor infliximab was permanent remission achieved.
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Affiliation(s)
- C Reynolds
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - N Schofer
- Universitäres Herzzentrum Hamburg GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - E Zengin
- Universitäres Herzzentrum Hamburg GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A W Lohse
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Faiss
- Gastroenterologie und Interventionelle Endoskopie, Viszeralmedizinisches Zentrum, Asklepios-Klinik Barmbek, Hamburg, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland. .,Ambulanzzentrum, Bereich Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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25
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Meisner S, Polywka S, Memmler M, Nashan B, Lohse AW, Sterneck M, Pischke S. Definition of chronic hepatitis E after liver transplant conforms to convention. Am J Transplant 2015; 15:3011-2. [PMID: 26288311 DOI: 10.1111/ajt.13428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/14/2015] [Accepted: 06/21/2015] [Indexed: 01/25/2023]
Affiliation(s)
- S Meisner
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Institute for Virology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - B Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Galante A, Pischke S, Polywka S, Luetgehethmann M, Suneetha PV, Gisa A, Hiller J, Dienes HP, Nashan B, Lohse AW, Sterneck M. Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting. Transpl Infect Dis 2015; 17:617-22. [PMID: 26094550 DOI: 10.1111/tid.12411] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 12/11/2014] [Revised: 03/12/2015] [Accepted: 05/21/2015] [Indexed: 12/29/2022]
Abstract
The chronic course of hepatitis E virus (HEV) infections in orthotopic liver transplant (OLT) recipients has been described previously, but prospectively collected data are rare. We aimed to study the role of chronic hepatitis E in OLT in a real-life setting. Therefore, 287 adult OLT recipients (169 male [59%], median age 56 years) were prospectively tested by HEV polymerase chain reaction assay (lower level of detection = 10 IU/mL), irrespective of their level of liver enzymes. In 4 patients (1.4%), chronic HEV infection was diagnosed. All 4 patients were male, and their age (median 48.5 years), the time since transplantation (median 45.5 months), and bilirubin level (median 0.6 mg/dL) did not differ significantly from the total cohort. However, alanine transaminase and aspartame transaminase levels were significantly higher in HEV-infected patients (75-646 U/L, median 216 U/L and 68-317 U/L, median 108 U/L) than in non-infected patients (6-617 U/L, median 41 and 6-355 U/L, median 36; P = 0.004 and 0.040, Mann-Whitney test). In 3 patients, liver biopsy was performed and revealed signs of inflammation and chronic liver disease, as enlarged densely infiltrated portal tracts with mild-to-moderate interface hepatitis. All infected patients were treated with ribavirin with the starting dose adjusted to renal function (400-800 mg/day). In 2 patients, dose reduction was necessary. Transaminases normalized in all 4 patients, and all patients cleared their infection within 3 months of ribavirin treatment. However, 1 patient experienced viral relapse 12 weeks after discontinuation. Ribavirin medication was re-started and viral clearance occurred within 8 weeks and persisted. Sequence analysis of the HEV genome of this patient revealed that he was infected with an HEV variant, which recently has been shown to have a reduced response to ribavirin in cell culture. The risk of chronic HEV infections in OLT recipients in low-endemic countries should not be overestimated. No case of chronic hepatitis E was observed in patients with normal liver enzymes, indicating that general screening of all OLT recipients is not necessary. However, if chronic hepatitis E develops, it can be treated efficiently with ribavirin.
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Affiliation(s)
- A Galante
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Luetgehethmann
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P V Suneetha
- Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Gisa
- Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - J Hiller
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H P Dienes
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - B Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outpatient Clinic for Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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27
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Hartl J, Kreuels B, Polywka S, Addo M, Luethgehetmann M, Dandri M, Dammermann W, Sterneck M, Lohse AW, Pischke S. Comparison of autochthonous and imported cases of hepatitis A or hepatitis E. Z Gastroenterol 2015; 53:639-43. [PMID: 26167693 DOI: 10.1055/s-0034-1399236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hepatitis A and hepatitis E are not limited to tropical countries but are also present in industrialized countries. Both infections share similar clinical features. There is no comparative study evaluating the clinical parameters of autochthonous and imported hepatitis A virus and hepatitis E virus infections. AIMS The aim of this study was to determine differences between autochthonous and imported hepatitis A virus (HAV) and hepatitis E virus (HEV) infections. METHODS Medical charts of all patients at our center with acute HAV and HEV infections were analyzed retrospectively (n = 50, study period 01/2009 - 08/2013). RESULTS Peak bilirubin (median 8.6 vs. 4.4 mg/dL, p = 0.008) and ALT levels (median 2998 vs. 1666 IU/mL, p = 0.04) were higher in patients with hepatitis A compared to hepatitis E. In comparison to autochthones hepatitis E cases, patients with imported infections had significantly higher peak values for AST, ALT, bilirubin and INR (p = 0.009, p = 0.002, p = 0.04 and p = 0.049, respectively). In HAV infection, AST levels tended to be higher in imported infections (p = 0.08). CONCLUSIONS (i) It is not possible to differentiate certainly between acute HAV and HEV infections by clinical or biochemical parameters, however, HAV infections might be associated with more cholestasis and higher ALT values. (ii) Imported HEV infections are associated with higher transaminases, INR and bilirubin levels compared to autochthonous cases and (iii) imported HAV infections tend to be associated with higher transaminases in comparison to autochthonous cases.
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Affiliation(s)
- J Hartl
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - B Kreuels
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Clinical Mikrobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Addo
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Luethgehetmann
- Clinical Mikrobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Dandri
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - W Dammermann
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Outpatient Clinic for Livertransplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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28
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Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, Laleman W, Trebicka J, Elkrief L, Hopf C, Solís-Munoz P, Saliba F, Zeuzem S, Albillos A, Benten D, Montero-Alvarez JL, Chivas MT, Concepción M, Córdoba J, McCormick A, Stauber R, Vogel W, de Gottardi A, Welzel TM, Domenicali M, Risso A, Wendon J, Deulofeu C, Angeli P, Durand F, Pavesi M, Gerbes A, Jalan R, Moreau R, Ginés P, Bernardi M, Arroyo V, Bañares R, Bocci M, Catalina MV, Chin JL, Coenraad MJ, Coilly A, Dorn L, Gatta A, Gerber L, Grøenbæk H, Graupera I, Guevara M, Hausen A, Karlsen S, Lohse AW, Maggioli C, Markwardt D, Martinez J, Marzano A, de la Mata García M, Mesonero F, Mookerjee RP, Moreno C, Morrell B, Mortensen C, Nevens F, Peck‐Radosavljevic M, Rizzetto M, Romano A, Samuel D, Sauerbruch T, Simon‐Talero M, Solà E, Soriano G, Sperl J, Spindelboeck W, Steib C, Valla D, Verbeke L, Van Vlierberghe H, Wege H, Willars C, Baenas MY, Zaccherini G. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 2015; 62:243-52. [PMID: 25877702 DOI: 10.1002/hep.27849] [Citation(s) in RCA: 407] [Impact Index Per Article: 45.2] [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: 10/29/2014] [Accepted: 04/07/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. CONCLUSIONS Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.
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Affiliation(s)
- Thierry Gustot
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elisabet Garcia
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | | | - Wim Laleman
- University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Corinna Hopf
- University of Munich, Klinikum der LMU, Munich, Germany
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- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | - Marco Pavesi
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
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Grube RF, Heinlein W, Scheffer H, Rathmayer M, Schepp W, Lohse AW, Stallmach A, Wilke MH, Lerch MM. [Economic burden of Clostridium difficile enterocolitis in German hospitals based on routine DRG data]. Z Gastroenterol 2015; 53:391-7. [PMID: 25965986 DOI: 10.1055/s-0034-1398803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clostridium difficile associated diarrhea (CDAD) is not only a increasing medical but also economical problem. METHODS Data from the DRG project group of the German society for digestive and metabolic diseases (DGVS) were analyzed for CDAD. Out of 430,875 cases from 37 German hospitals 2,767 cases were grouped by having CDAD either as primary (PD) or secondary diagnosis (SD; likely to be from a hospital source) in an initial or recurring hospital stay (RD). For comparison non-CDAD cases from the same hospitals from that year where matched using propensity score matching. As endpoints we defined LOS (length of stay), difference of LOS to national average LOS, total costs per case and difference between costs and revenue for all three groups. RESULTS Patients from the PD group (n = 817) showed a mean LOS of 11.2 days compared to 8.5 days for the control group, 4,132 € mean cost per case (536 € more than control) and a mean loss of -1,064 € per case compared to -636 €. In the SD group (n = 1,840) patients stayed in the hospital for 28.8 days (control: 18.1 days), had costs of 19,381 € (control: 13,082 €) and a loss of -3,442 € compared to -849 € in the control group. Recurring cases (RD; n = 110) showed a LOS of 37.3 days (control: 21.3 days), had even higher costs (20.755 € vs. 13,101 €) and higher losses (-4,196 € vs. -1,109 €). CONCLUSION By extrapolating these findings CDAD not only harms patients but generates a yearly cost burden of 464 million € for the German healthcare system including a loss of 197 million € for German hospitals. To the authors' opinion sufficient measures against CDAD should include pre hospital risk reduction programs, introduction of effective therapeutic and hygienic strategies in hospitals as well as improvements in documentation for these cases to support further developments of the German DRG system.
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Affiliation(s)
| | | | | | | | - W Schepp
- Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Städt. Klinikum München - Klinikum Bogenhausen
| | - A W Lohse
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena
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Hagel S, Epple HJ, Feurle GE, Kern WV, Lynen Jansen P, Malfertheiner P, Marth T, Meyer E, Mielke M, Moos V, von Müller L, Nattermann J, Nothacker M, Pox C, Reisinger E, Salzberger B, Salzer HJF, Weber M, Weinke T, Suerbaum S, Lohse AW, Stallmach A. [S2k-guideline gastrointestinal infectious diseases and Whipple's disease]. Z Gastroenterol 2015; 53:418-59. [PMID: 25965989 DOI: 10.1055/s-0034-1399337] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- A W Lohse
- 1st Department of Medicine, Johannes-Gutenberg University, Mainz, FRG
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Riegel B, Broicher W, Wegscheider K, Andresen V, Brähler E, Lohse AW, Löwe B. Quality of life one year post-Shiga toxin-producing Escherichia coli O104 infection--a prospective cohort study. Neurogastroenterol Motil 2015; 27:370-8. [PMID: 25581112 DOI: 10.1111/nmo.12503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/11/2014] [Accepted: 12/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, a major outbreak of hemolytic-uremic syndrome (HUS) and bloody diarrhea related to infections from Shiga toxin-producing Escherichia coli O104 (STEC) occurred in Germany. While previous research has focused on the medical components of this disease, we aimed to investigate the course of health-related quality of life (HrQoL) over 12 months including somatic and psychosocial risk factors. Furthermore, the influence of chronic fatigue (CF) on HrQoL was examined. METHODS A prospective cohort study with n = 389 patients completing self-report scales at baseline, after 6 months (participation rate: 79%) and after 12 months (participation rate: 77%). The courses of physical and mental HrQoL over the 12 month period were calculated by employing general linear mixed models. KEY RESULTS While the physical component score of HrQoL reached a score comparable to the general population, the mental component score remained below average 12 months after STEC infection. Female gender, prior psychiatric disorder, and prior traumatic events were risk factors for a worse HrQoL course after 12 months, while social support was identified to be protective. CF was associated with low HrQoL. In addition, the somatic symptom burden remained persistently high. CONCLUSIONS & INFERENCES Our results show high somatic and psychosocial burden in patients 12 months after STEC infection. We recommend considering the risk factors and protective factors of poor HrQoL early in the treatment of STEC or similar diseases. Patients who are suffering from persisting somatic symptoms, CF, and impaired HrQoL may require specific aftercare.
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Affiliation(s)
- B Riegel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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Zenouzi R, Hartl J, Lohse A. Autoimmune Hepatitis – aktuelle Entwicklungen einer zunehmenden Erkrankung. Dtsch Med Wochenschr 2014; 139:2020-2. [DOI: 10.1055/s-0034-1370288] [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: 10/24/2022]
Affiliation(s)
- R. Zenouzi
- I. Medizinische Klinik und Poliklinik, Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Hamburg-Eppendorf
| | - J. Hartl
- I. Medizinische Klinik und Poliklinik, Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Hamburg-Eppendorf
| | - A. Lohse
- I. Medizinische Klinik und Poliklinik, Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Hamburg-Eppendorf
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Moehler M, Maderer A, Schimanski C, Kanzler S, Denzer U, Kolligs FT, Ebert MP, Distelrath A, Geissler M, Trojan J, Schütz M, Berie L, Sauvigny C, Lammert F, Lohse A, Dollinger MM, Lindig U, Duerr EM, Lubomierski N, Zimmermann S, Wachtlin D, Kaiser AK, Schadmand-Fischer S, Galle PR, Woerns M. Gemcitabine plus sorafenib versus gemcitabine alone in advanced biliary tract cancer: a double-blind placebo-controlled multicentre phase II AIO study with biomarker and serum programme. Eur J Cancer 2014; 50:3125-35. [PMID: 25446376 DOI: 10.1016/j.ejca.2014.09.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [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: 07/17/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since sorafenib has shown activity in different tumour types and gemcitabine regimens improved the outcome for biliary tract cancer (BTC) patients, we evaluated first-line gemcitabine plus sorafenib in a double-blind phase II study. PATIENTS AND METHODS 102 unresectable or metastatic BTC patients with histologically proven adenocarcinoma of gallbladder or intrahepatic bile ducts, Eastern Cooperative Oncology Group (ECOG) 0-2 were randomised to gemcitabine (1000 mg/m2 once weekly, first 7-weeks+1-week rest followed by once 3-weeks+1-week rest) plus sorafenib (400 mg twice daily) or placebo. Treatment continued until progression or unacceptable toxicity. Tumour samples were prospectively stained for sorafenib targets and potential biomarkers. Serum samples (first two cycles) were measured for vascular endothelial growth factors (VEGFs), vascular endothelial growth factor receptor 2 (VEGFR-2) and stromal cell-derived factor 1 (SDF1)α by enzyme-linked immunosorbent assay (ELISA). RESULTS Gemcitabine plus sorafenib was generally well tolerated. Four and three patients achieved partial responses in the sorafenib and placebo groups, respectively. There was no difference in the primary end-point, median progression-free survival (PFS) for gemcitabine plus sorafenib versus gemcitabine plus placebo (3.0 versus 4.9 months, P=0.859), and no difference for median overall survival (OS) (8.4 versus 11.2 months, P=0.775). Patients with liver metastasis after resection of primary BTC survived longer with sorafenib (P=0.019) compared to placebo. Patients who developed hand-foot syndrome (HFS) showed longer PFS and OS than patients without HFS. Two sorafenib targets, VEGFR-2 and c-kit, were not expressed in BTC samples. VEGFR-3 and Hif1α were associated with lymph node metastases and T stage. Absence of PDGFRβ expression correlated with longer PFS. CONCLUSION The addition of sorafenib to gemcitabine did not demonstrate improved efficacy in advanced BTC patients. Biomarker subgroup analysis suggested that some patients might benefit from combined treatment.
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Affiliation(s)
- M Moehler
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - A Maderer
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Schimanski
- Department of Internal Medicine, Marienhospital Darmstadt, Darmstadt, Germany
| | - S Kanzler
- 2nd Department of Medicine, Leopoldina Hospital, Schweinfurt, Germany
| | - U Denzer
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - F T Kolligs
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - M P Ebert
- 2nd Department of Medicine, University Hospital Mannheim, Mannheim, Germany
| | - A Distelrath
- Tumor Department, Hospital Fulda, Fulda, Germany
| | - M Geissler
- Department of Internal Medicine, Hospital Esslingen, Esslingen, Germany
| | - J Trojan
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - M Schütz
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - L Berie
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Sauvigny
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - F Lammert
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - A Lohse
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - M M Dollinger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - U Lindig
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - E M Duerr
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - N Lubomierski
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - S Zimmermann
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - D Wachtlin
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - A-K Kaiser
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - S Schadmand-Fischer
- Department of Radiology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - P R Galle
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - M Woerns
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
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Lynen Jansen P, Stallmach A, Lohse AW, Lerch MM. [Development of gastrointestinal infectious diseases between 2000 and 2012]. Z Gastroenterol 2014; 52:549-57. [PMID: 24905106 DOI: 10.1055/s-0033-1356442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Infectious gastroenterological diseases are of increasing medical and health-economic significance. METHOD To evaluate the development of gastroenterolgical infections (GI) over the past 10 years, we have analysed the published data of the German Federal Statistics Office on GI hospital admissions between 2001 and 2011 and the data on cases of infection reported to the Robert-Koch Institute between 2001 and 2012. RESULTS In 2011 520795 patients with infectious diarrhoea (ICD 10 A00-A09) required hospital admission. The number of coded main diagnoses alone has more than doubled from 127867 to 282199 cases per year. The increase in the group of over 65-year-old patients was particularly high. The highest increase among hospitalised patients was seen for Clostridium difficile infections (99779 cases in 2011) together with noro- and rotavirus infections, whereas the number of cases with salmonella declined. The number of hospital deaths related to infectious gastrointestinal diseases (major clinical diagnosis) rose from 401 in 2000 to 4152 in 2011. Particularly frequent were deaths coded under the ICD 10 diagnosis A04, which includes Clostridium difficile infections (CDI). DISCUSSION In spite of the limitations due to differing data sources, reporting and recording rules, the analysed data do allow conclusions as to the development of the last 10 years. Gastrointestinal infections have not only markedly increased but also required increasing hospital capacities in gastroenterological departments. Since, with the exception of rotavirus infections, no vaccination strategies are available, these developments will have to be combatted above all by improved infectiological training for gastroenterologists.
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Affiliation(s)
- P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, Berlin
| | - A Stallmach
- Klinik für Innere Medizin IV und Integriertes Forschungs- und Behandlungszentrum (IFB) "Sepsis und Sepsisfolgen", Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
| | - A W Lohse
- Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - M M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin der Ernst-Moritz-Arndt-Universität, Greifswald
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Allweiss L, Volz T, Giersch K, Petersen J, Lohse AW, Lütgehetmann M, Dandri M. Proliferation of hepatitis B virus infected human hepatocytes in humanized mice treated with the entry inhibitor Myrcludex-B induces strong cccDNA reduction and maintenance of cccDNA-free hepatocytes. Z Gastroenterol 2014. [DOI: 10.1055/s-0033-1361045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Heim D, Cornils K, Schulze K, Fehse B, Lohse AW, Brümmendorf TH, Wege H. Retroviral insertional mutagenesis in telomerase-immortalized hepatocytes identifies RIPK4 as novel tumor suppressor in human hepatocarcinogenesis. Oncogene 2014; 34:364-72. [DOI: 10.1038/onc.2013.551] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 09/30/2013] [Accepted: 11/03/2013] [Indexed: 12/28/2022]
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Holzhüter J, Rösch T, Block A, Lohse AW, Lüth S. [A 44-year-old woman with hereditary nonpolyposis colon carcinoma: screening examinations for non-colonic tumors]. Internist (Berl) 2013; 54:353-8. [PMID: 23392234 DOI: 10.1007/s00108-012-3224-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 44-year-old woman presented in March 2010 for surveillance esophagogastroduodenoscopy (EGD). In October 2004, rectal cancer had been diagnosed and treated by resection of the rectum with adjuvant chemotherapy. A diagnosis of hereditary nonpolyposis colon carcinoma (HNPCC) was established on the basis of the Amsterdam II criteria. Due to a lack of clear guidelines we decided to perform annual systematic surveillance examinations of the stomach and the most frequent tumor manifestations. Until 2009, extracolonic tumors were not observed in the patient. In March 2010, EGD showed a discrete erosive lesion in the gastric antrum, which was biopsied. Most notably, the histopathological examination revealed a poorly differentiated mucinous adenocarcinoma. Due to the poor differentiation, we decided against technically possible, endoscopic resection. The patient underwent subtotal gastrectomy and is still doing fine 28 months after surgery. This case prompted us to evaluate our surveillance approach in HNPCC patients and to review the literature.
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Affiliation(s)
- J Holzhüter
- I. Medizinische Klinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg, Martinistr. 52, 20246, Hamburg, Deutschland.
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Weiler-Normann C, Sebode M, Lohse AW. Autoimmune hepatitis 2013 and beyond. MINERVA GASTROENTERO 2013; 59:133-141. [PMID: 23831905] [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: 06/02/2023]
Abstract
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease leading to cirrhosis and its complications if left untreated. Clinical features include elevated transaminases, elevated immunoglobulin G and the presence of autoantibodies. A liver biopsy is necessary for the establishment of the diagnosis. If treated properly and timely, prognosis of AIH is excellent. Standard treatment today consists of azathioprine and prednisolone and leads to remission in the vast majority of patients. Intolerance to standard treatment or incomplete remission as well as special patient groups such as pregnant patients or elderly patients require second- or sometimes even third-line treatments. For those patients, a number of effective drugs are available off-label and induction of remission will be possible in the vast majority of patients. Choice of drug regimen is important as drug-drug-interactions, concomitant diseases, age and gender of the patients have to be taken into account to achieve a tolerable side effect profile and good quality of life in patients. Mycophenolate mofetil is the drug of first choice in azathioprine intolerance. Other treatments may include the use of cyclosporine, tacrolimus, cyclophosphamide or biologicals such as rituximab or infliximab. Close monitoring of the patients will be necessary as side effects may occur.
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Affiliation(s)
- C Weiler-Normann
- Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany -
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Kuhn A, Weiler-Normann C, Schramm C, Kluge S, Behne M, Lohse A, Benten D. Acute Liver Failure Following Minocycline Treatment – A Case Report and Review of the Literature. Z Gastroenterol 2012; 50:771-5. [DOI: 10.1055/s-0031-1299443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractWe present the case of a 23-year-old female patient with acute liver failure following intake of minocycline. This patient had severe hypereosinophilia and massively increased IgE levels. Experimental studies in this case revealed elevated IFN-γ-, as well as TNF-α-producing CD4+ and CD8+ T-cells after in vitro stimulation with minocycline, indicating a type I/IgE-mediated as well as type II/cytotoxic reaction in the pathogenesis of minocycline-induced liver failure. Although mild forms of liver involvement are well known side effects of minocycline, only 8 cases with acute liver failure have been reported, and we present a review of all cases.
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Affiliation(s)
- A. Kuhn
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Weiler-Normann
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Kluge
- Intensive Care Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M. Behne
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D. Benten
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
INTRODUCTION Pyogenic liver abscess (PLA) is a disease with changing origins as well as diagnostic and therapeutic options in the last decades. MATERIALS AND METHODS A retrospective study of the last 20 patients treated at a gastroenterological department of a university clinic for the major diagnosis of PLA was conducted. Epidemiological, clinical, microbiological and therapeutic aspects were recorded. RESULTS 75 % of the patients were male. The mean age was 51.7 ± 16.6 years. Most of PLA (70 %) had a hepatobiliary origin. Diabetes mellitus (25 %) and cholangiocarcinoma (20 %) were the major risk factors for PLA. Crohn's disease was a possible cause in at least one patient. Fever (70 %) and tachycardia (50 %) were the most common symptoms. The C-reactive protein was elevated in all patients. Enterococci (> 40 %) and anaerobes (> 20 %) were the most frequent organisms in abscess cultures, Escherichia coli (25 %) was the most frequent organism in blood cultures. DISCUSSION The clinical presentation of PLA is usually non-specific. Therefore especially with patients having typical risk factors the differential diagnosis of PLA should be considered. Particularly patients suffering from PLA without any pre-existing illness should be examined for an underlying disease.
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Affiliation(s)
- R Zenouzi
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
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Röder C, Jordan S, Hoepner L, Pudelski N, Supplieth M, Lohse AW, Schulze zur Wiesch J, Lüth S. Chronische Hepatitis C Infektion: Herausforderung Alter. Z Gastroenterol 2012. [DOI: 10.1055/s-0031-1295931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Collection of data in transplantation medicine is required to define ethical standards, to assess indications and contra-indications and to determine rules for organ allocation. Similarly, assessment of quality of the transplantation process and practice of transplantation centres requires relevant data in transplantation medicine. Apart from data in quality reports, Eurotransplant and organ procurement, any form of data collection is lacking in Germany. In this article the problems caused by this shortcoming are described.
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Affiliation(s)
- G Otto
- Abteilung für Transplantationschirurgie der Universitätsmedizin, Johannes-Gutenberg-Universität Mainz.
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Naderi J, Lohse AW, Galle PR, Schramm C. [A rare cause of variceal bleeding]. Z Gastroenterol 2010; 48:1215-8. [PMID: 20886427 DOI: 10.1055/s-0029-1245465] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Agnogenic myeloid metaplasia (AMM) is a clonal stem cell disease, which is characterized by myelofibrosis, osteosclerosis and pancytopenia. Affected patients frequently develop portal hypertension secondary to extramedullary hematopoiesis, which rarely becomes clinically relevant. CASE REPORT We here report on a 63-year-old patient with a first presentation of variceal bleeding. The patient was diagnosed with portal hypertension and due to marked splenomegaly, liver cirrhosis was suspected. Subsequently, an extramedullary hematopoiesis and AMM could be diagnosed. The variceal bleeding was initially treated endoscopically. The patient has received cytoreductive therapy and a splenorenal shunt, which has led to remission and long-term survival. CONCLUSION Agnogenic myeloid metaplasia is a rare cause of portal hypertension and may present with variceal bleeding. Clinicians should be aware of this rare cause of portal hypertension, as treatment of the underlying disease with cytoreductive therapy and appropriate management of portal hypertension may lead to long-term survival.
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Affiliation(s)
- J Naderi
- Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Lutgehetmann M, Meyer F, Volz T, Lohse AW, Fischer C, Dandri M, Petersen J. [Knowledge about HBV, prevention behaviour and treatment adherence of patients with chronic hepatitis B in a large referral centre in Germany]. Z Gastroenterol 2010; 48:1126-32. [PMID: 20839162 DOI: 10.1055/s-0029-1245304] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The incidence of chronic hepatitis B in Germany is approximately 0.5 %. Data regarding knowledge about HBV, prevention behaviour and treatment adherence in patients with chronic HBV are scarce. METHODS In this prospective study 201 consecutive patients with CHB infection were studied from a large urban academic outpatient clinic at the University Medical Centre in Hamburg. Patients were interviewed with a questionnaire that contained 47 questions covering social demographic dates, knowledge about HBV, treatment adherence and prevention. The success rate of interviews was 100 % with free translation service offered. RESULTS 20.4 % of the CHB patients were born in Germany, but the majority of the patients were immigrants (80.6 %). 51 % of the patients had a good, 34 % a moderate and 15 % a poor knowledge about HBV. 89 % of the patients knew that HBV can be transmitted through blood contacts, but 34 % believed that inadequate hygienic conditions and 24 % that food products may transmit the virus. 96 % of the patients had knowledge about the existence of an HBV vaccine. Furthermore, 82 % considered a vaccination of all persons in the household important. Despite the knowledge of the existence and importance of a vaccine, only 61,7 % of the 300 affected children/siblings of HBV-positive family members were vaccinated. However, the child vaccination rate was significantly higher among patients with knowledge about the protective effect of the vaccine (p < 0.001), the free of charge vaccination program for children up to 18 years (p < 0.001) and higher school education (p < 0.001). Migrants with poor German language skills had lower knowledge scores (p < 0.001) and showed lower vaccination rates (p = 0.016) compared to immigrants with good German language skills. 43 % of all patients were treated with nucleot(s)ide analogues with a median treatment duration of 2 - 5 years. 65 % of these patients declared to never have missed a dose and 27 % missed less than one dose per month. 90 % of the patients tolerated the antiviral drugs very well and between patients with or without side effects there was no significant difference in quality of life. CONCLUSION Chronic hepatitis B in Germany is characterised by awareness problems and language barriers. More attention is needed for HBV-infected immigrants in the form of multilingual information about CHB and awareness campaigns.
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Affiliation(s)
- M Lutgehetmann
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Wolkersdörfer GW, Emmanuel K, Denzer U, Puespoek A, Neureiter D, Kiesslich T, Lohse AW, Berr F. Efficacy of temoporfin photodynamic therapy (PDT) for bile duct cancer. Z Gastroenterol 2010. [DOI: 10.1055/s-0030-1263811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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von Kalckreuth V, Glowa F, Geibler M, Lohse AW, Denzer UW. Terlipressin in 30 patients with hepatorenal syndrome: results of a retrospective study. Z Gastroenterol 2009; 47:21-6. [PMID: 19156588 DOI: 10.1055/s-0028-1109084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Terlipressin is known to improve renal function in patients with liver cirrhosis and hepatorenal syndrome (HRS). This study investigated effects of duration and dose of terlipressin therapy and predictive factors for positive response to treatment. The clinical charts of 30 consecutive patients with HRS who received terlipressin and albumin based on a determined therapeutic scheme, were retrospectively studied. In 25 (66 %) of 38 treatment episodes complete response was achieved (Kaplan-Meier survival method). Predictive for positive response to treatment were duration of treatment and cumulative terlipressin dosis (p < 0.01, 95 % CI 0.31 - 0.59 and p < 0.01, 95 % CI 0.93 - 0.98, respectively) as well as a low level of serum creatinine and MELD score at inclusion (p = 0.01, 95 % CI 0.3 - 9.85 and p < 0.01, 95 % CI 0.87 - 0.98 respectively) and HRS type II (p = 0.04, 95 % CI 1.04 - 9.93). The median duration of therapy was 6 days +/- 4.9 (SD) vs. 8 days +/- 6.3 in the nonresponder group. The median dose of terlipressin in the responder group was 3.9 mg +/- 1.3 per day vs. 3.4 mg +/- 1.4 in the nonresponder group (p = n. s.). The probability that complete response was obtained at day 17 of treatment was 84 % (95 % CI 0.64 - 0.96), whereas at day 7 it was just 52 % (95 % CI 0.36 - 0.7). In conclusion, these data confirm that terlipressin plus albumin is effective in two-thirds of patients with HRS. Prolongation of treatment beyond 7 days up to 20 days is capable of increasing the response rates. Whether outcome can be predicted depending on parameters like type of HRS and base-level of serum creatinine needs to be confirmed in further studies, especially with regard on the previously revised criteria of HRS.
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Affiliation(s)
- V von Kalckreuth
- I. Department of Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany.
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Schramm C, Schneider A, Marx A, Lohse AW. Adalimumab could suppress the activity of non alcoholic steatohepatitis (NASH). Z Gastroenterol 2008; 46:1369-71. [PMID: 19053005 DOI: 10.1055/s-2008-1027411] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of non-alcoholic steatohepatitis (NASH) is increasing. NASH confers an increased risk of liver-related morbidity and mortality with a substantial risk of developing liver cirrhosis. At present, there is no established medical treatment for NASH. The pathogenesis of NASH is incompletely understood. Several lines of evidence suggest that TNF-alpha may be involved in the pathogenesis of NASH by promoting liver inflammation, insulin resistance and hepatocyte apoptosis. Anti-TNF-alpha therapy has not been evaluated for the treatment of NASH. We report here on a patient with NASH who has experienced rapid normalization of liver biochemistry during treatment of an associated rheumatoid arthritis with the humanized anti-TNF-alpha antibody adalimumab. This observation suggests that pilot studies may be warranted to evaluate the role of adalimumab for the treatment of NASH.
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Affiliation(s)
- C Schramm
- III. Department of Medicine, University Medical Center Hamburg.
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Affiliation(s)
- U W Denzer
- Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg.
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Pace A, Topalidis T, Bläker M, Guthoff A, de Weerth A, Lohse AW. [Autoimmune pancreatitis with normal IgG4-Levels: 4 case reports and review of the literature]. Z Gastroenterol 2008; 45:1245-51. [PMID: 18080226 DOI: 10.1055/s-2007-963447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report four cases of autoimmune pancreatitis in an 18-, a 22- and a 26-year-old male patient and a 20-year-old female patient. The 20-year-old female patient was admitted to the hospital with upper abdominal pain and jaundice, the 18-year-old patient with recurrent acute pancreatitis and cholestasis, the 26-year-old patient with right upper abdominal pain for four weeks and laboratory findings suggesting an acute pancreatitis. The 22-year-old patient presented with painless jaundice. EUS-guided fine needle aspiration was performed in all patients. The cytological findings and the EUS were decisive for the diagnosis of autoimmune pancreatitis in all four cases. In contrast, no patient showed elevated IgG4, or antibodies for carboanhydrase-II, for lactoferrin, or rheumatoid factor, serum markers reported to be positive in autoimmune pancreatitis. All patients were treated successfully with steroids, one patient relapsed after discontinuing the steroid medication and required renewed therapy. These case reports demonstrate that autoimmune pancreatitis should be considered in the differential diagnosis in cases of pancreatitis and/or jaundice also in western countries. As demonstrated, the diagnosis should not be based solely on the elevation of IgG4 or autoantibodies.
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Affiliation(s)
- A Pace
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Hamburg-Epppendorf.
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