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Bertram F, Hajek A, König HH, Wulff B, Ondruschka B, Püschel K, Heinrich F. Psychiatric and somatic health of homeless individuals in the context of their migration history. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Descriptions of homeless individuals’ somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access.
Methods
A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status.
Results
306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals.
Conclusions
Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system.
Key messages
• Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants.
• Our data underline the need for specific care services for homeless individuals.
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Affiliation(s)
- F Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - A Hajek
- Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - H-H König
- Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - B Wulff
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - B Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - K Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - F Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
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Gaspar N, Marshall LV, Binner D, Herold R, Rousseau R, Blanc P, Capdeville R, Carleer J, Copland C, Kerloeguen Y, Norga K, Pacaud L, Sevaux MA, Spadoni C, Sterba J, Ligas F, Taube T, Uttenreuther-Fischer M, Chioato S, O'Connell MA, Geoerger B, Blay JY, Soria JC, Kaye S, Wulff B, Brugières L, Vassal G, Pearson ADJ. Joint adolescent-adult early phase clinical trials to improve access to new drugs for adolescents with cancer: proposals from the multi-stakeholder platform-ACCELERATE. Ann Oncol 2018; 29:766-771. [PMID: 29351570 PMCID: PMC5889024 DOI: 10.1093/annonc/mdy002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- N Gaspar
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France.
| | - L V Marshall
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK
| | - D Binner
- Create for Chloe and UK Representative for aPODD, European Medicines Agency, London, UK
| | - R Herold
- Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - R Rousseau
- Gritstone Oncology, Inc., Emeryville, USA
| | - P Blanc
- Imagine for Margo, Fourqueux, France
| | | | - J Carleer
- Belgium Federal Agency for Medicines and Health Products, EUROSTATION, Brussels, Belgium
| | - C Copland
- Centre for English Language Teaching, University of York, York, UK
| | - Y Kerloeguen
- Pharmaceuticals Division, PDOA, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - K Norga
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK; Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | | | | | - C Spadoni
- aPODD Foundation, City Point, London, UK
| | - J Sterba
- Pediatric Oncology Department, University Hospital Brno, School of Medicine Masaryk University Brno, Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, ICRC Brno, St. Anna University Hospital Brno, Czech Republic
| | - F Ligas
- Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - T Taube
- Boehringer Ingelheim, Pharma GmbH&Co KG, TA Oncology, Biberach, Germany
| | | | - S Chioato
- Regulatory Strategy Oncology, Pfizer Italia, Milano, Italy
| | - M A O'Connell
- Regulatory Strategy Oncology, Pfizer Italia, Milano, Italy
| | - B Geoerger
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - J-Y Blay
- Centre Léon Bérard and University Claude Bernard Lyon 1, Lyon
| | - J C Soria
- Drug Development Department (DITEP), Gustave Roussy, Villejuif and University Paris-Sud, Orsay, France
| | - S Kaye
- Adult Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - B Wulff
- Paediatric Haematology/Oncology, Clinical Research/Paediatric Drug Development, University Childreńs Hospital III Hufelandstraße, Essen, Germany
| | - L Brugières
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - G Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif and Paris-Sud University, Le Kremlin-Bicêtre, France
| | - A D J Pearson
- Paediatric and Adolescent Drug Development Team, Oak Centre for Children & Young People, The Royal Marsden Hospital & The Institute of Cancer Research, London, UK
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Krause M, Museyko O, Wulff B, Campbell G, Damm T, Daug schies M, Huber G, Lu Y, Peña J, Waldhausen S, Bastgen J, Rohde K, Breer S, Steinebach I, Thomsen F, Amling M, Barkmann R, Engelke K, Morlock M, Pfeilschifter J, Püschel K, Glüer CC. New horizons for the in vivo assessment of major aspects of bone quality. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1630120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe Biomechanically founded individualised osteoporosis Assessment and treatment (BioAsset) consortium pursues experimental and clinical studies in the context of skeletal effects of bisphosphonate treatment. Here, first results using newly developed diagnostic methods in a set of vertebral bone specimen obtained from donors with documented bisphosphonate history ranging from 0 to more than 5 years of treatment are presented. A new thoracolumbar quantitative computed tomography (QCT) protocol covering T6 to L4 plus high-resolution QCT (HRQCT) assessment of T12 were compared with high-resolution peripheral QCT (HRpQCT) and micro-CT scans of excised specimens serving as gold standard techniques. Finite element (FE) modelling was performed. Material, ultrastructural, and micromechanical properties were tested on a set of single trabeculae obtained from the donor specimens. A newly developed quantitative ultrasound (QUS) device for measuring the anisotropy of cortical material properties at the tibia was designed and built. The thoracolumbar QCT protocol permitted in situ imaging with good image quality and automated segmentation of vertebral bodies in the whole range from T6 to L4. The duration of bisphosphonate treatment was significantly associated with increased levels of mineralization and this effect could be measured with HRQCT performed on excised specimens. Microstructural parameters contributed to vertebral bone strength modelled by FE analysis independently of bone mineral density. The new QUS tibia scanner permitted measuring the acoustical anisotropy of reference materials. Taken together, these results document that new methods developed in BioAsset permit a more comprehensive assessment of bone fragility. The set of donor specimens with a documented history of bisphosphonate treatment allows for the assessment of the effects of long-term treatment from the organ down to the tissue and material level. These results will ultimately be linked to the parallel clinical study to provide guidance for determining the optimum duration of bisphosphonate treatment to reduce the incidence of osteoporotic fractures.
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Krause M, Soltau M, Zimmermann EA, Hahn M, Kornet J, Hapfelmeier A, Breer S, Morlock M, Wulff B, Püschel K, Glueer CC, Amling M, Busse B, Busse B. Effects of long-term alendronate treatment on bone mineralisation, resorption parameters and biomechanics of single human vertebral trabeculae. Eur Cell Mater 2014; 28:152-63; discussion 163-5. [PMID: 25241965 DOI: 10.22203/ecm.v028a12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Indexed: 01/31/2023] Open
Abstract
Due to their well-established fracture risk reduction, bisphosphonates are the most frequently used therapeutic agent to treat osteoporosis. Bisphosphonates reduce fracture risk by suppressing bone resorption, but the lower bone turnover could have a negative impact on bone quality at the tissue level. Here, we directly assess the structural and mechanical characteristics of cancellous bone from the lumbar vertebrae (L5) in non-treated osteoporotic controls (n=21), mid-term alendronate-treated osteoporotic patients (n=6), and long-term alendronate-treated osteoporotic patients (n=7). The strength and toughness of single trabeculae were evaluated, while the structure was characterised through measurements of microdamage accumulation, mineralisation distribution, and histological indices. The alendronate-treated cases had a reduced eroded surface (ES/BS, p<0.001) and a higher bone mineralisation in comparison to non-treated controls (p=0.037), which is indicative of low turnover associated with treatment. However, the amount of microdamage and the mechanical properties were similar among the control and treatment groups. As the tissue mineral density (TMD) increased significantly with alendronate treatment compared to non-treated osteoporotic controls, the reduction in resorption cavities could counterbalance the higher TMD allowing the alendronate-treated bone to maintain its mechanical properties and resist microdamage accumulation. A multivariate analysis of the possible predictors supports the theory that multiple factors (e.g., body mass index, TMD, and ES/BS) can impact the mechanical properties. Our results suggest that long-term alendronate treatment shows no adverse impact on mechanical cancellous bone characteristics.
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Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg,
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Krause M, Museyko O, Breer S, Wulff B, Duckstein C, Vettorazzi E, Glueer C, Püschel K, Engelke K, Amling M. Accuracy of trabecular structure by HR-pQCT compared to gold standard μCT in the radius and tibia of patients with osteoporosis and long-term bisphosphonate therapy. Osteoporos Int 2014; 25:1595-606. [PMID: 24566588 DOI: 10.1007/s00198-014-2650-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/05/2014] [Indexed: 12/27/2022]
Abstract
UNLABELLED Despite an increasing use of high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone morphology in vivo, there are reservations about its applicability in patients with osteoporosis and antiresorptive therapy. This study shows that HR-pQCT provides acceptable in vivo accuracy for bone volume fraction (BV/TV) in patients with osteoporosis and bisphosphonate (BP) treatment. INTRODUCTION The primary aim was to analyze agreement of trabecular structure between HR-pQCT and gold standard microtomography (μCT) in patients with osteoporosis and long-term BP therapy. METHODS In the BioAsset study, we analyzed cadaver radii and tibiae of 34 postmenopausal females (81.1 ± 7.1 years) with osteoporosis (no BP n = 22, 1-5 years BP n = 5, >5 years BP n = 7). Two HR-pQCT protocols (patient-mode and μCT-mode) were compared with gold standard μCT after image registration. Undecalcified histological sections were obtained to quantify nonmineralized bone matrix. Bland-Altman plots illustrated methodological agreement. Multiple regression analysis was used to test for variables associated with method agreement. RESULTS In the radius and tibia, patient-mode HR-pQCT derived indices including bone volume fraction, trabecular number, and trabecular separation correlated well with gold standard μCT (R(2) = 0.78 - 0.88) except for trabecular thickness (R(2) = 0.11). Bland-Altman plots illustrated adequate agreement for bone volume fraction. Lower agreement of trabecular number and trabecular separation improved with decreasing structural impairment at the tibia only. Trabecular thickness was not appropriately assessed with HR-pQCT at both skeletal sites. Higher agreement for bone volume fraction was associated with increasing tissue mineral density in the tibia. CONCLUSIONS HR-pQCT provides acceptable in vivo accuracy for BV/TV in patients with osteoporosis and BP treatment. Higher TMD was associated with higher BV/TV accuracy in vivo. Overall, methodological agreement got less accurate with increasing structural impairment in the tibia.
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Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wulff B, Iwersen- Bergmann S, Pabel T, Püschel K. Suizide von über 80-jährigen in Hamburg unter Berücksichtigung geschlechtsspezifischer Aspekte. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0945-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Museyko O, Heinemann A, Krause M, Wulff B, Amling M, Püschel K, Glüer CC, Kalender W, Engelke K. A low-radiation exposure protocol for 3D QCT of the spine. Osteoporos Int 2014; 25:983-92. [PMID: 24142100 DOI: 10.1007/s00198-013-2544-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
SUMMARY Cadaver and phantom measurements and simulations confirmed that radiation exposure in 3D QCT of the spine can be reduced if 80 kV instead of 120 kV protocols are used; 120 mAs and slice thicknesses of 1-1.3 mm should be usable but obese patient will require higher milliampere-second settings. PURPOSE To develop a low-radiation exposure CT acquisition protocol for 3D QCT of the thoracolumbar spine. METHODS Twenty-six cadavers were scanned with a standard protocol of 120 kV, 100 mAs and with a low-dose protocol using 90 kV, 150 mAs. The scan range included the vertebrae T6 to L4. Each vertebra was segmented and the integral volume and BMD of the total vertebral body were determined. Effective dose values were estimated. The impact of milliampere-second reduction on image quality was simulated by adding noise. RESULTS One hundred ninety-six vertebrae were analyzed. Integral volume as well as integral BMD correlated significantly (p < 0.001) between standard and low-dose protocols (volume, r (2) = 0.991, residual root mean square (RMS) error, 0.77 cm(3); BMD, r (2) = 0.985, RMS error, 4.21 mg/cm(3)). The slope significantly differed from 1 for integral BMD but not for volume hinting at residual field inhomogeneity differences between the two voltage settings that could be corrected by cross-calibration. Compared to the standard protocol, effective dose was reduced by over 50 % in the low-dose protocol. Adding noise in the 90 kV images to simulate a reduction from 150 to 100 mAs did not affect the results for integral volume or BMD. CONCLUSIONS For 3D QCT of the spine, depending on scanner type, 80 or 90 kV instead of 120 kV protocols may be considered as an important option to reduce radiation exposure; 120 mAs and slice thicknesses of 1-1.5 mm are usable if segmentation is robust to noise. In obese patients, higher milliampere-second settings will be required.
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Affiliation(s)
- O Museyko
- Institute of Medical Physics (IMP), University of Erlangen-Nuremberg, Henkestr. 91, 91052, Erlangen, Germany,
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Hagen RM, Wulff B, Loderstaedt U, Fengler I, Frickmann H, Schwarz NG, Polywka S. Is rapid hepatitis C virus testing from corpses a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field? J ROY ARMY MED CORPS 2013; 160:226-31. [PMID: 24113204 DOI: 10.1136/jramc-2013-000133] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We tested a commercially available rapid hepatitis C virus (HCV) test assay for its potential use for analyses of corpses as a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field. MATERIALS AND METHODS 50 blood samples were drawn from 16 recently deceased confirmed HCV-positive patients whose corpses were stored at 4°C in the mortuary and were analysed at admission and up to 48 h post mortem by rapid serological testing using the ImmunoFlow HCV test (Core Diagnostics, Birmingham, UK) in comparison with automated serological assays and PCR. Samples from 50 HCV-negative corpses were also analysed. RESULTS The blood of only four of the 16 HCV-positive corpses reacted clearly with the ImmunoFlow HCV test, while in five cases the result was only weakly reactive and three cases showed very weak reactivity. Four of the infected corpses showed initially negative results, three of which became very weakly reactive 48 h post mortem. 49 out of 50 samples (98%) from HCV-negative corpses tested negative. DISCUSSION The rapid test system we investigated showed insufficient sensitivity regarding the identification of HCV positivity. Automated serological testing or PCR should be preferred if it is realistically available in the deployed military setting.
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Affiliation(s)
- Ralf M Hagen
- Department of Tropical Medicine at the Bernhard, Nocht Institute, German Armed Forces Hospital Hamburg, Hamburg, Germany
| | - B Wulff
- Institue for Forensic Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - U Loderstaedt
- Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany
| | - I Fengler
- Laboratory Department 1, Central Institute of the German Armed Forces Medical Services, Koblenz, Germany
| | - H Frickmann
- Department of Tropical Medicine at the Bernhard, Nocht Institute, German Armed Forces Hospital Hamburg, Hamburg, Germany Institute for Medical Microbiology, Virology and Hygiene, University Hospital of Rostock, Rostock, Germany
| | - N G Schwarz
- Department of Infectious Disease Epidemiology, Bernard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - S Polywka
- Institute for Medical Microbiology, Virology and Hygiene, University Hospital Eppendorf, Hamburg, Germany
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Wulff B, Heinemann A, Meins S, Püschel K, Müller K. A retrospective evaluation of informed consent for tissue donation within a year of the donor's death. Forensic Sci Int 2013; 231:240-3. [DOI: 10.1016/j.forsciint.2013.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 04/04/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
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Frickmann H, Wulff B, Loderstædt U, Hagen RM, Sturm D, Polywka S. From IEDs to AIDS? Detection of HIV in human corpses by rapid screening tests after suspected intentional transmission in terrorist attacks. J ROY ARMY MED CORPS 2013; 159:278-82. [DOI: 10.1136/jramc-2013-000048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Edler C, Wulff B, Schroder AS, Wilkemeyer I, Polywka S, Meyer T, Kalus U, Pruss A. A prospective time-course study on serological testing for human immunodeficiency virus, hepatitis B virus and hepatitis C virus with blood samples taken up to 48 h after death. J Med Microbiol 2011; 60:920-926. [DOI: 10.1099/jmm.0.027763-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tschiedel E, Gierenz N, Wieland R, Wulff B, Ballauff A. [Severe aplastic anaemia in six children after non-A-E hepatitis without hepatic failure]. Z Gastroenterol 2010; 48:825-8. [PMID: 20687018 DOI: 10.1055/s-0028-1109900] [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: 10/19/2022]
Abstract
Aplastic anaemia can coincide with non-A-E hepatitis. Treatment follows a standardised study protocol of the German Society of Paediatric Oncology and Haematology (GPOH). Patients receive immunosuppression and/or bone marrow transplantation. We present six cases of aplastic anaemia after non-A-E hepatitis with different courses. In four of these children illness first presented with acute gastroenteritis. Five out of six children fully recovered, two of these with immunosuppression alone, three after bone marrow transplantation. One patient died due to complications of the bone marrow transplantation. In two patients steroid therapy was carried out to treat the hepatitis. This did not have any effect on the course of their aplastic anemia. We emphasise this common combination of aplastic anemia following non-A-E hepatitis. This overview underlines the necessity of regular blood testing after non-A-E hepatitis. Often gastroenteritis seems to precede illness thus perhaps indicating an infectious trigger.
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Affiliation(s)
- E Tschiedel
- Kinderklinik, Universitätskinderklinik Essen.
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Wulff B, Schmidt C, Lehmann N, Liu Y, Eggert A, Kremens B, Dobos G, Spahn G. Pericardium 6 acupressure and acupuncture as additive antiemetic therapy during chemotherapy in children and adolescents—A randomized placebo-controlled pilot study. Eur J Integr Med 2009. [DOI: 10.1016/j.eujim.2009.08.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wulff B, Jungbluth T, Esnaashari H, Franke C, Bruch HP. [Surgical management of peripheral arterial disease. Operative methods and results]. Radiologe 2006; 46:931-40. [PMID: 17075710 DOI: 10.1007/s00117-006-1438-8] [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: 11/30/2022]
Abstract
Various operative and interventional methods are available to treat patients with peripheral arterial disease (PAD). The selection of the appropriate therapy should be made after a careful review of the patient's general condition, the morphology of the arterial occlusion, the risk of possible complications, and the likelihood of long-term success for each type of treatment. The different procedures complement one another in their technical possibilities and their risk profile The combination of surgical and interventional methods offers new therapeutic possibilities. The different surgical procedures and their long-term outcome are presented in this publication.
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Affiliation(s)
- B Wulff
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein--Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Wulff B, Jungbluth T, Franke C, Bruch HP. Indikation zur endovasculären Therapie aufgrund des Alters – ist die konventionelle Operation des BAA für den alten Patienten gefährlicher? Zentralbl Chir 2006. [DOI: 10.1055/s-2006-944397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fleischhack G, Schmidt-Niemann M, Wulff B, Havers W, Marklein G, Hasan C, Bode U. Piperacillin, beta-lactam inhibitor plus gentamicin as empirical therapy of a sequential regimen in febrile neutropenia of pediatric cancer patients. Support Care Cancer 2001; 9:372-9. [PMID: 11497392 DOI: 10.1007/s005200000225] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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: 11/26/2022]
Abstract
The beta-lactam/beta-lactamase inhibitor combinations are a good choice for empirical antimicrobial therapy in febrile neutropenic patients, because their antibacterial spectra include both gram-negative and gram-positive pathogens. This trial was initiated to assess the efficacy and safety of piperacillin with the beta-lactam inhibitors sulbactam (PSG group) or tazobactam (PTG group) and gentamicin as initial therapy in febrile neutropenia of pediatric patients. In a prospective study, 239 episodes of fever and neutropenia were analyzed for the clinical and microbiological response dependent on infection etiology and treatment group: 66.5% of episodes were classified as fever of unknown origin (FUO) and 33.5%, as microbiologically or clinically documented infections; 19.2% of all episodes were due to bacteremia, predominantly caused by gram-positive organisms (69.6%). The response to the initial therapy was 55.2% overall and 65.4% in episodes of FUO with a significant higher success rate in the PSG group than in the PTG group (70.1% vs. 52.4%, P=0.039), and 35.0% in documented infections. In episodes with documented infection longer duration of fever and antimicrobial therapy was recorded than for FUO episodes. Four patients died of causes related to infection. Fever relapse occurred in 26 episodes (11.1%), predominantly in patients who were still neutropenic. Toxic side effects were minimal. The initial therapy of piperacillin with sulbactam or tazobactam in combination with gentamicin is well tolerated, and its efficacy is comparable to that of other combination therapies or of monotherapy with beta-lactam antibiotics in pediatric neutropenic cancer patients.
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Affiliation(s)
- G Fleischhack
- Department of Pediatric Hematology/Oncology, University of Bonn, Germany.
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Fleischhack G, Hartmann C, Simon A, Wulff B, Havers W, Marklein G, Hasan C, Bode U. Meropenem versus ceftazidime as empirical monotherapy in febrile neutropenia of paediatric patients with cancer. J Antimicrob Chemother 2001; 47:841-53. [PMID: 11389117 DOI: 10.1093/jac/47.6.841] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
This trial assessed the efficacy and safety of meropenem versus ceftazidime as empirical monotherapy for febrile neutropenia in paediatric cancer patients. In a prospective randomized study, 172 evaluable febrile episodes in the meropenem arm and 170 episodes in the ceftazidime arm were analysed for the clinical and microbiological response dependent on the kind of infection. About half the episodes were classified as fever of unknown origin (FUO) and the remainder as microbiologically or clinically documented infections. The most frequently documented infections in both arms were bacteraemias (22.1 versus 26.5%), predominantly caused by Gram-positive organisms (57.9 versus 71.1%). The success rate of the initial monotherapy differed significantly between the two arms and was 55.8% in the meropenem and 40.0% in the ceftazidime arm (P = 0.003). In addition, a significantly longer duration of fever and of antimicrobial therapy was observed in the ceftazidime arm than in the meropenem arm (median 5 versus 4 days, P = 0.022, and 7 versus 6 days, P = 0.009, respectively). With respect to the kind of infection, differences between the two arms were significant only in episodes classified as FUO but not in documented infections. In both arms, side effects were minimal. Despite the greater response rate for meropenem in FUO, the fact that ceftazidime has been proven to be as effective as meropenem in documented infections in the present study suggests that both drugs are useful as empirical monotherapy in febrile paediatric cancer patients.
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Affiliation(s)
- G Fleischhack
- Department of Paediatric Haematology/Oncology, Children's Medical Hospital, University of Bonn, Adenauerallee 119, D-53113 Bonn, Germany.
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Abstract
UNLABELLED Primary lymphoma of bone (PLB) is a rare entity of extranodal non-Hodgkin lymphoma (NHL). We report on two children with PLB focussing on diagnostic evaluation and treatment strategy. Clinical and radiographic presentation in both children suggested a primary bone tumour such as Ewing sarcoma. A 13-year-old girl showed osteolytic tumours in the right 7th rib and right iliac crest. Additional skeletal lesions were found by whole-body positron emission tomography. A 6-year-old boy presented with an isolated, osteolytic lesion of the left distal femur. In both patients staging procedures excluded any organ involvement besides the skeletal tumours. Tumour biopsy and immunohistological studies revealed lymphoblastic non-Hodgkin lymphoma of B-cell lineage in both children. They received a polychemotherapy for B-cell lymphoma according to the NHL-BFM 95 protocol and are in complete remission with a follow up of 24 and 18 months respectively. CONCLUSION Isolated, primary lymphoma of bone in children may clinically and radiographically impose as primary bone tumour. Multiple therapeutic strategies have been applied in the treatment of this malignancy, however, treatment modalities are not well focussed on immunological patterns in the case of primary lymphoma of bone. Staging techniques should include immunophenotyping to initiate specific cell lineage treatment.
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Affiliation(s)
- C Döll
- Department of Paediatric Haematology, Oncology and Endocrinology, Universitätsklinikum GH Essen, Zentrum für Kinderheilkunde, Hufelandstrasse 55, 45122 Essen, Germany.
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Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of duration on the interaction between training and a fat-rich or a carbohydrate-rich diet on endurance performance. METHODS Fifteen untrained males were randomly assigned to consume a fat-rich (T-FAT) or a carbohydrate-rich diet (T-CHO) while following an endurance training program. Endurance performance at 80% of pretraining VO2max was measured before, after 2 wk, and after 4 wk. RESULTS Time to exhaustion, when exercising at the same absolute workload, was similar in T-FAT and T-CHO at all tests and was significantly increased by 166% and 150% in T-FAT and T-CHO, respectively, after 4 wk. Maximal oxygen uptake increased by 9% in both groups (P < 0.05). After 4 wk, RER was significantly lower during exercise in T-FAT both compared with the initial test and with T-CHO, while no changes appeared in T-CHO. CONCLUSIONS The present findings showed that endurance performance was enhanced similarly after both 2 and 4 wk of adaptation to training and a fat-rich or a carbohydrate-rich diet.
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Affiliation(s)
- J W Helge
- Copenhagen Muscle Research Centre, August Krogh Institute, University of Copenhagen, Denmark.
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Wulff B, Møller Knudsen S, Adelhorst K, Fahrenkrug J. The C-terminal part of VIP is important for receptor binding and activation, as evidenced by chimeric constructs of VIP/secretin. FEBS Lett 1997; 413:405-8. [PMID: 9303545 DOI: 10.1016/s0014-5793(97)00942-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The structural requirements of vasoactive intestinal polypeptide (VIP) for receptor binding and cAMP production were studied in a cell line stable transfected with the cDNA for rat VIP receptor 1 (rVIPR 1). Using a number of chimeric constructs of VIP and the homologue peptide secretin, it was found that the N-terminal half of VIP (1-11) can be exchanged with the corresponding sequences in secretin with only modest influence on binding and activation, whereas the opposite chimeras with N-terminal VIP and C-terminal secretin were unable to bind to the VIP receptor. The data suggest that the C-terminal region of VIP is important for receptor binding and activation.
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Affiliation(s)
- B Wulff
- Department of Molecular Pharmacology, Novo-Nordisk Park, Måløv, Denmark
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Bielack SS, Wulff B, Delling G, Göbel U, Kotz R, Ritter J, Winkler K. Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS). Med Pediatr Oncol 1995; 24:6-12. [PMID: 7968796 DOI: 10.1002/mpo.2950240103] [Citation(s) in RCA: 62] [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: 01/28/2023]
Abstract
The case histories of all patients with osteosarcoma of the trunk entered into the consecutive studies COSS 80 through COSS 86 of the Cooperative German/Austrian Osteosarcoma Study Group (COSS) were analyzed in order to evaluate their clinical characteristics and the impact of modern neoadjuvant therapy on prognosis. They were compared to those of all patients with extremity osteosarcoma treated according to the same protocols. While tumors of the trunk comprised only 32 (4.8%) of 665 primary classical osteosarcomas, secondary osteosarcomas were much more likely to be located in bones of the axial skeleton (6 of 18, 33%). Patients with primary osteosarcoma of the axial skeleton were older (mean: 20.8 vs. 15.2 years, P < 0.01) and were more likely to present with metastases at diagnosis (34% vs 12%, P < 0.001) than those with primary extremity osteosarcoma. In contrast to extremity tumors, local surgical treatment failure was very common in osteosarcomas of the trunk. Complete tumor removal was achieved in less than half of all evaluable cases. The prognosis of eight patients with localized primary axial osteosarcoma and effective surgical local control was not inferior to that of 483 equally evaluable patients with extremity tumors. In conclusion, while secondary systemic spread of axial osteosarcoma may be avoided in patients treated with multiagent chemotherapy, successful treatment is often barred by primary metastatic disease and inability to control the local tumor site.
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Affiliation(s)
- S S Bielack
- Department of Pediatric Hematology and Oncology, University Hospital, Hamburg, Germany
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