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Aepinus C, Adolph E, von Eiff C, Podbielski A, Petzsch M. Kytococcus schroeteri: a probably underdiagnosed pathogen involved in prosthetic valve endocarditis. Wien Klin Wochenschr 2008; 120:46-9. [PMID: 18239991 DOI: 10.1007/s00508-007-0903-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 08/27/2007] [Indexed: 11/30/2022]
Abstract
Kytoccoccus schroeteri is an emerging pathogen found mainly in association with prosthetic valve endocarditis. A striking aspect of this species is its resistance to penicillins, including isoxazolylpenicillins, making glycopeptide administration and valve replacement the treatment of choice. We present the case of a 38-year-old female diabetic patient with fever up to 39.1 degrees C for two months. Infection of her prosthetic aortic valve was suspected clinically. Repeated blood cultures revealed growth of K. schroeteri. Transesophageal echocardiography demonstrated a vegetation on the prosthetic aortic valve. Antibiotic treatment with vancomycin, rifampin and gentamicin was started and this regimen led to complete resolution of symptoms and disappearance of the vegetation. It is of particular interest that the patient recovered without further surgical procedures. Since the first description of K. schroeteri in 2002, four cases of endocarditis have been published, suggesting antecedent and continuing underdiagnosis.
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Affiliation(s)
- Christian Aepinus
- Department of Medical Microbiology, Hygiene and Virology, University of Rostock, Rostock, Germany.
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Ince H, Valgimigli M, Petzsch M, de Lezo JS, Kuethe F, Dunkelmann S, Biondi-Zoccai G, Nienaber CA. Cardiovascular events and re-stenosis following administration of G-CSF in acute myocardial infarction: systematic review and meta-analysis. Heart 2008; 94:610-6. [PMID: 17761504 DOI: 10.1136/hrt.2006.111385] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because of the recently published results of the MAGIC study there is confusion as to whether administration of granulocyte-colony stimulating factor (G-CSF) after acute myocardial infarction (MI) should be regarded as a potentially harmful treatment. This meta-analysis of appropriate clinical studies is intended to show the impact of G-CSF given after MI on aggravated incidence of coronary re-stenosis or progression of coronary lesions. METHODS We used a fixed effects model based on the Mantel-Haenszel method to combine results from the different trials. These studies provided the basis for the current analysis comprising 106 patients of whom 62 were subjected to G-CSF treatment. RESULTS Minimum lumen diameter (MLD) measured immediately after percutaneous coronary intervention (PCI) was similar in both groups with a diameter stenosis of 12.3% (SD 9.5%) in the G-CSF group and 10.3% (8.5%) in the control group (p = 0.32). At follow-up, both MLD and percentage stenosis were not different between G-CSF-treated and control patients. Subsequently, averaged late lumen loss revealed similar results and no differences between groups (p = 0.11), and neither stent thrombosis nor re-infarction in either group. CONCLUSIONS The current meta-analysis of clinical reports fails to justify an elevated risk for coronary re-stenosis after PCI in acute MI or adverse events following G-CSF in the setting of MI when used after state of the art treatment in carefully conducted clinical protocols.
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Affiliation(s)
- H Ince
- Department of Medicine, Divisions of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany
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Ince H, Rehders TC, Kische S, Drawert S, Adolf E, Kleinfeldt T, Petzsch M, Nienaber CA. G-CSF in the setting of acute myocardial infarction. Eur Heart J Suppl 2006. [DOI: 10.1093/eurheartj/sul060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ince H, Petzsch M, Rehders TC, Dunkelmann S, Nienaber CA. G-CSF in acute myocardial infarction - experimental and clinical findings. Anadolu Kardiyol Derg 2006; 6:261-3. [PMID: 16943113] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Early data from clinical studies suggest that intracoronary injection of autologous progenitor cells may beneficially affect postinfarction remodeling and perfusion. Beyond intracoronary infusion of autologous bone marrow mononuclear CD34+ cells (MNCCD34+), mobilization of stem cells by G-CSF has recently attracted attention because of various advantages such as the noninvasive nature of MNCCD34+ mobilization by subcutaneous injections. It is the aim of the present work to give an overview about the current experimental and clinical findings of G-CSF treatment in acute myocardial infarction.
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Affiliation(s)
- Hüseyin Ince
- Department of Medicine, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.
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Nienaber CA, Petzsch M, Kleine HD, Eckard H, Freund M, Ince H. Effects of granulocyte-colony-stimulating factor on mobilization of bone-marrow-derived stem cells after myocardial infarction in humans. ACTA ACUST UNITED AC 2006; 3 Suppl 1:S73-7. [PMID: 16501636 DOI: 10.1038/ncpcardio0443] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 11/02/2005] [Indexed: 01/24/2023]
Abstract
Recent experimental studies have shown that granulocyte-colony-stimulating factor (G-CSF) enhanced cardiac function after infarction. The concept of direct cytokine or cell-mediated effects on postischemic myocardial function was tested in the setting of human myocardial infarction subjected to percutaneous coronary intervention. In the FIRSTLINE-AMI study 50 consecutive patients with first ST-elevation myocardial infarction were randomly assigned to receive either 10 microg/kg G-CSF for 6 days after percutaneous coronary intervention in addition to standard medication, or standard care alone. G-CSF administration led to mobilization of CD34(+) mononuclear stem cells (MNC(CD34+)), with a 20-fold increase to 64 +/- 37 MNC(CD34+)/microl at day 6 without significant associated changes in rheology, blood viscosity or inflammatory reaction, or any major adverse effects. At 4 months the G-CSF group showed improved left ventricular ejection fraction of 54 +/- 8% versus 48 +/- 4% at baseline (P <0.001), and no evidence of left ventricular end-diastolic remodeling, with a diameter of 55 +/- 5 mm and improved segmental wall thickening (P <0.001); conversely, in control patients left ventricular ejection fraction was 43 +/- 5% at 4 months (P <0.001), with increased left ventricular end-diastolic dimension of 58 +/- 4 mm (P <0.001), and no segmental wall thickening. In conclusion, the FIRSTLINE-AMI study showed that G-CSF administration and mobilization of MNC(CD34+) after reperfusion of infarcted myocardium may offer a pragmatic strategy for preservation of human myocardium and prevention of remodeling without evidence of aggravated atherosclerosis.
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Affiliation(s)
- Christoph A Nienaber
- Department of Cardiology, Rostock University Hospital, Rostock School of Medicine, Rostock, Germany.
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Ince H, Petzsch M, Kleine HD, Eckard H, Rehders T, Burska D, Kische S, Freund M, Nienaber CA. Prevention of left ventricular remodeling with granulocyte colony-stimulating factor after acute myocardial infarction: final 1-year results of the Front-Integrated Revascularization and Stem Cell Liberation in Evolving Acute Myocardial Infarction by Granulocyte Colony-Stimulating Factor (FIRSTLINE-AMI) Trial. Circulation 2006; 112:I73-80. [PMID: 16159869 DOI: 10.1161/circulationaha.104.524827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Experimental and clinical evidence has recently shown that pluripotent stem cells can be mobilized by granulocyte colony-stimulating factor (G-CSF) and may enhance myocardial regeneration early after primary percutaneous coronary intervention (PCI) management of acute myocardial infarction. Sustained or long-term effects of mobilized CD34-positive mononuclear stem cells, however, are unknown. METHODS AND RESULTS Thirty consecutive patients with ST-elevation myocardial infarction undergoing primary PCI with stenting and abciximab were selected for the study 85+/-30 minutes after PCI; 15 patients were randomly assigned to receive subcutaneous G-CSF at 10 microg/kg body weight for 6 days in addition to standard care including aspirin, clopidogrel, an angiotensin-converting enzyme inhibitor, beta-blocking agents, and statins. In patients with comparable demographics and clinical and infarct-related characteristics, G-CSF stimulation led to sustained mobilization of CD34 positive mononuclear cells (MNC(CD34+)), with a 20-fold increase (from 3+/-2 at baseline to 66+/-54 MNC(CD34+)/microL on day 6; P<0.001); there was no evidence of leukocytoclastic effects, accelerated restenosis rate, or any late adverse events. Within 4 months, G-CSF-induced MNC(CD34+) mobilization led to enhanced resting wall thickening in the infarct zone of 1.16+/-0.29 mm (P<0.05 versus control), which was sustained at 1.20+/-0.28 after 12 months (P<0.001 versus control). Similarly, left ventricular ejection fraction improved from 48+/-4% at baseline to 54+/-8% at 4 months (P<0.005 versus control) and 56+/-9% at 12 months (P<0.003 versus control and paralleled by sustained improvement of wall-motion score index from 1.70+/-0.22 to 1.42+/-0.26 and 1.33+/-0.21 at 4 and 12 months, respectively), after G-CSF (P<0.05 versus baseline and P<0.03 versus controls). Accordingly, left ventricular end-diastolic diameter showed no remodeling and stable left ventricular dimensions after G-CSF stimulation, whereas left ventricular end-diastolic diameter in controls revealed enlargement from 55+/-4 mm at baseline to 58+/-4 mm (P<0.05 versus baseline) at 12 months after infarction and no improvement in diastolic function. CONCLUSIONS Mobilization of MNC(CD34+) by G-CSF after primary PCI may offer a pragmatic strategy for improvement in ventricular function and prevention of left ventricular remodeling 1 year after acute myocardial infarction.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology, Department of Medicine, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany
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Chatterjee T, Ritz A, Rehders TC, Ince H, Kische S, Petzsch M, Nienaber CA. Percutaneous transcatheter closure of patent foramen ovale. Minerva Cardioangiol 2006; 54:31-9. [PMID: 16467740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In presence of a patent foramen ovale (PFO) with cryptogenic cerebral embolism, traditional therapy consists of oral anticoagulation or antiplatelet therapy. Surgery was considered only in case of recurrence. Transcatheter closure of PFO is currently performed. The availability of new user friendly devices and the increasing knowledge of pathophysiology, epidemiology, and follow-up of these patients has broadened the indications and marked reduced morbidity related to interventional PFO closure. This review presents the current knowledge and our own data concerning transcatheter closure of PFO.
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Affiliation(s)
- T Chatterjee
- Division of Cardiology, University Hospital Rostock, Rostock, Germany.
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Schneider H, Weber F, Paranskaja L, Holzhausen C, Petzsch M, Nienaber CA. [Interventional therapy of acute ST-elevation myocardial infarction in a regional network]. Z Kardiol 2006; 94 Suppl 4:IV/85-89. [PMID: 16416072 DOI: 10.1007/s00392-005-1418-4] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Management of acute ST-elevation myocardial infarction (STEMI) demands rapid and complete reflow to the infarct related artery (IRA). Primary PCI (percutaneous coronary intervention) performed by experienced operators is superior to thrombolytic thrombolytic therapy and reduces mortality, occurrence of non-fatal reinfarction and stroke, but is not available in rural Germany. We established a regional infarction-network using established therapeutic guidelines comprising of 1 interventional center and 7 referring community hospitals without PCI facilities. PATIENTS AND METHODS We analyzed 322 patients with STEMI treated by PCI within the network; 160 patients were transferred from a community hospital without PCI facilities (transfer group (TG): 63.4 yrs., 71.8% men) and 162 patients were admitted directly to the interventional center (center group (CG): 61.7 yrs., 73.8% men). The interval from onset of symptoms to first medical contact was 205 minutes in TG, and 195 minutes in CG (n.s.); 7.8% of the CG and 7.2% of the TG patients were in cardiogenic shock; 95% of patients completed 12- months of follow-up. RESULTS In the TG, median transportation time to PCI was 54 minutes. PCI of the infarct-related artery (IRA) was performed in 95.1% of TG patients and in 94.1% of CG patients. In addition, 96% of all patients received a GP IIb/IIIa receptor inhibitor. In case of pre-interventional application of GP IIb/IIIa receptor inhibitor 22.3% of patients revealed TIMI-3 flow of the IRA before PCI. After PCI, normalized flow to the IRAwas documented in 87.5% of CG versus 86.3% of TG. There were no differences between groups with respect to infarct size (TG vs. CG: CK 2482 vs. 2481 U/I; CKMB 302 vs. 264 U/I), mortality (30 days: 5.3 vs. 5.2%, 6 months: 7.3 vs. 7.1%, 12 months: 7.9 vs. 7.8%); NYHA (1.41 vs. 1.43) and left ventricular ejection fraction (0.41 vs. 0.43). CONCLUSIONS The organization of a regional STEMI-network with logistic alliance of community hospitals and one experienced interventional center ensures timely PCI treatment of patients with STEMI according to present guidelines even in rural areas, and relegates thrombolytic treatment to bail-out scenarios only.
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Affiliation(s)
- H Schneider
- Drip&Ship-Netzwerk: Klinik und Poliklinik fur Innere Medizin, Universität Rostock, Abt. Kardiologie, Postfach 100-888, 18055 Rostock
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Ince H, Petzsch M, Kleine HD, Schmidt H, Rehders T, Körber T, Schümichen C, Freund M, Nienaber CA. Preservation from left ventricular remodeling by front-integrated revascularization and stem cell liberation in evolving acute myocardial infarction by use of granulocyte-colony-stimulating factor (FIRSTLINE-AMI). Circulation 2005; 112:3097-106. [PMID: 16275869 DOI: 10.1161/circulationaha.105.541433] [Citation(s) in RCA: 227] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Considering experimental evidence that stem cells enhance myocardial regeneration and granulocyte colony-stimulating factor (G-CSF) mediates mobilization of CD34+ mononuclear blood stem cells (MNCCD34+), we tested the impact of G-CSF integrated into primary percutaneous coronary intervention (PCI) management of acute myocardial infarction in man. METHODS AND RESULTS Fifty consecutive patients with ST-segment elevation myocardial infarction were subjected to primary PCI stenting with abciximab and followed up for 6 months; 89+/-35 minutes after successful PCI, 25 patients were randomly assigned in this pilot study (PROBE design) to receive subcutaneous G-CSF at 10 microg/kg body weight for 6 days in addition to standard care, including aspirin, clopidogrel, an ACE inhibitor, beta-blocking agents, and statins. By use of CellQuest software on peripheral blood samples incubated with CD45 and CD34, mobilized MNCCD34+ were quantified on a daily basis. With homogeneous demographics and clinical and infarct-related characteristics, G-CSF stimulation led to mobilization of MNCCD34+ to between 3.17+/-2.93 MNCCD34+/microL at baseline and 64.55+/-37.11 MNCCD34+/microL on day 6 (P<0.001 versus control); there was no indication of leukocytoclastic effects, significant pain, impaired rheology, inflammatory reactions, or accelerated restenosis at 6 months. Within 35 days, G-CSF and MNCCD34+ liberation led to enhanced resting wall thickening in the infarct zone of between 0.29+/-0.22 and 0.99+/-0.32 mm versus 0.49+/-0.29 mm in control subjects (P<0.001); under inotropic challenge with dobutamine (10 microg.kg(-1).min(-1)), wall motion score index showed improvement from 1.66+/-0.23 to 1.41+/-0.21 (P<0.004 versus control) and to 1.35+/-0.24 after 4 months (P<0.001 versus control), respectively, coupled with sustained recovery of wall thickening to 1.24+/-0.31 mm (P<0.001 versus control) at 4 months. Accordingly, resting wall motion score index improved with G-CSF to 1.41+/-0.25 (P<0.001 versus control), left ventricular end-diastolic diameter to 55+/-5 mm (P<0.002 versus control), and ejection fraction to 54+/-8% (P<0.001 versus control) after 4 months. Morphological and functional improvement with G-CSF was corroborated by enhanced metabolic activity and 18F-deoxyglucose uptake in the infarct zone (P<0.001 versus control). CONCLUSIONS G-CSF and mobilization of MNC(CD34+) after reperfusion of infarcted myocardium may offer a pragmatic strategy for preservation of myocardium and prevention of remodeling without evidence of aggravated restenosis.
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Affiliation(s)
- Hüseyin Ince
- Department of Internal Medicine, University Hospital Rostock, School of Medicine, Rostock, Germany
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Adolph E, Chatterjee T, Ince H, Eckard H, Rehders T, Kische S, Drawert S, Petzsch M, Nienaber CA. [Contrast-media-induced nephrotoxicity]. Dtsch Med Wochenschr 2005; 130:2391-6. [PMID: 16235148 DOI: 10.1055/s-2005-918582] [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: 10/25/2022]
Abstract
The use of diagnostic and therapeutic catheterization is increasing and so is the exposure to radiocontrast media. As a consequence, an increasing incidence of contrast media-associated nephropathy is being observed. This article reviews pathogenesis, clinical symptoms and preventive measures of contrast media-associated nephropathy. Most important prophylactic measures is identification of high-risk patients, careful selection to be exposed to contrast media, application of non-ionic low osmolality or -- most recently -- iso-osmolality contrast media, adjusted hydration with isotonic saline before/during catheter interventions, and potentially the administration of acetylcysteine.
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Affiliation(s)
- E Adolph
- Universität Rostock, Klinik und Poliklinik für Innere Medizin, Abteilung für Kardiologie
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Chatterjee T, Petzsch M, Ince H, Rehders TC, Körber T, Weber F, Schneider H, Auf der Maur C, Nienaber CA. Interventional closure with Amplatzer PFO occluder of patent foramen ovale in patients with paradoxical cerebral embolism. J Interv Cardiol 2005; 18:173-9. [PMID: 15966921 DOI: 10.1111/j.1540-8183.2005.04050.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Percutaneous transcatheter closure has been proposed as an alternative to surgical closure or long-term anticoagulation in patients with presumed paradoxical embolism and patent foramen ovale (PFO). We report our mid-term results of 55 consecutive symptomatic patients (mean age: 47 years, range: 20-79) who underwent percutaneous transcatheter closure of PFO after at least one event of cerebral ischemia; 16 (29%) patients had at least one transient ischemic attack and 39 (71%) patients at least one embolic stroke. Multiple embolic events had occurred in 6 (11%) patients. Percutaneous transcatheter closure was technically successful in all 55 patients (100%). For the majority of patients, an Amplatzer PFO occluder measuring 25 mm in diameter (n=49) or an Amplatzer PFO occluder measuring 35 mm in diameter (n=6) was used. Complete occlusion by color Doppler and transesophageal contrast echocardiography investigation was achieved in 96% at follow-up 3-6 months after implantation; only 2 patients had a trivial residual shunt at follow-up. Mean fluoroscopy time was 6.7 minutes (range: 1.7-47.1), and in-hospital follow-up was uneventful except for 1 patient who developed a cardiac tamponade requiring uneventful and successful needle pericardiocentesis. At a mean follow-up of 19 months (range: 3-32) no recurrent embolic neurological events was observed. Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism and aneurysmatic or nonaneurysmatic PFO. Percutaneous closure is associated with a high success rate, low incidence of hospital complications, and freedom of cerebral ischemia events.
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Affiliation(s)
- Tushar Chatterjee
- Division of Cardiology, University Hospital Rostock, Rostock, Germany.
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Ince H, Petzsch M, Rehders TC, Kische S, Chatterjee T, Nienaber CA. Perkutane intramyokardiale Implantation von autologen Myoblasten bei ischämischer Kardiomyopathie. Herz 2005; 30:223-31. [PMID: 15902373 DOI: 10.1007/s00059-005-2623-7] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 11/30/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Cell transplantation is emerging as a novel approach for the treatment of end-stage cardiac disease. In contrast to most human studies using intramyocardial injection of myoblasts during coronary artery bypass grafting (CABG) or left ventricular assist device implantation, the authors investigated both safety and feasibility of transcatheter transplantation of autologous skeletal myoblast as a standalone procedure in six patients with ischemic heart failure, and compared them to six control patients matched for demographic and clinical characteristics. METHODS AND RESULTS Skeletal myoblast transplantation by catheter-based injection was technically successful in all six patients with no complications; 19+/-10 injections were performed/patient corresponding to 210 x 10(6)+/-150 x 10(6) cells/patient. Postinterventional Holter monitoring and ICD memory check documented three episodes of ventricular tachycardia in two patients after myoblast implantation, one at 30 days in patient 1, and two at 27 and 41 days in patient 2. Patient 1, although asymptomatic, was subsequently subjected to oral amiodarone since he refused an ICD; in patient 2 each tachycardia was terminated by a previously implanted ICD. Both patients were followed for 6 months without any evidence of repeat ventricular arrhythmia. Matched control patients revealed one episode of ventricular tachycardia in three patients each of which was aborted by ICD discharge within 6 months of observation. None of the documented ventricular tachycardias in both groups occurred in relation to any new myocardial necrosis which was excluded by ECG and cardiac enzymes. Left ventricular ejection fraction (LVEF) rose from 24.3+/-6.7% at baseline to 33.2+/-10.2% 6 months after myoblast implantation (p=0.02 vs. baseline); in matched controls LVEF decreased from 24.7+/-4.6% to 22.2+/-6.2% (p<0.05 vs. myoblasttreated group at 6 months). Moreover, the 6-min walk test revealed an improvement from 371+/-49 m to 493+/-86 m 6 months after implantation (p=0.003 vs. baseline and p=0.015 vs. controls), whereas matched controls were unchanged at 360+/-24 m and 369+/-26 m, respectively. Accordingly, NYHA functional class improved from 3.17+/-0.41 to 1.67+/-0.82 within 6 months of myoblast implantation (p=0.001 vs. baseline and p=0.01 vs. controls), while NYHA class remained unchanged at 3+/-0 in matched controls. CONCLUSION Transcatheter transplantation of autologous skeletal myoblasts for severe left ventricular dysfunction in postinfarction patients is feasible, safe and promising and, thus, warrants the scrutiny of larger randomized double-blind multi-center trials with longer follow-up surveillance.
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Affiliation(s)
- Hüseyin Ince
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin, Medizinische Fakultät der Universität Rostock, Rostock
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Abstract
PURPOSE To explore the safety and feasibility of stent-graft placement in the dissected descending thoracic aorta of patients with Marfan syndrome. METHODS Six consecutive patients (4 men; mean age 33+/-15 years, range 24-61) with Marfan syndrome were offered endovascular repair for dissection after previous aortic root repair in 5 and solitary type B dissection in 1. RESULTS Transluminal placement of customized Talent stent-grafts was technically successful in all patients, with no 30-day or 1-year intervention-related mortality. Complete abolition of the dissection and reconstruction of the entire dissected aorta was documented in 2 patients. Over a mean 51+/-22-month follow-up (range 12-74), elective conversion to surgical repair was necessary in 2 patients at 22 and 43 months after stent-graft implantation. In a third patient, conversion to surgery is being considered at 74 months after stent-grafting. One patient died suddenly 12 months after endovascular repair. CONCLUSIONS Nonsurgical reconstruction of postsurgical distal aortic dissection in patients with Marfan syndrome is feasible and technically successful. Stent-graft placement may either avoid or bridge to repeat surgery of distal aortic dissections after previous aortic root repair. Technical expertise and close postinterventional surveillance appear mandatory and may limit the procedure to centers of competence for aortic diseases.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology, University Hospital, Rostock School of Medicine, 18057 Rostock, Germany
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Stamm C, Liebold A, Westphal B, Kleine H, Dunkelmann S, Nienaber C, Petzsch M, Freund M, Steinhoff G. Intramyocardial delivery of Endothelial Progenitor Cells (EPC) is more effective in patients with severely reduced left ventricular function. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-861960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ince H, Petzsch M, Rehders TC, Chatterjee T, Nienaber CA. Transcatheter Transplantation of Autologous Skeletal Myoblasts in Postinfarction Patients With Severe Left Ventricular Dysfunction. J Endovasc Ther 2004; 11:695-704. [PMID: 15615560 DOI: 10.1583/04-1386r.1] [Citation(s) in RCA: 52] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report a case-controlled safety and feasibility study of transcatheter transplantation of autologous skeletal myoblasts as a stand-alone procedure in patients with ischemic heart failure. METHODS Six men (mean age 66.2+/-7.2 years) were eligible for transcatheter transplantation of autologous skeletal myoblasts cultured from quadriceps muscle biopsies. Six other men (mean age 65.7+/-6.3 years) were selected as matched controls (no muscle biopsies). A specially designed injection catheter was advanced through a femoral sheath into the left ventricle cavity, where myoblasts in solution (0.2 mL/injection) were injected into the myocardium via a 25-G needle. At baseline and in follow-up, both groups underwent Holter monitoring, a 6-minute walk test, New York Heart Association (NYHA) class determination, and echocardiography with dobutamine challenge. RESULTS Skeletal myoblast transplantation was technically successful in all 6 patients with no complications; 19+/-10 injections were performed per patient (210 x 10(6)+/-150 x 10(6) cells implanted per patient). Left ventricular ejection fraction (LVEF) rose from 24.3%+/-6.7% at baseline to 32.2%+/-10.2% at 12 months after myoblast implantation (p=0.02 versus baseline and p<0.05 versus controls); in matched controls, LVEF decreased from 24.7%+/-4.6% to 21.0%+/-4.0% (p=NS). Walking distance and NYHA functional class were significantly improved at 1 year (p=0.02 and p=0.001 versus baseline, respectively), whereas matched controls were unchanged. CONCLUSIONS Transcatheter transplantation of autologous skeletal myoblasts for severe left ventricular dysfunction in postinfarction patients is feasible, safe, and promising. Scrutiny with randomized, double-blinded, multicenter trials appears warranted.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology/Angiology and Department of Internal Medicine at the University Hospital Rostock, Germany
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Rehders TC, Petzsch M, Ince H, Kische S, Korber T, Koschyk DH, Chatterjee T, Weber F, Nienaber CA. Intentional Occlusion of the Left Subclavian Artery During Stent-Graft Implantation in the Thoracic Aorta:Risk and Relevance. J Endovasc Ther 2004; 11:659-66. [PMID: 15620344 DOI: 10.1583/04-1311r.1] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [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
PURPOSE To examine the clinical consequences and/or potential need for postinterventional transposition after stent-graft occlusion of the left subclavian artery (LSA). METHODS The records of 171 consecutive patients (128 men; mean age 60.2+/-13.2 years, range 20-83) undergoing elective stent-graft repair in the thoracic aorta were reviewed to identify intentional endograft coverage of the ostial LSA, as documented by transesophageal echocardiography and/or aortography. Patients were treated for subacute type B dissection, true aneurysm, pseudoaneurysm, or previously operated type A dissection with persistent false lumen flow in the descending aorta. Among the 171 cases, 22 (12.9%) patients were identified with stent-graft occlusion of the LSA. RESULTS A systolic blood pressure differential existed between the right (138.4+/-14.0 mmHg) and the left (101.8+/-21.0 mmHg; p<0.05) arms after occlusion of the LSA. No patient showed a malperfusion syndrome during postinterventional hospitalization. During a mean follow-up of 24.0+/-15.8 months, 15 (68.2%) patients remained completely asymptomatic, with no functional deficit or temperature differential between the arms, while 7 patients reported mild symptoms of a subclavian steal syndrome. However, no patient required any secondary surgical intervention. CONCLUSIONS Stent-graft-induced occlusion of the ostial LSA was tolerated by all patients without chronic functional deficit. In the absence of stenotic vertebral and/or carotid arteries and with a documented intact vertebrobasilar system, prophylactic transposition of the LSA is not required prior to intentional stent-graft occlusion of the LSA.
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Affiliation(s)
- Tim C Rehders
- Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Germany
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Weber F, Schneider H, Schwarz C, Holzhausen C, Petzsch M, Nienaber CA. Sirolimus-eluting stents for percutaneous coronary intervention in acute myocardial infarction. ACTA ACUST UNITED AC 2004; 93:938-43. [PMID: 15599568 DOI: 10.1007/s00392-004-0149-2] [Citation(s) in RCA: 10] [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] [Received: 04/20/2004] [Accepted: 07/13/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Given the encouraging results on early restenosis rate with drug-eluting coronary stents, both safety and 6 months outcomes of PCI with sirolimus-eluting stents (SES) in acute myocardial infarction are scarce. METHODS AND RESULTS Fifty consecutive patients with acute myocardial infarction were subjected to acute PCI with SES and compared to 50 matched control patients who received a bare metal stent (BMS). All patients were followed over 6 months; in addition repeat angiography was obtained in 88.0% of SES and 92.0% of BMS patients. As a result of matching both groups were similar with regard to demographic, clinical, and infarction characteristics, as well as procedural data and adjunctive medication. SES diameter was 3.0 +/- 0.1 versus 3.3 +/- 0.5 mm with BMS, while the length of stented segment was 24 +/- 11 mm with SES versus 16 +/- 8 mm with BMS (p<0.05). No subacute stent thrombosis occurred in either group. At 6 months, all-cause mortality was 2.0% with SES, and 4.0% with BMS (n. s.); reinfarction rate was 2.0% in both groups, but binary restenosis rate (4.0 versus 18.0%; p<0.05) and target vessel revascularization (TVR) were improved with SES (2.0 versus 16.0%; p<0.05) resulting in lower MACE rate of 6.0 versus 22.0% with BMS (p<0.05). CONCLUSION Placement of SES with PCI for myocardial infarction is feasible and as safe as BMS; 6-month outcome is superior with SES due to the lower rate of both angiographic restenosis and TVR.
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Affiliation(s)
- F Weber
- University Hospital Rostock, Department of Internal Medicine, Division of Cardiology, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany.
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Schneider H, Weber F, Paranskaja L, Holzhausen C, Petzsch M, Severin R, Nienaber CA. Leitlinienkonforme interventionelle Therapie des akuten ST-Hebungsinfarktes in ländlichen Regionen durch Netzwerkbildung. Dtsch Med Wochenschr 2004; 129:2162-6. [PMID: 15457395 DOI: 10.1055/s-2004-831859] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Therapy of acute myocardial infarction demands rapid and complete myocardial reperfusion. Primary percutaneous coronary intervention (PCI) performed is superior to thrombolytic therapy in reducing mortality, non-fatal reinfarction and stroke, but is not available in rural Germany. PATIENTS AND METHODS : From 8/2001 to 12/2002 322 patients with STEMI were treated by PCI with standardized therapeutic guidelines within a regional infarction-network comprising one interventional centre and 7 community hospitals without PCI facilities. 160 patients were relocated (transferred) from a community hospital without PCI facilities (transfer group, 63.4 yrs., 71.8 % men); 162 patients were admitted directly to the interventional centre (centre group, 61.7 yrs., 73.8 % men). The interval from onset of symptoms to first medical contact was 205 minutes in the transfer group, and 195 minutes in the centre group. 7.8 % of the centre group and 7.2 % of the transfer group patients were in cardiogenic shock. 95 % of patients have completed a 6-month's follow-up. RESULTS In the transfer group median transportation time to PCI was 54 minutes. PCI of the infarct-related artery (IRA) was performed in 95.1 % of transferred patients after transfer and in 94.1 % of patients with direct admission. In addition 96 % of all patients received a GP IIb/IIIa receptor inhibitor. In case of pre-interventional application of the GP IIb/IIIa receptor inhibitor 22.3 % of patients revealed normal (TIMI-3) flow of the IRA before PCI, compared to 14.9 % TIMI-3 flow with 5000 IE Heparin/500 mg aspirin alone (p < 0.05). After PCI normalized flow in the IRA was documented in 87.5 % after direct admission and 86.3 % after transfer. No differences between groups were shown with respect to infarct size (transfer vs. centre: CK 2482 vs. 2481 U/I; CKMB 302 vs. 264 U/I), mortality (30 days: 5.3 vs. 5.2 %, 6 months: 7.3 vs. 7.1 %); NYHA (1.41 vs. 1.43) and left ventricular ejection fraction (0.41 vs. 0.43). CONCLUSIONS The organization of a regional infarction-network with logistic alliance of community hospitals with one experienced interventional centre ensures timely PCI for patients with STEMI according to present guidelines even in rural areas.
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Affiliation(s)
- H Schneider
- Drip and Ship Netzwerk der Universität Rostock
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19
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Stamm C, Kleine HD, Westphal B, Petzsch M, Kittner C, Nienaber CA, Freund M, Steinhoff G. CABG and bone marrow stem cell transplantation after myocardial infarction. Thorac Cardiovasc Surg 2004; 52:152-8. [PMID: 15192775 DOI: 10.1055/s-2004-817981] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Bone marrow-derived adult stem cells may be able to regenerate infarcted myocardium. We initiated a phase-I study of autologous stem cell transplantation in patients undergoing coronary artery bypass grafting. METHODS Inclusion criteria were: acute myocardial infarction > 10 days ago; presence of a distinct area of infarcted and akinetic myocardium; CABG indicated to treat ischemia of other LV wall areas. Stem cells were isolated from bone marrow using a ferrite-conjugated AC133 antibody, and were injected in the infarct border zone during the CABG operation. RESULTS To date, 12 patients were treated without major complications. There is no evidence of new ventricular arrhythmia or neoplasia. Scintigraphic imaging demonstrated significantly improved local perfusion in the stem cell-treated infarct area. LV dimensions (LVEDV 140 +/- 38 ml vs. 124 +/- 30 ml, p = 0.004, paired t-test) and LV ejection fraction (39.7 +/- 9 % vs. 48.7 +/- 6 %, p = 0.007) have improved. CONCLUSIONS Bone marrow stem cell transplantation for myocardial regeneration can be safely performed in humans. There is evidence of improved revascularization and contractility of infarct areas, but controlled studies are needed to clearly determine the clinical benefit.
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Affiliation(s)
- C Stamm
- Department of Cardiac Surgery, University of Rostock, Rostock, Germany
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20
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Petzsch M, Leber W, Westphal B, Crusius S, Reisinger EC. Progressive Staphylococcus lugdunensis endocarditis despite antibiotic treatment. Wien Klin Wochenschr 2004; 116:98-101. [PMID: 15008319 DOI: 10.1007/bf03040704] [Citation(s) in RCA: 7] [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: 11/30/2022]
Abstract
A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negative Staphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted. S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.
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Affiliation(s)
- Michael Petzsch
- Division of Cardiology, Department of Medicine, University of Rostock, Rostock, Germany
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Mueller SC, Uehleke B, Woehling H, Petzsch M, Majcher-Peszynska J, Hehl EM, Sievers H, Frank B, Riethling AK, Drewelow B. Effect of St John's wort dose and preparations on the pharmacokinetics of digoxin. Clin Pharmacol Ther 2004; 75:546-57. [PMID: 15179409 DOI: 10.1016/j.clpt.2004.01.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [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: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE St John's wort preparations vary in composition, main constituents, formulation, and daily dose administered. The aim of the study was to evaluate the possible pharmacokinetic interaction of marketed St John's wort formulations and doses with digoxin. METHODS A randomized, placebo-controlled, parallel-group study was performed in 96 healthy volunteers in 3 study parts. A 7-day loading phase with digoxin was followed by 14 days of comedication with placebo or one of 10 St John's wort products varying in dose and formulation. The pharmacokinetics of digoxin was determined before comedication and on day 14 of comedication. RESULTS Comedication comprised traditionally used Hypericum products; 2 g powder without hyperforin, tea, juice, oil extract, and placebo had no significant interaction with digoxin nor did hyperforin-free extract (Ze 117) or low daily doses of hyperforin-containing Hypericum powder (1 g, 0.5 g). However, comedication with the high-dose hyperforin-rich extract LI 160 resulted in a reduction of digoxin area under the curve from time 0 to 24 hours (AUC(0-24)) of -24.8% (95% confidence interval [CI], -28.3 to -21.3), a reduction in digoxin maximal plasma concentration (C(max)) of -37% (95% CI, -42 to -32), and a reduction in digoxin plasma concentration at 24 hours after previous dosing (C(trough)) of -19% (95% CI, -27 to -11). Comedication with 4 g Hypericum powder with comparable hyperforin content resulted in a reduction in digoxin AUC(0-24) of -26.6% (95% CI, -37.3 to -15.9), a reduction in digoxin C(max) of -38% (95% CI, -48 to -18), and a reduction in digoxin C(trough) of -19% (95% CI, -27 to -10). Two grams of Hypericum powder with half the hyperforin content resulted in a less prominent reduction in AUC(0-24) of -17.7% (95% CI, -21.6 to -13.7), C(max) (-21%; 95% CI, -40 to -2), and C(trough) (-13%; 95% CI, -21 to -5). CONCLUSIONS The interaction of St John's wort and digoxin varies within St John's wort preparations and doses and seems to be correlated with the dose, particularly of hyperforin.
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Affiliation(s)
- Silke C Mueller
- Center of Pharmacology and Toxicology, Institute of Clinical Pharmacology, University of Rostock, Rostock, Germany.
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22
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Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, Cooper JV, Januzzi JL, Ince H, Sechtem U, Bossone E, Fang J, Smith DE, Isselbacher EM, Pape LA, Eagle KA. Gender-related differences in acute aortic dissection. Circulation 2004; 109:3014-21. [PMID: 15197151 DOI: 10.1161/01.cir.0000130644.78677.2c] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD). METHODS AND RESULTS Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (P=0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, P=0.04), predominantly in the 66- to 75-year age group. Moreover, surgical outcome was worse in women than men (P=0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics. CONCLUSIONS Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.
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Affiliation(s)
- Christoph A Nienaber
- Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany.
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23
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Nienaber CA, Richartz BM, Rehders T, Ince H, Petzsch M. Aortic intramural haematoma: natural history and predictive factors for complications. Heart 2004; 90:372-4. [PMID: 15020504 PMCID: PMC1768157 DOI: 10.1136/hrt.2003.027615] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- C A Nienaber
- Division of Cardiology at the University Hospital Rostock, Department of Internal Medicine, Rostock, Germany.
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Abstract
Background—
Formation of aortic aneurysm late after surgical repair of coarctation carries a significant risk of rupture and lethal outcome, and repeat surgery is associated with a 14% in-hospital mortality rate and morbidity from paraplegia, injury to the central nervous system, or from bleeding. The potential of nonsurgical endovascular repair by the use of stent-grafts in lieu of repeat surgery for postcoarctation aneurysm is unknown.
Methods and Results—
The concept of postsurgical endovascular stent-graft placement was evaluated with respect to feasibility and safety in 6 consecutive patients with late aneurysm formation after coarctation repair. All patients had aneurysm formation late after patch aortoplasty; placement of an elephant trunk during surgical repair of secondary type I dissection preceded formation of a local aneurysm in 2 cases. Patient age was 49±12 years, ranging from 31 to 68 years. Transluminal placement of customized stent-grafts was successful, with no 30-day or 1-year intervention-related mortality or morbidity. Follow-up survey of 11 to 47 months revealed optimal reconstruction of the thoracic aorta; 1 patient died 11 months after endovascular repair from cancer.
Conclusions—
Nonsurgical aortic reconstruction of postsurgical thoracic aneurysms forming late after coarctation repair is safe and feasible; interventional stent-graft placement has the potential to avoid repeat surgery of postsurgical aortic aneurysm.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany
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25
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Nienaber CA, Ince H, Weber F, Rehders T, Petzsch M, Meinertz T, Koschyk DH. Emergency stent-graft placement in thoracic aortic dissection and evolving rupture. J Card Surg 2003; 18:464-70. [PMID: 12974937 DOI: 10.1046/j.1540-8191.2003.02082.x] [Citation(s) in RCA: 60] [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: 11/20/2022]
Abstract
BACKGROUND Even with rapid diagnosis and effective medical treatment mortality in type B aortic dissection with evidence of extraaortic leakage of blood remains high. Considering a mortality rate of 29% to 50% associated with emergency surgical repair, the concept of endovascular stent-graft placement may become a life-saving option in impending or evolving rupture by endovascular sealing of the entry tear and subsequent abortion of leakage. METHODS The concept was tested by comparing short-term and 1-year outcomes of 11 patients after emergency endovascular stent-graft placement with historic-matched control patients subjected to conventional therapy. All patients had acute type B dissection complicated by loss of blood into periaortic spaces. RESULTS Emergency stent-graft placement was successful without periprocedural morbidity, aborted leakage, and ensured reconstruction of the dissected aorta; at a mean follow-up of 15 +/- 6 months no death had occurred in the stent-graft group whereas four patients had died with conventional treatment (p < 0.05). CONCLUSION With appropriate logistics and expertise, type B aortic dissection with leakage and evolving rupture may benefit from nonsurgical reconstruction of the dissected segment by endovascular stent grafts.
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Affiliation(s)
- Christoph A Nienaber
- Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Ernst-Heydemann-Strasse 6, 18055 Rostock, Germany.
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Rehders TC, Schareck W, Weber F, Ince H, Schneider H, Körber T, Petzsch M, Nienaber CA. Images in cardiovascular medicine. Giant true aneurysm of the left subclavian artery. Circulation 2003; 107:1827-8. [PMID: 12682030 DOI: 10.1161/01.cir.0000060809.14711.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tim C Rehders
- Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18055 Rostock, Germany
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27
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Weber F, Schneider H, Warzok F, Petzsch M, von Knorre GH, Nienaber CA. Randomized comparison of direct and provisional stenting in de novo coronary artery lesions: the RADICAL study. Z Kardiol 2003; 92:173-81. [PMID: 12596079 DOI: 10.1007/s00392-003-0894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although preliminary reports have demonstrated excellent primary success and improved economics with direct stenting, a clinically relevant reduction of restenosis rate has not been documented yet. AIMS Aims of the study were the comparison of restenosis rate (primary endpoint), procedural success, fluoroscopy time, amount of contrast dye and clinical outcome (secondary endpoints). METHODS AND RESULTS Between January and December 1999, 250 patients were randomly assigned either to direct stent implantation without predilatation (DS; 125 patients) or provisional stenting (PB; 125 patients) and followed for 7.9+/-2.7 (6-9) months. Angiographic follow-up was available in 92.0% of patients. Procedural success rate was 92.8% in DS and 100% in PB (n.s.), while radiation exposure was lower (4.7+/-4.3 versus 5.1+/-1.8 min; p<0.0001) with DS. Conversely, the amount of contrast dye (131+/-62 versus 139+/-36 ml; n.s.) was not different between DS and PB. Direct stenting leads to a 25.0% reduction in binary restenosis rate (15.7% in DS versus 20.9% in PB), indicating an advantageous trend, missing however the level of statistical significance. Similarly, there was a trend to fewer major cardiac events with DS (DS 16.8%, PB 21.6%). CONCLUSIONS We conclude that direct stenting is at least as safe and efficacious as balloon dilatation followed by provisional stent implantation, but failed to reduce restenosis rate or improve outcome within 6 months. Larger prospective randomized trials are required to assess the potential of direct stenting to reduce restenosis rate and improve clinical outcome in subgroups of patients.
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Affiliation(s)
- F Weber
- University Hospital Rostock, Department of Internal Medicine, Division of Cardiology, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany.
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Stamm C, Westphal B, Kleine HD, Petzsch M, Kittner C, Klinge H, Schümichen C, Nienaber CA, Freund M, Steinhoff G. Autologous bone-marrow stem-cell transplantation for myocardial regeneration. Lancet 2003. [PMID: 12517467 DOI: 10.1016/s0140- 6736(03)12110-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Implantation of bone-marrow stem cells in the heart might be a new method to restore tissue viability after myocardial infarction. We injected up to 1.5x10(6) autologous AC133+ bone-marrow cells into the infarct border zone in six patients who had had a myocardial infarction and undergone coronary artery bypass grafting. 3-9 months after surgery, all patients were alive and well, global left-ventricular function was enhanced in four patients, and infarct tissue perfusion had improved strikingly in five patients. We believe that implantation of AC133+ stem cells to the heart is safe and might induce angiogenesis, thus improving perfusion of the infarcted myocardium. See Commentary page 11
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Affiliation(s)
- Christof Stamm
- Department of Cardiac Surgery, University of Rostock, 18057, Rostock, Germany
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29
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Stamm C, Westphal B, Kleine HD, Petzsch M, Kittner C, Klinge H, Schümichen C, Nienaber CA, Freund M, Steinhoff G. Autologous bone-marrow stem-cell transplantation for myocardial regeneration. Lancet 2003; 361:45-6. [PMID: 12517467 DOI: 10.1016/s0140-6736(03)12110-1] [Citation(s) in RCA: 1037] [Impact Index Per Article: 49.4] [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] [Indexed: 12/13/2022]
Abstract
Implantation of bone-marrow stem cells in the heart might be a new method to restore tissue viability after myocardial infarction. We injected up to 1.5x10(6) autologous AC133+ bone-marrow cells into the infarct border zone in six patients who had had a myocardial infarction and undergone coronary artery bypass grafting. 3-9 months after surgery, all patients were alive and well, global left-ventricular function was enhanced in four patients, and infarct tissue perfusion had improved strikingly in five patients. We believe that implantation of AC133+ stem cells to the heart is safe and might induce angiogenesis, thus improving perfusion of the infarcted myocardium. See Commentary page 11
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Affiliation(s)
- Christof Stamm
- Department of Cardiac Surgery, University of Rostock, 18057, Rostock, Germany
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30
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Weber F, Schneider H, Körber T, Petzsch M, Rehders T, Nienaber CA. [Percutaneous stents for the treatment of stenosis of descending aorta]. Z Kardiol 2003; 92:84-9. [PMID: 12545306 DOI: 10.1007/s00392-003-0871-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Stenotic processes of the descending aorta lead to a transstenotic gradient with either risk of proximal hypertension especially affecting the cerebral circulation combined with the risk of distal malperfusion. This article describes the technique of percutaneous stenting of suprarenal aortic stenosis in two patients with different genesis of aortic obstruction in whom operative correction was refused due to elevated surgical risk. The first patient (female, 38 years) suffered from aortic stenosis at the thoracoabdominal level revealing a residual lumen of 3 mm. The second patient (male, 71 years) had a chronic type B aortic dissection and developed dynamic compression of true lumen and thus peripheral malperfusion. Both patients were treated successfully with percutaneous implantation of self-expanding stents. During the follow-up of 6 and 10 months, respectively, both patients were free of any symptoms. The technique of percutaneous stenting of static and dynamic stenotic processes of the aorta led to excellent mid-term results. Long-term results of large patient cohorts are not available yet; however, all patients subjected to such a palliative procedure should be followed in structured registries in an effort to standardize the concept and develop therapeutic recommendations.
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Affiliation(s)
- F Weber
- Universität Rostock, Klinik und Poliklinik für Innere Medizin, Abteilung Kardiologie, Postfach 100888, 18055 Rostock
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Abstract
The acute aortic syndrome (AAS) is described. Its pathophysiology is discussed for each of the three entities (penetrating aortic ulcer, intramural hematoma and aortic dissection). The natural history of these three pathologies is reviewed. Diagnostic features and investigation imaging techniques are summarized. The technique of stentgraft-placement is described in detail. The authors report their clinical experience with 127 patients, presenting acute type B aortic dissection or its variants, and treated with an endovascular stent-graft-device. These results are in part compared with a group of control patients with acute type B dissection, submitted to medical non-invasive therapy.
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Affiliation(s)
- Chr A Nienaber
- Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Rostock.
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32
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Körber T, Petzsch M, Pulya K, Ismer B, Placke J, Westphal B, Nienaber CA. [Perforated mitral valve aneurysm as a rare course of bacterial endocarditis]. Z Kardiol 2001; 90:867-71. [PMID: 11771454] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
A 65 year old man with a history of mechanical aortic valve replacement acquired Enterococcus faecalis mediated infective endocarditis about 3 years later. Transesophageal echocardiography revealed formation of an aneurysm confined to the anterior mitral valve leaflet. The aortic valve revealed no signs of endocarditis by transesophageal ultrasound. With sudden perforation of the mitral valve aneurysm, subsequent hemodynamic deterioration and pulmonary oedema, the patient underwent emergency mitral and aortic valve replacement. The postoperative course was uneventful.
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Affiliation(s)
- T Körber
- Universität Rostock Klinik und Poliklinik für Innere Medizin Abteilung Kardiologie Ernst-Heydemann-Strasse 6 18055 Rostock, Germany
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Petzsch M, Pulya K, Anders O. [Augmentation of left ventricular outflow tract gradient by digitalis glycosides in a case of cardiac (AL-) amyloidosis]. Dtsch Med Wochenschr 2001; 126:909-12. [PMID: 11514926 DOI: 10.1055/s-2001-16499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 10/16/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 61-year-old man suffering from histologically confirmed amyloidosis associated with coagulation disturbances presented with exercise induced shortness of breath and symptoms of cardiac asthma after four cycles of chemotherapy with melphalan and prednisolone. As a result, treatment with digitoxin was initiated. In addition furosemide and an oral nitrate were administered. INVESTIGATIONS Disparity between electrocardiogram and echocardiographic findings was observed in that, while the electrocardiogram showed loss of 'R wave in precordial leads V(2 - 4), excessive thickening of both left and right ventricular wall was shown in the echocardiogram. Doppler-echocardiography revealed a left ventricular outflow tract obstruction at rest with a peak pressure gradient of 64 mm Hg which rose to 145 mm Hg during Valsalva manoeuvre. Colour Doppler presented a moderate mitral insufficiency and the transmitral Doppler flow studies detected a restrictive left ventricular filling pattern. DIAGNOSIS, TREATMENT AND COURSE Digitalis therapy was stopped because of the outflow tract obstruction complicating cardiac amyloidosis. Cardiac symptoms abated over the following weeks. This improvement was reflected in a significant reduction of the outflow tract gradient, the gradients now being 16 mm Hg under resting conditions and a maximum of 36 mm Hg during the Valsalva manoeuvre. The transmitral Doppler flow pattern showed a pseudonormalisation and the mitral regurgitation regressed nearly completely. The patient was free from cardiac complaints until his sudden death 21 months after the diagnosis of cardiac amyloidosis. CONCLUSION Cardiac amyloidosis can present with left ventricular outflow tract obstruction mimicking hypertrophic obstructive cardiomyopathy. This fact must be borne in mind to avoid therapy with preload-reducing or positive inotropic drugs and especially glycosides.
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Affiliation(s)
- M Petzsch
- Abteilung Kardiologie, Klinik und Poliklinik für Innere Medizin, Universität Rostock.
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Körber T, Petzsch M, Placke J, Ismer B, Schulze C. [Acute thrombosis of pelvic and leg veins in agenesis of the renal segment of the inferior vena cava]. Z Kardiol 2001; 90:52-7. [PMID: 11220087] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A 19-year-old, otherwise asymptomatic man presented to the hospital of orthopaedic surgery with acute severe pain like lumbago. Symptomatic treatment was performed after extensive orthopaedic diagnostic procedures. On the third day after admission he showed clinical signs of deep vein thrombosis with painful swelling and livid discoloration of both legs. Colour duplex ultrasound revealed complete thrombosis of the leg and pelvic veins bilaterally, but the cranial extent was not clear. Contrast-enhanced helical computer tomography of the abdomen and the pelvis confirmed deep pelvic vein thrombosis and showed extension into the inferior vena cava. Moreover, the study revealed the agenesis of the renal segment of the inferior vena cava with collateral flow through dilated lumbar veins to enlarged azygous and hemiazygous, through vertebral and paravertebral venous plexus. The renals were drained via dilated capsular veins. The agenesis of renal vena cava is a very rare anomaly causing acute thrombosis of the deep leg and pelvic veins. Other risk factors of thromboembolic disease were not found. The patient was treated successfully with systemic thrombolysis. Therefore we used ultra-high streptokinase infusion (9 million units over 6 hours). Colour duplex ultrasound revealed good flow into deep leg and pelvic veins after three cycle of lysis. Magnetic resonance angiography of the abdomen and pelvis was performed to evaluate the successful fibrinolysis with complete recanalisation of the pelvic veins and to demonstrate the venous anatomy. Permanent oral anticoagulation with phenprocoumon is indicated to decrease the high rate of recurrent thrombosis. Compression stockings were prescribed. To prevent thrombosis, additional risk factors like smoking, immobilization and unusual physical activity should be strictly avoided.
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Affiliation(s)
- T Körber
- Universität Rostock Klinik und Poliklinik für Innere Medizin Abteilung Kardiologie Ernst-Heydemann-Strasse 6 18055 Rostock, Germany
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Eggers J, Rolfs A, Benecke R, Petzsch M. Monitoring the effectiveness of anticoagulative therapy in left atrial spontaneous echo contrast by cerebral microemboli detection. Stroke 1999; 30:1977-81. [PMID: 10471515 DOI: 10.1161/01.str.30.9.1974c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
DDD pacemakers differ considerably in device specific extents of AV delay (AVD) programmability. To demonstrate the requirements of a mean DDD pacemaker patient population optimal AVDs in 200 DDD pacemaker patients (age 8 to 91 years) were estimated by left atrial electrography. The results should help to define an AVD programmability standard. Left atrial electrograms were recorded via a bipolar filtered esophageal lead. The method aims on adjusting the left atrial electrogram to 70 ms prior to the ventricular spike, both during VDD and DDD operation of the pacemaker. In atrial sensed stimulation the optimal AVD varied from 40 to 205 ms (100.5 +/- 24.5 ms) and in atrial paced stimulation from 85 to 245 ms (169.1 +/- 24.5 ms). The difference of the mean values is statistically significant (p < 0.001). The difference between both values in the individual patient, the individual AVD correction time, varied from 0 to 170 ms (68.7 +/- 26.6 ms). Thus, from our findings requirements on AV delay programmability standard can be derived: AVDs (1) should have a range from 40 to 250 ms, (2) should be independently programmable during atrial sensed and atrial paced operation, and (3) should provide as nominal settings 100 ms for atrial sensed and 170 ms for atrial paced stimulation.
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Affiliation(s)
- G H Von Knorre
- Department of Cardiology, University of Rostock, Germany
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Petzsch M, Vassallo J, Roessner A, Zwadlo G, Sorg C, Vollmer E, Grundmann E. Biological characterization of human bone tumors. VIII. Expression of HLA-DR antigens in bone tumors and tumor-like lesions. J Cancer Res Clin Oncol 1986; 112:144-50. [PMID: 3464610 DOI: 10.1007/bf00404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A total of 45 cases of bone tumors and tumor-like lesions were studied in order to determine the expression of an HLA-DR antigen by the monoclonal antibody 910-D-7, and its possible correlation with histology, using the indirect immunoperoxidase method on frozen sections. The pattern of antigen expression was nearly constant for the individual cell types, though varying in intensity, and did not depend on the biological behavior of the respective lesions. No clear correlation could be established between antigen expression and cell maturation. Although the biological significance of antigen expression in these tumors is not yet understood, it is clear that here, too, the mere presence of an HLA-DR antigen cannot be interpreted as a sign of malignant transformation.
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