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Wick A, Sander A, Koch M, Bendszus M, Combs S, Haut T, Dormann A, Walter S, Pertz M, Merkle-Lock J, Selkrig N, Limprecht R, Baumann L, Kieser M, Sahm F, Schlegel U, Winkler F, Platten M, Wick W, Kessler T. Improvement of functional outcome for patients with newly diagnosed grade 2 or 3 gliomas with co-deletion of 1p/19q - IMPROVE CODEL: the NOA-18 trial. BMC Cancer 2022; 22:645. [PMID: 35692047 PMCID: PMC9190129 DOI: 10.1186/s12885-022-09720-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Given the young age of patients with CNS WHO grade 2 and 3 oligodendrogliomas and the relevant risk of neurocognitive, functional, and quality-of-life impairment with the current aggressive standard of care treatment, chemoradiation with PCV, of the tumour located in the brain optimizing care is the major challenge. Methods NOA-18 aims at improving qualified overall survival (qOS) for adult patients with CNS WHO grade 2 and 3 oligodendrogliomas by randomizing between standard chemoradiation with up to six six-weekly cycles with PCV and six six-weekly cycles with lomustine and temozolomide (CETEG) (n = 182 patients per group accrued over 4 years) thereby delaying radiotherapy and adding the chemoradiotherapy concept at progression after initial radiation-free chemotherapy, allowing for effective salvage treatment and delaying potentially deleterious side effects. QOS represents a new concept and is defined as OS without functional and/or cognitive and/or quality of life deterioration regardless of whether tumour progression or toxicity is the main cause. The primary objective is to show superiority of an initial CETEG treatment followed by partial brain radiotherapy (RT) plus PCV (RT-PCV) at progression over partial brain radiotherapy (RT) followed by procarbazine, lomustine, and vincristine (PCV) chemotherapy (RT-PCV) and best investigators choice (BIC) at progression for sustained qOS. An event concerning a sustained qOS is then defined as a functional and/or cognitive and/or quality of life deterioration after completion of primary therapy on two consecutive study visits with an interval of 3 months, tolerating a deviation of at most 1 month. Assessments are done with a 3-monthly MRI, assessment of the NANO scale, HRQoL, and KPS, and annual cognitive testing. Secondary objectives are evaluation and comparison of the two groups regarding secondary endpoints (short-term qOS, PFS, OS, complete and partial response rate). The trial is planned to be conducted at a minimum of 18 NOA study sites in Germany. Discussion qOS represents a new concept. The present NOA trial aims at showing the superiority of CETEG plus RT-PCV over RT-PCV plus BIC as determined at the level of OS without sustained functional deterioration for all patients with oligodendroglioma diagnosed according to the most recent WHO classification. Trial registration Clinicaltrials.govNCT05331521. EudraCT 2018–005027-16.
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Affiliation(s)
- A Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - A Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M Koch
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - S Combs
- Department of Radiation Oncology at the Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - T Haut
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - A Dormann
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - S Walter
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - M Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - J Merkle-Lock
- Coordination Centre for Clinical Trials (KKS), Medical Faculty & University Hospital Heidelberg, Heidelberg, Germany
| | - N Selkrig
- Coordination Centre for Clinical Trials (KKS), Medical Faculty & University Hospital Heidelberg, Heidelberg, Germany
| | - R Limprecht
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - L Baumann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - F Sahm
- Department of Neuropathology, University Hospital Heidelberg, DKTK and CCU Neuropathology, DKFZ, Heidelberg, Germany
| | - U Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - F Winkler
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Platten
- DKTK, Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, DKFZ, Heidelberg, Germany.,Department of Neurology, Medical faculty, MCTN, University of Heidelberg, Mannheim, Germany
| | - W Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Neurology Clinic, University of Heidelberg & CCU Neurooncology, DKFZ, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany.
| | - T Kessler
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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2
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Hasseli R, Müller-Ladner U, Keil F, Broll M, Dormann A, Fräbel C, Hermann W, Heinmüller CJ, Hoyer BF, Löffler F, Özden F, Pfeiffer U, Saech J, Schneidereit T, Schlesinger A, Schwarting A, Specker C, Stapfer G, Steinmüller M, Storck-Müller K, Strunk J, Thiele A, Triantafyllias K, Vagedes D, Wassenberg S, Wilden E, Zeglam S, Schmeiser T. The influence of the SARS-CoV-2 lockdown on patients with inflammatory rheumatic diseases on their adherence to immunomodulatory medication: a cross sectional study over 3 months in Germany. Rheumatology (Oxford) 2021; 60:SI51-SI58. [PMID: 33704418 PMCID: PMC7989169 DOI: 10.1093/rheumatology/keab230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
Objectives To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-months lockdown in Germany. Methods From March 16th until June 15th 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments which included rheumatology primary care centres and university hospitals participated. 4252 questionnaires were collected and evaluated. Results The majority of patients (54%) were diagnosed with rheumatoid arthritis, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). The majority of patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients (<60 years) reported just as often as older patients to discontinue their therapy. Conclusion The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behavior with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendation of the German Society of Rheumatology were well received, supporting the well-established physician-patient-relationship in times of a crisis.
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Affiliation(s)
- R Hasseli
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - U Müller-Ladner
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - F Keil
- Department of Electrical Engineering and Information Technology, Technical University Darmstadt, Darmstadt, Germany
| | - M Broll
- Private Practice, Wetzlar, Germany
| | - A Dormann
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - C Fräbel
- Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - W Hermann
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - B F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus, Kiel, Germany
| | - F Löffler
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - F Özden
- Private Practice, Nienburg, Germany
| | - U Pfeiffer
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - J Saech
- Private Practice 'Rheumatologie-Centrum', Leverkusen, Germany
| | - T Schneidereit
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - A Schlesinger
- Department of Internal Medicine, Pulmonology and Rheumatology, Marienhospital, Cologne, Germany
| | - A Schwarting
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - C Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
| | - G Stapfer
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | - J Strunk
- Department of Rheumatology, Hospital Porz am Rhein, Cologne, Germany
| | - A Thiele
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - K Triantafyllias
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - D Vagedes
- Medical Care Centre Barmherzige Brüder, Straubing, Germany
| | - S Wassenberg
- Private Practice 'Rheumazentrum Ratingen', Ratingen, Germany
| | - E Wilden
- Private Practice, Cologne, Germany
| | - S Zeglam
- Department of Internal Medicine, Pulmonology and Rheumatology, Marienhospital, Cologne, Germany
| | - T Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
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Lange J, Dormann A, Bulian DR, Hügle U, Eisenberger CF, Heiss MM. VACStent: Combining the benefits of endoscopic vacuum therapy and covered stents for upper gastrointestinal tract leakage. Endosc Int Open 2021; 9:E971-E976. [PMID: 34079885 PMCID: PMC8159583 DOI: 10.1055/a-1474-9932] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background and study aims Endoscopic treatment has markedly improved the high morbidity and mortality in patients with upper gastrointestinal tract leakage. Most procedures employ either covered self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT), both with good clinical success but also with concomitant significant shortcomings inherent in each technique. A newly developed device, the VACStent, combines the fully covered SEMS with a polyurethane sponge cylinder anchored on the outside. This allows endoluminal EVT while keeping the intestinal lumen patent. The benefit is prevention of stent migration because the suction force of the sponge-cylinder immobilizes the VACStent on the intestinal wall, while at the same time, the attached external vacuum pump suctions off any secretions and improves healing with negative-pressure wound treatment (NPWT). Patients and methods In this pilot study, the first patients to receive the VACStent were assessed. Outcomes included the applicability and stability of the VACStent system together with the clinical course. Results Three patients with different clinical courses were managed with the VACStent. The first patient suffered anastomotic leakage following subtotal esophagectomy and was successfully treated with two postoperative VACStents for 12 days. The second patient received a covered SEMS for 14 days for acute Boerhaave syndrome. Due to persistent leakage, management was converted to EVT. Seven days, later a VACStent was inserted to allow oral nutrition while the leak finally closed. In the third patient, a LINX Reflux Management System had to be removed for erosion, leaving the gastroesophageal junction (GEJ) with a full-thickness gap. After VACstent insertion, successful closure was achieved within 4 days. Conclusions These clinical cases demonstrate the applicability and efficacy of the VACstent in management of esophageal and anastomotic leakage. With its vacuum sponge, the stent fosters wound healing while the covered SEMS keeps the passage patent for nutrition.
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Affiliation(s)
- Jonas Lange
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Arno Dormann
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - Dirk Rolf Bulian
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Ulrich Hügle
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - Claus Ferdinand Eisenberger
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - Markus Maria Heiss
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
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Schmeiser T, Broll M, Dormann A, Fräbel C, Hermann W, Hudowenz O, Keil F, Müller-Ladner U, Özden F, Pfeiffer U, Saech J, Schwarting A, Stapfer G, Steinchen N, Storck-Müller K, Strunk J, Thiele A, Triantafyllias K, Wassenberg S, Wilden E, Hasseli R. [A cross sectional study on patients with inflammatory rheumatic diseases in terms of their compliance to their immunsuppressive medication during COVID-19 pandemic]. Z Rheumatol 2020; 79:379-384. [PMID: 32303821 PMCID: PMC7163348 DOI: 10.1007/s00393-020-00800-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The current COVID-19 pandemic inherits an unprecedented challenge for the treating rheumatologists. On the one hand, antirheumatic drugs can increase the risk of infection and potentially deteriorate the course of an infection. On the other hand, an active inflammatory rheumatic disease can also increase the risk for an infection. In the recommendations of the German Society for Rheumatology (www.dgrh.de), it is recommended that our patients continue the antirheumatic therapy to maintain remission or low state of activity despite the pandemic. In this study, patients with inflammatory rheumatic disease were asked in the first weeks of the pandemic on their opinion of their immunomodulating therapy. The result shows that over 90% of the patients followed the recommendation of the rheumatologist to continue the antirheumatic therapy, and only a small percentage of the patients terminated the therapy on their own. This result was independent of the individual anti-rheumatic therapy. Taken together, the results of this study illustrate not only the trustful patient-physician partnership in a threatening situation but also the high impact of state-of-the art recommendations by the respective scientific society.
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Affiliation(s)
- T Schmeiser
- Klinik für Rheumatologie, Immunologie und Osteologie, Krankenhaus St. Josef Wuppertal, Wuppertal, Deutschland
| | - M Broll
- Praxisklinik Mittelhessen, Wetzlar, Deutschland
| | - A Dormann
- Klinik für Rheumatologie, Immunologie und Osteologie, Krankenhaus St. Josef Wuppertal, Wuppertal, Deutschland
| | - C Fräbel
- Medizinische Klinik I, Klinik für Kardiologie und Angiologie Standort Gießen, UKGM Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
| | - W Hermann
- Campus Kerckhoff, Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland
| | - O Hudowenz
- Campus Kerckhoff, Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland
| | - F Keil
- Fachgebiet "Integrierte Elektronische Systeme", Technische Universität Darmstadt, Darmstadt, Deutschland
| | - U Müller-Ladner
- Campus Kerckhoff, Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland
| | - F Özden
- Facharzt-Praxis für Rheumatologie und Osteologie Nienburg, Nienburg, Deutschland
| | - U Pfeiffer
- Klinik für Rheumatologie, Immunologie und Osteologie, Krankenhaus St. Josef Wuppertal, Wuppertal, Deutschland
| | - J Saech
- Gemeinschaftspraxis Rheumatologie-Centrum Leverkusen, Leverkusen, Deutschland
| | - A Schwarting
- Medizinische Klinik I, Klinik für Rheumatologie, Universitätsmedizin Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- ACURA Rheuma-Akutzentrum Bad Kreuznach, Bad Kreuznach, Deutschland
| | - G Stapfer
- Campus Kerckhoff, Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland
| | - N Steinchen
- Praxis für Rheumatologie Kassel, Kassel, Deutschland
| | - K Storck-Müller
- Kompetenzzentrum für Rheumatologie Bad Endbach, Rheumazentrum Mittelhessen, Bad Endbach, Deutschland
| | - J Strunk
- Klinik für Rheumatologie, Krankenhaus Porz am Rhein (Köln), Köln, Deutschland
| | - A Thiele
- Klinik für Rheumatologie, Immunologie und Osteologie, Krankenhaus St. Josef Wuppertal, Wuppertal, Deutschland
| | - K Triantafyllias
- ACURA Rheuma-Akutzentrum Bad Kreuznach, Bad Kreuznach, Deutschland
| | | | - E Wilden
- Rheumapraxis Wilden Köln-Ehrenfeld, Köln, Deutschland
| | - R Hasseli
- Campus Kerckhoff, Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland.
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Turowski F, Hügle U, Dormann A, Bechtler M, Jakobs R, Gottschalk U, Nötzel E, Hartmann D, Lorenz A, Kolligs F, Veltzke-Schlieker W, Adler A, Becker O, Wiedenmann B, Bürgel N, Tröger H, Schumann M, Daum S, Siegmund B, Bojarski C. Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study. Surg Endosc 2018. [PMID: 29532224 DOI: 10.1007/s00464-018-6141-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The aim of the study was to evaluate the usefulness and diagnostic and therapeutic outcome of the single-operator cholangiopancreatoscopy (SOC) with SpyGlassDS™. METHODS In a retrospective multicenter study between November 2015 and January 2017, SpyGlassDS™ procedures were analyzed in participating centers. Indications, accuracy of SOC-guided biopsies, management of large bile duct stones, and complications were analyzed. Follow-up was 4 months. RESULTS Two hundred and six patients out of 250 examinations were evaluated. Indications were biliary stones (n = 132), bile duct stenosis (n = 93), stones and stenosis combined (n = 24), and bile duct leakage (n = 1). Of the 117 cases which were suspicious of malignancy, in 99 cases the lesion could be stratified into benign (n = 55) or malignant (n = 44) indicating a sensitivity of 95.5% and a specificity of 94.5% for the indication tumor. SOC-guided biopsies revealed a sensitivity of 57.7% with a specificity of 100%. In 107 examinations, biliary stones were visualized and could be completely removed in 91.1% with a need of three procedures (range 1-6) to achieve final stone clearance. In 75 cases, lithotripsy was performed and was successful in 71 cases (95%). Four out of 45 patients (8.9%) underwent cholecystectomy with surgical bile duct revision as a final therapy. Adverse Event (AE) occurred in 33/250 patients (13.2%) and Serious Adverse Event (SAE) occurred in 1/250 patients (0.4%). Cholangitis was 1% (n = 102) after peri-interventional administration of antibiotics and 12.8% (n = 148) without antibiotic prophylaxis (p < 0.001). CONCLUSIONS SOC with SpyGlassDS™ became a new standard for the diagnosis of indefinite biliary lesions and therapy of large bile duct stones. The diagnostic yield of SOC-guided biopsies facilitated a definite diagnosis in most cases and should be improved by standardized biopsy protocols. SOC-guided interventions allowed removal of large biliary stones by SOC-guided lithotripsy. The complication rate of 13.2% can be considerably reduced by use of a single-shot antibiotic treatment.
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Affiliation(s)
- Felicia Turowski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ulrich Hügle
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Arno Dormann
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Matthias Bechtler
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Uwe Gottschalk
- Klinik für Innere Medizin I, Dietrich Bonhoeffer Klinikum, Salvador-Allende-Str. 30, 17036, Neubrandenburg, Germany
| | - Ellen Nötzel
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Dirk Hartmann
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Albrecht Lorenz
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Frank Kolligs
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Wilfried Veltzke-Schlieker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Adler
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Olaf Becker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bertram Wiedenmann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nataly Bürgel
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hanno Tröger
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Michael Schumann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Severin Daum
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Britta Siegmund
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Bojarski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Lehmann C, Kochanek M, Abdulla D, Becker S, Böll B, Bunte A, Cadar D, Dormann A, Eickmann M, Emmerich P, Feldt T, Frank C, Fries J, Gabriel M, Goetsch U, Gottschalk R, Günther S, Hallek M, Häussinger D, Herzog C, Jensen B, Kolibay F, Krakau M, Langebartels G, Rieger T, Schaade L, Schmidt-Chanasit J, Schömig E, Schüttfort G, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Wieland U, Wiesmüller G, Wolf T, Fätkenheuer G. Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016. ACTA ACUST UNITED AC 2018; 22. [PMID: 29019307 PMCID: PMC5709954 DOI: 10.2807/1560-7917.es.2017.22.39.17-00088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In a patient transferred from Togo to Cologne, Germany, Lassa fever was diagnosed 12 days post mortem. Sixty-two contacts in Cologne were categorised according to the level of exposure, and gradual infection control measures were applied. No clinical signs of Lassa virus infection or Lassa specific antibodies were observed in the 62 contacts. Thirty-three individuals had direct contact to blood, other body fluids or tissue of the patients. Notably, with standard precautions, no transmission occurred between the index patient and healthcare workers. However, one secondary infection occurred in an undertaker exposed to the corpse in Rhineland-Palatinate, who was treated on the isolation unit at the University Hospital of Frankfurt. After German authorities raised an alert regarding the imported Lassa fever case, an American healthcare worker who had cared for the index patient in Togo, and who presented with diarrhoea, vomiting and fever, was placed in isolation and medevacked to the United States. The event and the transmission of Lassa virus infection outside of Africa underlines the need for early diagnosis and use of adequate personal protection equipment (PPE), when highly contagious infections cannot be excluded. It also demonstrates that larger outbreaks can be prevented by infection control measures, including standard PPE.
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Affiliation(s)
- Clara Lehmann
- Department I of Internal Medicine, University of Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Matthias Kochanek
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Diana Abdulla
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Stephan Becker
- German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany.,Institute for Virology, Universität Marburg, Germany
| | - Boris Böll
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Anne Bunte
- Public Health Department Cologne, Germany
| | - Daniel Cadar
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Arno Dormann
- Municipal Hospital of Cologne, Medical Department Holweide, Germany
| | - Markus Eickmann
- German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany.,Institute for Virology, Universität Marburg, Germany
| | - Petra Emmerich
- Department of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Torsten Feldt
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jochen Fries
- Department of Pathology, University of Cologne, Germany
| | - Martin Gabriel
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Udo Goetsch
- Health Protection Authority City of Frankfurt am Main, Germany
| | - René Gottschalk
- University Hospital Frankfurt, Institute of Medical Virology, Germany.,Health Protection Authority City of Frankfurt am Main, Germany
| | - Stephan Günther
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Michael Hallek
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Dieter Häussinger
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herzog
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Björn Jensen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Felix Kolibay
- Department for Clinical Affairs, University of Cologne, Germany
| | - Michael Krakau
- Municipal Hospital of Cologne, Medical Department Holweide, Germany
| | | | - Toni Rieger
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Jonas Schmidt-Chanasit
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Gundolf Schüttfort
- University Hospital Frankfurt, Department of Infectious Diseases, Germany
| | - Alexander Shimabukuro-Vornhagen
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | | | | | - Timo Wolf
- University Hospital Frankfurt, Department of Infectious Diseases, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University of Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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7
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Mueller-Gerbes D, Hartmann B, Lima JP, de Lemos Bonotto M, Merbach C, Dormann A, Jakobs R. Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients. Endosc Int Open 2017; 5:E603-E607. [PMID: 28670617 PMCID: PMC5482745 DOI: 10.1055/s-0043-106582] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Buried bumper syndrome is an infrequent complication of percutaneous endoscopic gastrostomy (PEG) that can result in tube dysfunction, gastric perforation, bleeding, peritonitis or death. The aim of this study was to compare the efficacy of different PEG tube removal methods in the management of buried bumper syndrome in a large retrospective cohort. PATIENTS AND METHODS From 2002 to 2013, 82 cases of buried bumper syndrome were identified from the databases of two endoscopy referral centers. We evaluated the interval between gastrostomy tube placement and diagnosis of buried bumper syndrome, type of treatment, success rate and complications. Four methods were analyzed: bougie, grasp, needle-knife and minimally invasive push method using a papillotome, which were selected based on the depth of the buried bumper. RESULTS The buried bumper was cut free with a wire-guided papillotome in 35 patients (42.7 %) and with a needle-knife in 22 patients (26.8 %). It could be pushed into the stomach with a dilator without cutting in 10 patients (12.2 %), and was pulled into the stomach with a grasper in 12 patients (14.6 %). No adverse events (AEs) were registered in 70 cases (85.4 %). Bleeding occurred in 7 patients (31.8 %) after cutting with a needle-knife papillotome and in 1 patient (8.3 %) after grasping. No bleeding was recorded after using a standard papillotome or a bougie ( P < 0.05). Ten of 22 patients (45.5 %) treated with the needle-knife had a serious AE and 1 patient died (4.5 %). CONCLUSIONS We recommend that incomplete buried bumpers be removed with a bougie. In cases of complete buried bumper syndrome, the bumper should be cut with a wire-guided papillotome and pushed into the stomach.
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Affiliation(s)
- Daniela Mueller-Gerbes
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik/Gastroenterologie, Köln, Germany,Corresponding author Daniela Mueller-Gerbes Kliniken der Stadt Köln gGmbHKrankenhaus Holweide, Medizinische KlinikNeufelder Str. 3251067 Köln
| | - Bettina Hartmann
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
| | | | - Michele de Lemos Bonotto
- Santa Casa Hospital/Porto Alegre University of Health Sciences, Department of Gastroenterology, Porto Alegre, Brazil
| | | | - Arno Dormann
- Kliniken der Stadt Köln gGmbH – Medizinische Klinik, Köln, Germany
| | - Ralf Jakobs
- Klinikum Ludwigshafen – Medizinische Klinik C, Ludwighafen, Germany
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8
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Krakau M, Gerbershagen K, Frost U, Hinzke M, Brockmann M, Schildgen V, Gomann A, Limmroth V, Dormann A, Schildgen O. Case Report: Human Bocavirus Associated Pneumonia as Cause of Acute Injury, Cologne, Germany. Medicine (Baltimore) 2015; 94:e1587. [PMID: 26496262 PMCID: PMC4620797 DOI: 10.1097/md.0000000000001587] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/04/2015] [Accepted: 08/22/2015] [Indexed: 12/27/2022] Open
Abstract
Although the human bocavirus (HBoV) is known since a decade, limited information about its pathogenesis is available due to the lack of an animal model. Thus, clinical cases and studies are the major source of novel information about the course of infection and the related pathophysiology.In this context, a clinical case of an adult patient suffering from severe HBoV-pneumonia is described that was associated with loss of consciousness followed by acute rib fracture and subsequent neurological disorder.Following initial global respiratory dysfunction the clinical respiratory symptoms recovered but the neurological symptoms maintained after weaning and intensive care in the stroke unit. During the initial phase, an acute active HBoV infection was confirmed by positive polymerase chain reactions from bronchoalveolar lavage fluid and serum.The case further demonstrates that HBoV can cause severe pneumonia, induce secondary disease also in adults, and may be associated with neurological symptoms as previously assumed.
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Affiliation(s)
- Michael Krakau
- From the Kliniken der Stadt Köln gGmbH, Medizinische Klinik Holweide, Lehrkrankenhaus der Universität zu Köln, Köln, Germany (MK, AD); Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Neurologische Klinik, Köln, Germany (KG, UF, MH, VL, OS); Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Köln, Germany (MB, VS); and Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Radiologische Klinik, Köln, Germany (AG)
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9
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Abstract
A clinical case of persisting and reactivated HBoV infection is described. HBoV can be detected in iliac crest in MDS patients. The current episode appears to be a reactivation of the HBoV-1 strain that was detected 5 years ago in a colorectal biopsy of the patient.
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Affiliation(s)
- Michael Krakau
- Kliniken der Stadt Köln gGmbH, Medizinische Klinik Holweide, Lehrkrankenhaus der Universität zu Köln, Cologne, Germany
| | - Michael Brockmann
- Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Cologne, Germany
| | - Bärbel Titius
- Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Cologne, Germany
| | - Christina Limmroth
- Kliniken der Stadt Köln gGmbH, Medizinische Klinik Holweide, Lehrkrankenhaus der Universität zu Köln, Cologne, Germany
| | - Soumaya Khalfaoui
- Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Cologne, Germany
| | - Verena Schildgen
- Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Cologne, Germany
| | - Arno Dormann
- Kliniken der Stadt Köln gGmbH, Medizinische Klinik Holweide, Lehrkrankenhaus der Universität zu Köln, Cologne, Germany
| | - Oliver Schildgen
- Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke mit Sitz in Köln, Institut für Pathologie, Cologne, Germany.
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10
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Schmidt A, Riecken B, Rische S, Klinger C, Jakobs R, Bechtler M, Kähler G, Dormann A, Caca K. Wing-shaped plastic stents vs. self-expandable metal stents for palliative drainage of malignant distal biliary obstruction: a randomized multicenter study. Endoscopy 2015; 47:430-6. [PMID: 25590188 DOI: 10.1055/s-0034-1391232] [Citation(s) in RCA: 18] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND STUDY AIMS Previous studies have shown superior patency rates for self-expandable metal stents (SEMS) compared with plastic stents in patients with malignant biliary obstruction. The aim of this study was to compare stent patency, patient survival, and complication rates between a newly designed, wing-shaped, plastic stent and SEMSs in patients with unresectable, malignant, distal, biliary obstruction. PATIENTS AND METHODS A randomized, multicenter trial was conducted at four tertiary care centers in Germany. A total of 37 patients underwent randomization between March 2010 and January 2013. Patients underwent endoscopic retrograde cholangiography with insertion of either a wing-shaped, plastic stent without lumen or an SEMS. RESULTS Stent failure occurred in 10/16 patients (62.5 %) in the winged-stent group vs. 4/18 patients (22.2 %) in the SEMS group (P = 0.034). The median time to stent failure was 51 days (range 2 - 92 days) for the winged stent and 80 days (range 28 - 266 days) for the SEMS (P = 0.002). Early stent failure (< 8 weeks after placement) occurred in 8 patients (50 %) vs. 2 patients (11.1 %), respectively (P = 0.022). After obtaining the results from this interim analysis, the study was discontinued because of safety concerns. CONCLUSIONS The frequency of stent failure was significantly higher in the winged-stent group compared with the SEMS group. A high incidence of early stent failure within 8 weeks was observed in the winged-stent group. Thus, the winged, plastic stent without central lumen may not be appropriate for mid or long term drainage of malignant biliary obstruction. Study registration ClinicalTrials.gov (NCT01063634).
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Affiliation(s)
- Arthur Schmidt
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Susanne Rische
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Christoph Klinger
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Ralf Jakobs
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Matthias Bechtler
- Department of Gastroenterology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Georg Kähler
- Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Arno Dormann
- Department of Medicine, Cologne City Hospital, Holweide, Cologne, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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11
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12
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Müller-Gerbes D, Beeck A, Dormann A. Hämostase mit Pulver – Erfahrungen mit EndoClotTM bei schwierigen oberen GI-Blutungen. ACTA ACUST UNITED AC 2014. [DOI: 10.1055/s-0033-1355954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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Müller-Gerbes D, Beeck A, Dormann A. Erfahrungen mit EndoClot™ PHS bei Blutungen im oberen Gastrointestinaltrakt. Z Gastroenterol 2013. [DOI: 10.1055/s-0033-1353097] [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: 02/06/2023]
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14
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Oren R, Sfez R, Korbakov N, Shabtai K, Cohen A, Erez H, Dormann A, Cohen H, Shappir J, Spira ME, Yitzchaik S. Electrically conductive 2D-PAN-containing surfaces as a culturing substrate for neurons. Journal of Biomaterials Science, Polymer Edition 2012; 15:1355-74. [PMID: 15648568 DOI: 10.1163/1568562042368077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the present contribution we report on a novel route to synthesize 2D-polyaniline (2D-PAN) on sulfonated-poly(styrene) (SPS) templates by allowing first monomer assembly followed by chemical oxidation to achieve polymerization. We show that Aplysia neurons grown on 2D-PAN exhibit an unusual growth pattern and adhesion to this conducting substrate that is manifested by the formation of giant lamellipodia. The lamellipodial domains are characterized by small gap between the plasma membrane and the 2D-PAN substrate (ca. 30 nm) and actin rich skeleton resembling the skeleton of growth cones. This behavior is characteristic to uniform substrates containing only 2D-PAN. However, in patterned substrates containing additionally poly(L-lysine) Aplysia neurons prefer to extend new neurites on the poly(L-lysine) domains.
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Affiliation(s)
- R Oren
- Department of Neurobiology, the Hebrew University of Jerusalem, Jerusalem 91904, Israel
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15
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Affiliation(s)
- D Müller-Gerbes
- Medizinische Klinik, Krankenhaus Holweide, Kliniken der Stadt Köln gGmbH.
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16
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Dormann A, Aymaz S, Malfertheiner P. Einzeitige Button-Gastrostomie mittels Gastropexie – klinische Ergebnisse einer neuen Technik zur perkutanen Sondenanlage. Z Gastroenterol 2009; 47:740-3. [DOI: 10.1055/s-0028-1109259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Köppen S, Wejda B, Dormann A, Hoffmeister D, Stolte M, Huchzermeyer H. [Gastrointestinal stromal tumours (GIST) of the jejunum in a patient with neurofibromatosis type 1 (von Recklingshausen's disease)]. Z Gastroenterol 2005; 42:1183-7. [PMID: 15508060 DOI: 10.1055/s-2004-813587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CASE REPORT A 72-year-old female patient with known neurofibromatosis type 1 was admitted to the hospital with symptomatic anaemia and a history of melaena. Upper and lower endoscopy did not show any signs of bleeding. Ultrasound and computed tomography revealed an abdominal mass. The histological analysis of a US-guided puncture showed a mesenchymal tumour with spindle-shaped appearance. Laparotomy revealed two jejunal tumours which could be classified as gastrointestinal stromal tumours (GIST) by immunohistochemistry. CONCLUSION Patients with neurofibromatosis type 1 have an increased risk of developing gastrointestinal tumours including rare types such as GIST. Because the localisation in the small intestine by conventional endoscopy can be difficult, further diagnostic means such as ultrasound, computed tomography or possibly capsule endoscopy should be considered.
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Affiliation(s)
- S Köppen
- Medizinische Klinik, Klinikum Minden.
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18
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Abstract
BACKGROUND A benign condition is a relative contraindication to the use of self-expanding metallic stents, because these devices usually are not retrievable. The self-expanding plastic stent is removable and induces less tissue hyperplasia. This study prospectively evaluated the use of a self-expanding plastic stent to treat benign esophageal conditions. METHODS Over 4 years, 21 patients underwent self-expanding plastic stent placement for various benign esophageal disorders, including refractory peptic (n = 2), caustic (n = 3), post-radiotherapy (n = 3), and anastomotic (n = 4) stenoses; hyperplastic (n = 5) stenosis within a previously implanted metallic stent; and anastomotic leak (n = 4) after esophagectomy. The self-expanding plastic stent was removed from all patients. Patients were followed for at least 8 months after stent removal. RESULTS Implantation was successful in all cases. Temporary self-expanding plastic stent placement was curative in 17/21 patients, especially those with caustic and hyperplastic strictures and anastomotic fistula, all of which were treated successfully without re-intervention. Median follow-up was 21 months (range 8-39 months) after stent removal. Moreover, by inducing tissue ischemia, self-expanding plastic stent allowed delayed removal of metallic stents. Only one severe complication (tracheal compression) was encountered, and this resolved after stent removal. CONCLUSIONS A range of benign stenosing disorders of the esophagus can be treated safely with a self-expanding plastic stent. Because the long-term results were highly favorable, self-expanding plastic stent placement could be used as the initial treatment for various conditions. Self-expanding plastic stent insertion within an esophageal self-expanding metallic stent allowed removal of the latter, theoretically unretrievable, stent.
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Affiliation(s)
- Sylvie Evrard
- Department of Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
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19
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Koester MO, Pross M, Dormann A, Roecken C, Lippert H, Huchzermeyer H. [Multiple focal liver lesions of a 33 year-old female. Presentation of an unexpected differential diagnosis]. Internist (Berl) 2004; 46:69-74. [PMID: 15480523 DOI: 10.1007/s00108-004-1284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report the case of a 33 year-old female with a history of 16 years of oral contraception who had been admitted to hospital for further diagnosis of multiple focal liver lesions; laboratory findings showed elevated levels of gamma-GT und AP. Diagnostic procedures showed no primary malignancy as possible reason for metastasis. All further imaging procedures compared with doppler-enhanced ultrasound did not help in diagnosis and lead to inconsistent results. Transcutaneous liver-biopsy showed normal liver histology. In laparoscopic biopsy the result was multifocal adenoma. Because of the rupture risk and potential malignant transformation and no change of sonomorphologic appearance within 12 months a liver-segment resection has been undertaken. Pathology revealed the diagnosis of a multifocal hyperplastic-adenomateous focal-nodular hyperplasia. This case shows that there is no need to use different methods of medical imaging redundantly. We favor a fine-needle double-puncture (lesion and extra-lesion) and tissue examination through an experienced pathologist. A total resection of the lesion is necessary in case of resting uncertainty to characterize its tissue characteristics.
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20
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Köppen S, Wejda B, Dormann A. [Biliary ascariasis after cholecystectomy and papillotomy in a non-endemic area]. Dtsch Med Wochenschr 2004; 129:2035-7. [PMID: 15386206 DOI: 10.1055/s-2004-831842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 61-year-old woman was admitted to hospital with nausea and vomiting. Four years earlier she had undergone cholecystectomy and papillotomy. INVESTIGATIONS Laboratory examination showed a slight increase of aspartate and alanine aminotransferase, glutamyl transpeptidase, and moderate eosinophilia. Ultrasound revealed an elongated echogenic structure within the common bile duct. At endoscopic cholangiopancreaticography (ERCP) a 23 cm-long Ascaris lumbricoides was found. TREATMENT AND COURSE The worm was removed endoscopically with forceps. Antihelmintic therapy with mebendazole was given. After that the patient was well and laboratory findings were normal. CONCLUSION Biliary ascariasis should also be considered in a non-endemic area. Previous cholecystectomy and papillotomy are predisposing factors. In our case ERCP was the diagnostic and therapeutic method of choice.
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Affiliation(s)
- S Köppen
- Medizinische Klinik, Klinikum Minden, Minden.
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21
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Abstract
BACKGROUND AND STUDY AIMS The current standard approach to the management of malignant gastric outlet obstruction mainly involves bypass surgery, which is associated with significant rates of mortality and morbidity. Recently, metal stents have emerged as a new therapeutic option. The aim of the present study was to review the currently published evidence on the effectiveness and safety of this form of endoscopic treatment. MATERIALS AND METHODS A systematic review of the published data was carried out by searching medline, embase, and abstracts from the major gastroenterological conferences from January 1992 to September 2003. A total of 136 relevant publications were identified (case series, single case reports, letters and editorials, or reviews). The systematic review included 32 case series from a total of 46 publications identified as reporting primary clinical data. Abstracts and single case reports were not taken into account. Analysis of these 32 case series included data on technical success (successful stent placement and deployment), clinical success (relief of symptoms such as nausea and vomiting, and/or improvement of food intake), and complications. Pooled results were calculated from the 32 studies (10 of which were prospective). RESULTS Stent insertion was attempted in 606 patients with malignant symptomatic gastroduodenal obstruction; 94 % of the patients were unable to take food orally or were mainly ingesting liquids. Stent placement and deployment were successful in 589 of the patients (97 %). Clinical success was achieved in 526 patients in the group in which technical success was reported (89 %; 87 % of the entire group undergoing stenting). Disease-related factors accounted for the majority of clinical failures. Oral intake became possible in all of the patients in whom a successful procedure was carried out, with 87 % taking soft solids or a full diet, with final resolution of symptoms occurring after a mean of 4 days. There was no procedure-related mortality. Severe complications (bleeding and perforation) were observed in seven patients (1.2 %). Stent migration was reported in 31 patients (5 %). Stent obstruction occurred in 104 cases (18 %), mainly due to tumor infiltration. The mean survival period was 12.1 weeks. CONCLUSIONS Published evidence from case series suggests that gastroduodenal stenting offers good palliation and is a safe and effective treatment option in patients with a short remaining lifespan. However, patient selection for this intervention continues to be an issue requiring thorough consideration, and studies comparing the method with surgery are needed.
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Affiliation(s)
- A Dormann
- Dept. of Medicine, Minden Hospital, Minden, Germany.
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22
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Shang E, Suchner U, Dormann A, Senkal M. Structure and organisation of 47 nutrition support teams in Germany: a prospective investigation in 2000 German hospitals in 1999. Eur J Clin Nutr 2003; 57:1311-6. [PMID: 14506494 DOI: 10.1038/sj.ejcn.1601693] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluation. Contrary to the Anglo-American region, very little is known in Germany on the structure and organisation of nutrition support teams (NST). DESIGN Prospective investigation of the structure and organisation of German NST, using standardised interview questionnaires. SETTINGS Hospitals with more than 250 beds in Germany. SUBJECTS German NST (n=47). INTERVENTIONS Face-to-face interview in 1999, using a standardised questionnaire. RESULTS From a total of 2000 German hospitals, NST have been established at 47 hospitals (2.3%). Most NST are affiliated to a large university hospital or an academic teaching hospital. In general, the NST are not independently operating units but are affiliated to a special discipline, and were in operation for an average of 8 y. The NST cared for a median of 65 outpatients annually. At the university hospitals in average, 477 in-patients were treated per year, at the teaching hospitals 400 and at all other hospitals 179. The work of the NST centred on enteral nutrition. A total of 47% of the physicians, 19% of the nurses and 19% of the dietitians in the NST held a nutrition-specific additional qualification. A total of 2% of the physicians, 68% of the nurses and 77% of the dietitians are exclusively responsible for the NST. More than 70% of the financing of the personnel was secured through third-party funds. CONCLUSION In Germany, neither uniform nor comprehensive patient care by NST existed in 1999. More than 50% of all NST members do not hold a nutrition-specific additional qualification. Frequently, besides their tasks in the team, the NST staff also carries out other clinical functions. Contrary to the American NST, the German NST are not interdisciplinary operating units but are primarily financed through third-party funds of the industry.
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Affiliation(s)
- E Shang
- Department of Surgery, University Hospital Mannheim, Mannheim, Germany.
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Köppen S, Wejda B, Dormann A, Seesko H, Huchzermeyer H, Junghanss T. [Anaphylactic shock caused by rupture of an echinococcal cyst in a 25-year-old asylum seeker from Georgia]. Dtsch Med Wochenschr 2003; 128:663-6. [PMID: 12660898 DOI: 10.1055/s-2003-38280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 25-year-old asylum seeker from Georgia was admitted to hospital with acute right upper quadrant abdominal pain, vertigo, dyspnea, generalized urticaria and positive shock index (blood pressure 80/40 mmHg, pulse 120/min) several minutes after eating an instant soup. INVESTIGATIONS Laboratory investigations showed a slight increase of the eosinophilic cell count and GOT and GPT activities. Abdominal ultrasound scan (USS) and computed tomography (CT) revealed a multivesicular septated cystic space-occupying lesion of the right liver lobe (segment VII, 13 x 9 x 8 cm) and perihepatic fluid. TREATMENT AND COURSE Intravenous steroids, H 1 and H 2 antagonists and fluid were given. Emergency laparatomy with endocystectomy was performed. A 3-month course of antihelmintic therapy with albendazole was applied. During follow-up up to one year after surgery the patient did well. Ultrasonography and computed tomography showed only a small residual defect in the right liver lobe where the cyst had been removed. CONCLUSION In patients from echinococcosis-endemic regions who develop an anaphylactic reaction, a ruptured Echinococcus granulosus cyst should be considered in the differential diagnosis. Abdominal ultrasonography and serology (to be noted: substantial rate of false negative results!) should be performed.
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Affiliation(s)
- S Köppen
- Medizinische Klinik, Klinikum Minden
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24
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Dormann A, Stehle P, Radziwill R, Löser C, Paul C, Keymling M, Lochs H. DGEM-Leitlinie Enterale Ernährung:Grundlagen. Akt Ernähr Med 2003. [DOI: 10.1055/s-2003-36935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND & AIMS Interdisciplinary nutrition-support teams (NSTs) can improve the efficacy of clinical nutrition. The purpose of this survey was to investigate the prevalence, and structure of German NSTs. METHOD Hospitals in Germany with more that 250 beds were screened for the existence of NSTs. Eligible NSTs were interviewed about structural characteristics, administration of clinical nutrition and quality control in a face-to-face manner using a standardised questionnaire. RESULTS A total of 47 NSTs existed in Germany revealing a prevalence of 5.6%. Their main activities were creating nutritional regimens (100%), education (98%) and monitoring nutrition therapy (96%). Twenty-two of NST-physicians (50%) had a specific education as compared to 20.9% NST-nurses and 24% NST-dietitians. Only 12.7% of physicians and 17% of dieticians in comparison to 55.3% of nurses received funding support. Improvement of clinical nutrition by means of increased use of enteral nutrition and special diets was indicated by 72%, 23%, respectively. Some NSTs indicated a reduction of complications (38.3%) and cost-saving (34%) since their establishment. CONCLUSIONS There is a low prevalence of interdisciplinary NSTs in Germany. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.
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Affiliation(s)
- Metin Senkal
- Department of Surgery, Ruhr-University Bochum, St. Josef Hospital, Germany
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26
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Spira ME, Oren R, Dormann A, Ilouz N, Lev S. Calcium, protease activation, and cytoskeleton remodeling underlie growth cone formation and neuronal regeneration. Cell Mol Neurobiol 2001; 21:591-604. [PMID: 12043835 DOI: 10.1023/a:1015135617557] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The cytoarchitecture, synaptic connectivity, and physiological properties of neurons are determined during their development by the interactions between the intrinsic properties of the neurons and signals provided by the microenvironment through which they grow. Many of these interactions are mediated and translated to specific growth patterns and connectivity by specialized compartments at the tips of the extending neurites: the growth cones (GCs). The mechanisms underlying GC formation at a specific time and location during development, regeneration, and some forms of learning processes, are therefore the subject of intense investigation. Using cultured Aplysia neurons we studied the cellular mechanisms that lead to the transformation of a differentiated axonal segment into a motile GC. We found that localized and transient elevation of the free intracellular calcium concentration ([Ca2+]i) to 200-300 microM induces GC formation in the form of a large lamellipodium that branches up into growing neurites. By using simultaneous on-line imaging of [Ca2+]i and of intraaxonal proteolytic activity, we found that the elevated [Ca2+]i activate proteases in the region in which a GC is formed. Inhibition of the calcium-activated proteases prior to the local elevation of the [Ca2+]i blocks the formation of GCs. Using retrospective immunofluorescent methods we imaged the proteolysis of the submembrane spectrin network, and the restructuring of the cytoskeleton at the site of GC formation. The restructuring of the actin and microtubule network leads to local accumulation of transported vesicles, which then fuse with the plasma membrane in support of the GC expansion.
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Affiliation(s)
- M E Spira
- Department of Neurobiology, Institute of Life Sciences, The Hebrew University of Jerusalem, Israel.
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27
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Dormann A. [Endoscopic planning of percutaneous endoscopic gastrostomy (PEG-/PEJ-probe) for enteral nutrition]. Dtsch Med Wochenschr 2001; 126:191-2. [PMID: 11236530 DOI: 10.1055/s-2001-11197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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28
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Abstract
Procedures in clinical nutrition have gained both invasiveness as well as the complexity. Thus improved education of professionals and their alliance in hospital based nutritional support teams (NST) is demanding. Two forms of collaboration, the "interdisciplinary nutritional committee" and the "department for nutritional therapy", are discussed. It is the goal of this contribution to present structure and tasks of an independently working department for nutritional support therapy. The pertinent areas of activity are composed as followed: clinical nutritional therapy, home nutrition, education, research, and quality management. The team members include the physician, the dietitian, the nurse, the nutritionist, and the pharmacist. The individual tasks as well as the areas of responsibility are presented. We discuss, whether nutritional support teams might be suitable to achieve cost reduction, provided adequate working conditions are available. Issues like "performance related reimbursement" and "NST certification" by health care organizations are discussed. We also elude to the option to merge services with other health care providers in order to built up an inter-disciplinary organization system. We conclude that nutritional support teams have to be prepared to meet hospital needs. Costs/benefit balances have to be assessable and must be documented. Although the effectiveness of selected nutritional support teams was clearly shown, it is the challenge of each individual team to produce proof of effectiveness for itself. Acceptable working conditions, however, should be provided as they have to be considered indispensable to achieve high quality performance.
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Affiliation(s)
- U Suchner
- Klinik für Anästhesiologie, Klinikum Grosshadern, Ludwig-Maximilians Universität, München
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29
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Spira ME, Dormann A, Ashery U, Gabso M, Gitler D, Benbassat D, Oren R, Ziv NE. Use of Aplysia neurons for the study of cellular alterations and the resealing of transected axons in vitro. J Neurosci Methods 1996; 69:91-102. [PMID: 8912939 DOI: 10.1016/s0165-0270(96)00024-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present report describes the experimental advantages offered by the combined use of Aplysia neurons and contemporary techniques to analyze the cellular events associated with nerve injury in the form of axotomy. The experiments were performed by transecting, under visual control, the main axon of identified Aplysia neurons in primary culture while monitoring several related parameters. We found that in cultured Aplysia neurons axotomy leads to the elevation of the [Ca2+]i in both the proximal and distal axonal segments from a resting level of 100 nM up to the millimolar range for a duration of 3-5 min. This increase in [Ca2+]i led to identical alterations in the cytoarchitecture of the proximal and distal segments. The formation of a membrane seal over the transected ends by their constriction and the subsequent fusion of the membrane is a [Ca2+]i-dependent process and is triggered by the elevation of [Ca2+]i to the microM level. Seal formation was followed by down-regulation of the [Ca2+]i to control levels. Following the formation of the membrane seal an increase in membrane retrieval was observed. We hypothesize that the retrieved membrane serves as an immediately available membrane reservoir for growth cone extension.
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Affiliation(s)
- M E Spira
- Dept. of Neurobiology, Life Sciences Institute, The Hebrew University of Jerusalem, Israel
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30
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Abstract
We report a 35 year old male, human immunodeficiency virus (HIV)-infected patient with acquired immune deficiency syndrome (AIDS), who presented with rapidly progressive pulmonary Kaposi's sarcoma. The tumour regressed with treatment with liposomal daunorubicin and remained in partial remission until the patient died 12 months later from complications of HIV infection. Liposomal daunorubicin may be a safe and effective alternative to the treatment protocols in current use for pulmonary Kaposi's sarcoma.
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Affiliation(s)
- D Schürmann
- 2nd Dept of Internal Medicine (Dept for Infectious Diseases), Rudolf Virchow University Hospital, Freie Universität Berlin, Germany
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31
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Spira ME, Benbassat D, Dormann A. Resealing of the proximal and distal cut ends of transected axons: electrophysiological and ultrastructural analysis. J Neurobiol 1993; 24:300-16. [PMID: 8492108 DOI: 10.1002/neu.480240304] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The fates of the proximal and distal segments of transected axons differ. Whereas the proximal segment usually recovers from injury and regenerates, the distal segment degenerates. In the present report we studied the kinetics of the recovery processes of both proximal and distal axonal segments following axotomy and its temporal relations to the alterations in the cytoarchitecture of the injured neuron. The experiments were performed on primary cultured metacerebral neurons (MCn) isolated from Aplysia. We transected axons while monitoring the changes in transmembrane potential and input resistance (Rn) by inserting intracellular microelectrodes into the soma and axon. Correlation between the electrophysiological status of the injured axon and its ultrastructure was provided by rapid fixation of the neuron at selected times postaxotomy. Axotomy leads to membrane depolarization from a mean of -55.7 S.D. 12.8 mV to -12.7 S.D. 3.3 mV and decreased Rn from tens of M omega to 1-3 M omega. The transected axons remained depolarized for a period of 10-260 s for as long as the axoplasm was in direct contact with the bathing solution. Rapid repolarization and partial recovery of Rn was associated with the formation of a membrane seal over the cut ends by the constriction and subsequent fusion of the axolema. Prior to the formation of a membraneous barrier, electron-dense deposits aggregate at the tip of the cut axon and appear to form an axoplasmic "plug." Electrophysiological analysis revealed that this "plug" does not provide resistance for current flow and that the axoplasmic resistance is homogenously distributed. The kinetics of injury and recovery processes as well as the ultrastructural changes of the proximal and distal segments are identical suggesting that the different fates of the segments cannot be attributed to differences in the immediate response of the segments to axotomy.
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Affiliation(s)
- M E Spira
- Department of Neurobiology, Hebrew University of Jerusalem
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Spira ME, Dormann A, Zeldes D. Neuronal architecture, receptor and Ca2+ channel distribution in regenerating giant interneurons. J Basic Clin Physiol Pharmacol 1990; 1:125-40. [PMID: 1964801 DOI: 10.1515/jbcpp.1990.1.1-4.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M E Spira
- Department of Neurobiology, Life Sciences Institute, Hebrew University of Jerusalem, Israel
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33
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Spira ME, Zeldes D, Hochner B, Dormann A. The effects of microenvironment on the redifferentiation of regenerating neurones: neurite architecture, acetylcholine receptors and Ca2+ channel distribution. J Exp Biol 1987; 132:111-31. [PMID: 2448413 DOI: 10.1242/jeb.132.1.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Severed adult neurones, which are capable of regrowth, encounter different microenvironments from those encountered during development. Moreover, adult neurones may respond in a different manner from developing neurones to the same environmental cues. Thus, the recovery of the integrative and transmission capabilities (which depend on the neuronal architecture, passive and active membrane properties, and synaptic receptor distribution) by a regenerating adult neurone may not be complete. In the present review, we examine several aspects of the outcome of the interaction between the microenvironment and regrowing neurones using the cockroach giant interneurones (GINs) as a model system. We demonstrate that whereas extrinsic cues govern the morphological redifferentiation and distribution of synaptic receptors, the distribution of voltage-dependent Ca2+ channels is to a large extent determined by intrinsic factors. The pathway of regrowth and the architecture of regenerating GINs were studied by examination of intracellularly stained fibres. The environments provided by the connectives and ganglia are different. The elongating sprouts in the connective appeared as smooth cylinders. Within the ganglionic domain, the main longitudinal sprouts emitted neurites which extended and branched into the neuropile. The local cues for branching of neurites were eliminated by freezing and thawing of the ganglia prior to the arrival of the growing tips. The failure to extend neurites under these conditions is attributed to the elimination of extrinsic signals for morphological redifferentiation of the fibres, since the same fibres emit neurites in anterior ganglia which have not been subjected to freezing and thawing. The distribution of acetylcholine receptors (AChRs) on the GINs was mapped by ionophoretic application of ACh. In both the intact and regenerating GINs receptors were located only on the neurites. Freezing and thawing of a ganglion eliminated the local signals for insertion and/or activation of AChRs on the neurites. Thus, both the morphological redifferentiation and the distribution of AChRs are affected by the microenvironment. Voltage-dependent Ca2+ channels were detected after intracellular injection of tetraethylammonium into the GIN and in the presence of tetrodotoxin (TTX) and Ba2+ in the extracellular space. The regrowing axon tips always revealed large barium action potentials independent of the CNS microenvironment. This observation is consistent with the hypothesis that Ca2+ plays an important role in the growth process. However, increased Ba2+ responsiveness was also observed in axonal segments proximal to the region of neuronal extension.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- M E Spira
- Department of Neurobiology, Hebrew University, Jerusalem, Israel
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Meiri H, Dormann A, Spira ME. Comparison of ultrastructural changes in proximal and distal segments of transected giant fibers of the cockroach Periplaneta americana. Brain Res 1983; 263:1-14. [PMID: 6839162 DOI: 10.1016/0006-8993(83)91195-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
When the giant axons of the cockroach Periplaneta americana are transected the proximal segment (the part connected to the soma) regenerates by tip sprouting and the distal segment degenerates. The initial ultrastructural response (24-48 h post-transection) occurring in the cut ends of the proximal and distal segments are similar. This response includes the disappearance of neurotubules; appearance of amorphous material in the axoplasm and a gradual accumulation of large numbers of small mitochondria, vesicles of various sizes and smooth endoplasmic reticulum. The axolemma in the region of organelle accumulation invaginates and glial processes are present in the invagination. The similarity of the changes that occur in the cut ends of the proximal and distal segments indicates that the primary reaction to axotomy is of a local nature and does not depend on the soma. Two to four days after transection, the cut end of the distal axonal segment reveals signs of degeneration. These include the appearance of swollen mitochondria, lysosomes, myelinated bodies and shrinking of the axon. In addition there is a massive proliferation of glial processes around the degenerating axons. Sprouting from the tip of the proximal segment starts 5--7 days post axotomy. Sprouts were identified as profiles containing few neurotubules, many vesicles and abundant smooth endoplasmic reticulum. 'Growth cone-like' structures were identified. The ultrastructural reorganization of the cut end of the proximal segment is discussed in relation to changes in membrane properties of the regenerating tip, as previously described by us.
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35
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Peters PD, Yarom R, Dormann A, Hall T. X-ray microanalysis of intracellular Zinc: EMMA-4 examinations of normal and injured muscle and myocardium. J Ultrastruct Res 1976; 57:121-31. [PMID: 994282 DOI: 10.1016/s0022-5320(76)80102-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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36
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Yarom R, Stein H, Dormann A, Peters PD, Hall TA. Aurothiomalate as an ultrastructural marker. Electron microscopy and x-ray microanalysis of various tissues after in vivo gold injections. J Histochem Cytochem 1976; 24:453-62. [PMID: 1254942 DOI: 10.1177/24.2.1254942] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rabbits and rats were given single injections of aurothiomalate by different routes. The animals were killed at progressive intervals, and sections from various organs were examined by electron microscopic x-ray microanalysis. Ultrastructurally, characteristic material was regularly found in vacuoles, dense and heterogeneous bodies of macrophages, hepatocytes and renal epithelial cells. Occasionally, other mesenchymal cells also contained gold. Histochemical and analytical tests showed that the gold-containing organelles were devoid of acid phosphatase activity. The generalized rapid spread, retention and selectivity of localization after a single small dose make aurothiomalate a useful marker substance for ultrastructural studies.
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