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Schneider MM, Badhiwala JH, Alvi MA, Tetreault LA, Kalsi P, Idler RK, Wilson JR, Fehlings MG. Prevalence of Neck Pain in Patients with Degenerative Cervical Myelopathy and Short-Term Response After Operative Treatment: A Cohort Study of 664 Patients From 26 Global Sites. Global Spine J 2024; 14:830-838. [PMID: 36073893 DOI: 10.1177/21925682221124098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Ambispective cohort study. OBJECTIVES 1) To define the prevalence of neck pain in patients with degenerative cervical myelopathy (DCM). 2) To identify associated factors of preoperative neck pain in patients with DCM. 3) To assess the neck pain response to surgical intervention. METHODS 757 patients with DCM were enrolled at 26 global sites from 2005 to 2011. A total of 664 patients had complete neck pain scores preoperatively (Neck Disability Index, NDI). The prevalence and severity of neck pain preoperatively and at the 6-months follow-up was summarized. Functional assessments of individuals with and without pain were compared. Associations of preoperative neck pain and related factors were evaluated. RESULTS Preoperatively, 79.2% of patients reported neck pain while 20.8% had no neck pain. Of individuals with neck pain, 20.2% rated their pain as very mild, 27.9% as moderate, 19.6% as fairly severe, 9.6% as very severe and 1.9% as the worst imaginable. Functional status (mJOA), number of stenotic levels, age, and duration of symptoms did not significantly differ in patients with and without pain. Factors associated with the presence of neck pain were female gender, BMI ≥27 kg/m2, rheumatologic and gastrointestinal comorbidities, and age <57 years. Neck pain improved significantly from the preoperative examination to the 6-months postoperative follow-up (P < .0001). CONCLUSION Here, we demonstrate a high prevalence of neck pain in patients with DCM as well as a link between gender, body weight, comorbidity and age. We highlight a significant reduction in neck pain 6 months after surgery.
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Affiliation(s)
- Michel M Schneider
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Lindsay A Tetreault
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- School of Medicine, University College Cork, Cork, Ireland
| | - Pratipal Kalsi
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Randy K Idler
- Hackensack Meridian Health JFK University Medical Center, Edison, NJ, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Schneider MM, Hollinger B, Zimmerer A, Nietschke R, Michaely H, Migliorini F, Maffulli N, Burkhart KJ. Ossification of the posterior capitellum: description of a new pathology and its radiological appearance. Arch Orthop Trauma Surg 2023; 143:4019-4029. [PMID: 36399163 PMCID: PMC10293325 DOI: 10.1007/s00402-022-04689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Boxer elbow and handball goalkeeper elbow are causes of impingement characterized by osteophytes formation at the olecranon and coronoid tip as well as their corresponding fossae. Herein, we present another distinct pathology in these patients: the formation of an exostosis at the posterolateral aspect of the elbow. METHODS Between April 2016 and May 2020, 12 athletes with boxer elbow and handball goalkeeper elbow (mean age of 22 years) suffering from elbow pain were enrolled in the present study. Plain radiography, magnetic resonance imaging (MRI), and computer tomography (CT) scans were used to evaluate the bone conformation of the posterolateral aspect of the elbow. Assessment and staging of the ossification was performed by two independent fellowship-trained elbow surgeons. RESULTS Bone marrow edema of the posterior aspect of the elbow at the origin of the anconeus muscle was initially detected in MRI scans. With the progression of the condition, imaging revealed an ossification posterior to the capitellum with bony bridges. In the advanced stage of the disease, the exostoses was unstable as the ossification had no adherence to the posterior capitellum during surgical excision. Plain radiographs are limited in their ability to detect the condition, whereas MRI and CT scans allow to identify a signal enhancement at the posterolateral aspect of the elbow. CONCLUSION In patients without history of elbow trauma, bony irregularities of the posterior aspect of the capitellum may indicate ossification of the posterolateral aspect of the elbow, most likely caused by repetitive hyperextensions.
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Affiliation(s)
- M M Schneider
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany.
- University Witten/Herdecke, Witten, Germany.
| | - B Hollinger
- Abteilung Sportorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Germany
| | - A Zimmerer
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - R Nietschke
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - H Michaely
- MVZ Radiologie Karlsruhe, Karlsruhe, Germany
| | - F Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - N Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, England, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, England, UK
| | - K J Burkhart
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- University of Cologne, Cologne, Germany
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Zimmerer A, Hauschild M, Nietschke R, Schneider MM, Wassilew G, Sobau C, Miehlke W. Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:189-195. [PMID: 33044706 PMCID: PMC8783918 DOI: 10.1007/s00402-020-03623-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND A cause of groin pain after total hip arthroplasty (THA) is mechanical irritation or impingement of the iliopsoas tendon. The incidence is about 4%. If conservative therapy fails, an arthroscopic release of the iliopsoas tendon can be performed. The aim of the study was to assess the mid-term clinical outcome after arthroscopic release. We hypothesize that good results can be achieved by a minimally invasive endoscopic procedure. METHODS Using our in-house database, all patients who received an endoscopic release of the iliopsoas tendon due to mechanical irritation after THA were identified. Inclusion criteria were mechanical irritation of the iliopsoas tendon after cementless THA with minimal acetabular component prominence. Exclusion criteria were marked prominence of the acetabular component and groin pain after THA for any other reason. In these patients, the modified Harris Hip Score (mHHS), the pain level using the numerical analogue scale and the UCLA Activity Score were measured. The mean follow-up period was 7 ± 3.8 (2.6-11.7) years. RESULTS 25 patients were identified in whom an arthroscopic release of the iliopsoas tendon had been performed since 2007. The data of 20 patients were available at follow-up. The gender ratio was 1:1, the average age at the time of arthroscopy was 59 ± 27.7 (52-78) years. The average interval between THA and arthroscopy was 6.3 ± 4.0 (1.7-15) years. The mHHS showed a significant improvement from preoperative 31.2 ± 9.8 (17.6-47.3) to 82.0 ± 9.8 (46.2-100) points (p = 0.001). The pain level on the NAS decreased significantly from 8.5 ± 1.2 (7-10) to 2.5 ± 1.8 (0-6) points (p = 0.001). The activity level based on the UCLA Activity Score raised from 4.0 ± 2.7 (0-7) to 6.5 ± 1.8 (3-9) (p = 0.09). CONCLUSION Mechanical irritation and impingement of the iliopsoas tendon is an important diagnosis to be considered in persistent groin pain after total hip arthroplasty. In failure of non-operative treatment, good clinical results can be achieved with arthroscopic release and the pain level can be significantly reduced. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Zimmerer
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany.
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - M Hauschild
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany
| | - R Nietschke
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany
| | - M M Schneider
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - G Wassilew
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - C Sobau
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany
| | - W Miehlke
- ARCUS Sportklinik, Rastatterstr. 17-19, 75179, Pforzheim, Germany
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Affiliation(s)
- Rainer Nietschke
- Abteilung Obere Extremität, Arcus Sportklinik Pforzheim, Rastatter Str. 17-19, D-75179, Pforzheim, Deutschland.
| | - K J Burkhart
- Arcus Sportklinik, Pforzheim, Deutschland.,Universität zu Köln, Köln, Deutschland
| | - A Zimmerer
- Arcus Sportklinik, Pforzheim, Deutschland
| | | | | | - M M Schneider
- Arcus Sportklinik, Pforzheim, Deutschland.,Universität Witten/Herdecke, Witten/Herdecke, Deutschland
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5
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Nietschke R, Schneider MM, Hollinger B, Buder T, Zimmerer A, Zimmermann F, Burkhart KJ. [Performance control after arthroscopic arthrolysis with capsulectomy in fresh-frozen elbow joints]. Unfallchirurg 2018; 122:791-798. [PMID: 30478780 DOI: 10.1007/s00113-018-0584-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Posttraumatic or postoperative movement restrictions in elbow joints can often occur (including capsular contracture) and can generate everyday limitations. In persistent elbow stiffness, arthroscopic arthrolysis with removal of the dorsal and ventral capsule portions can be carried out. The purpose of this study was to assess the efficacy of arthroscopic capsulectomy by means of an in vitro anatomical study. METHODS A standardized elbow arthroscopy with ventral and dorsal capsulectomy was performed and image-documented in five fresh-frozen elbow specimens. Subsequently, open dissection of the elbow joint was performed to analyze the amount of residual capsule by means of photodocumentation of the specimens. RESULTS Regardless of the surgeon and surgical experience, anterior and posterior remnants of the capsule remained in all specimens. Dorsal capsule strands around the standard arthroscopy portals were noticed particularly more often in the area of the high dorsolateral camera portal. An incomplete capsulectomy was seen on the ulnar side at the level of the posterior medial ligament (PML) in the immediate vicinity of the ulnar nerve. Ventrally, a capsulectomy was performed from the radial side and also the ulnar side until the brachialis muscle and additionally a complete capsulectomy as far as the anterior medial ligament (AML) and radial collateral ligament (RCL) was achieved. The capsule was completely resected in a proximal direction. Distally, irrelevant capsular remnants were found in the region of the annular ligament and distal of the tip of the coronoid process. CONCLUSION Arthroscopic arthrolysis can be performed with a high degree of radicality. The radicality must be self-critically taken into account in one's own action. The radicality of the portal change may even be higher ventrally than with an isolated column procedure. On the other hand, it must be critically considered that posteriorly, the PML cannot be adequately addressed by means of arthroscopy due to the risk of ulnar nerve injury. Portal changes might help to enable a more complete visualization of the joint capsule and may avoid leaving possibly relevant remnants of the capsule. If a release of the PML is required, this may have to be carried out in combination with an ulnar nerve release in a mini-open technique.
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Affiliation(s)
- R Nietschke
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.
| | - M M Schneider
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.,Universität Witten/Herdecke, Alfred-Herrhausen-Strasse 50, 58455, Witten, Deutschland
| | - B Hollinger
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - T Buder
- Institut für Anatomie, Lehrstuhl I, Friedrich-Alexander Universität Erlangen-Nürnberg, Schlossplatz 4, 91054, Erlangen, Deutschland
| | - A Zimmerer
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - F Zimmermann
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - K J Burkhart
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.,Universität zu Köln, Albertus-Magnus-Platz, 50923, Köln, Deutschland
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Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D’Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schöni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, Fandino J, Marbacher S, D'Alonzo D, Coluccia D, Schmid N, Zumofen D, Roethlisberger M, Mariani L, Guzman R, Monsch AU, Bläsi S, Fung C, Bervini D, Beck J, Raabe A, Goldberg J, Schöni D, Gralla J, Zweifel-Zehnder A, Gutbrod K, Müri R, Maduri R, Thomas Daniel R, Starnoni D, Messerer M, Levivier M, Beaud V, Valsecchi D, Arrighi M, Venier A, Reinert M, Kuhlen DE, Robert T, Rossi S, Sacco L, Bijlenga P, Corniola M, Schaller K, Chicherio C, Seule MA, Ferrari A, Weyerbrock A, Hlavica M, Fournier JY, Früh S, Schatlo B, Burkhardt JK, Stienen MN, Keller E, Regli L, Bozinov O, Maldaner N, Finkenstädt S, Neidert MC, Brugger P, Mondadori C. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery 2018; 83:1286-1293. [DOI: 10.1093/neuros/nyx609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department Clinical Neurosciences, Service Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Michel M Schneider
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Marta Arrighi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Burkhart KJ, Gohlke F, Nietschke R, Schneider MM, Hollinger B. [Destruction of the radial head : Endoprosthesis, autologous reconstruction or anconeus arthroplasty?]. Orthopade 2017; 46:981-989. [PMID: 29071514 DOI: 10.1007/s00132-017-3492-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Radiocapitellar arthritis or defects most often result from trauma. Most of the patients are young and have high functional demands with high load capacities. Therefore, endoprosthetic options should be postponed for as long as possible. If conservative treatment cannot relieve symptoms sufficiently, radial head preservation, resection or replacement options are at the surgeon's disposal. In early stages of radiocapitellar arthritis, radial head preservation options can be taken into account. The chances ofgood results decrease with increasing cartilage damage. TREATMENT OPTIONS In addition to radial head preservation options this article discusses radial head resection with and without anconeus interposition and radial head as well as radiocapitellar replacement. Clinical data are rare. The advantages and disadvantages of each option must be discussed with the patient and the decision should be made individually on the basis of patient specific factors. The aim must be to postpone endoprosthetic options - especially total elbow arthroplasty - for as long as possible, while assuring a functional range of motion with an acceptable pain level.
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Affiliation(s)
- K J Burkhart
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland.
| | - F Gohlke
- Klinik für Schulterchirurgie, Rhön-Klinikum, Bad Neustadt/Saale, Deutschland
| | - R Nietschke
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - M M Schneider
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
| | - B Hollinger
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Deutschland
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Schneider MM, Balke M, Koenen P, Fröhlich M, Wafaisade A, Bouillon B, Banerjee M. Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 2016; 24:2192-6. [PMID: 25399347 DOI: 10.1007/s00167-014-3436-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The reliability of the Rockwood classification, the gold standard for acute acromioclavicular (AC) joint separations, has not yet been tested. The purpose of this study was to investigate the reliability of visual and measured AC joint lesion grades according to the Rockwood classification. METHODS Four investigators (two shoulder specialists and two second-year residents) examined radiographs (bilateral panoramic stress and axial views) in 58 patients and graded the injury according to the Rockwood classification using the following sequence: (1) visual classification of the AC joint lesion, (2) digital measurement of the coracoclavicular distance (CCD) and the horizontal dislocation (HD) with Osirix Dicom Viewer (Pixmeo, Switzerland), (3) classification of the AC joint lesion according to the measurements and (4) repetition of (1) and (2) after repeated anonymization by an independent physician. Visual and measured Rockwood grades as well as the CCD and HD of every patient were documented, and a CC index was calculated (CCD injured/CCD healthy). All records were then used to evaluate intra- and interobserver reliability. RESULTS The disagreement between visual and measured diagnosis ranged from 6.9 to 27.6 %. Interobserver reliability for visual diagnosis was good (0.72-0.74) and excellent (0.85-0.93) for measured Rockwood grades. Intraobserver reliability was good to excellent (0.67-0.93) for visual diagnosis and excellent for measured diagnosis (0.90-0.97). The correlations between measurements of the axial view varied from 0.68 to 0.98 (good to excellent) for interobserver reliability and from 0.90 to 0.97 (excellent) for intraobserver reliability. CONCLUSION Bilateral panoramic stress and axial radiographs are reliable examinations for grading AC joint injuries according to Rockwood's classification. Clinicians of all experience levels can precisely classify AC joint lesions according to the Rockwood classification. We recommend to grade acute ACG lesions by performing a digital measurement instead of a sole visual diagnosis because of the higher intra- and interobserver reliability. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- M M Schneider
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. .,Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
| | - M Balke
- Sportsclinic Cologne - Practice for Sportstraumatology, Cologne Merheim Medical Center (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - P Koenen
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - M Fröhlich
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - A Wafaisade
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - B Bouillon
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - M Banerjee
- Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Kottke R, Saurenmann RK, Schneider MM, Müller L, Grotzer MA, Kellenberger CJ. Contrast-enhanced MRI of the temporomandibular joint: findings in children without juvenile idiopathic arthritis. Acta Radiol 2015; 56:1145-52. [PMID: 25217514 DOI: 10.1177/0284185114548506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Contrast-enhanced magnetic resonance imaging (MRI) is highly sensitive for assessing temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA), but only sparse data exist on normal TMJ appearance in children. PURPOSE To determine normal MRI appearance and enhancement pattern of pediatric TMJ as basis for diagnosing early arthritis. MATERIAL AND METHODS In 27 children (age range, 1.2-16.8 years) without TMJ pathology undergoing head MRI, fat-saturated T2-weighted (T2W) and postcontrast fat-saturated T1-weighted (T1W) images sagittally aligned to the 54 TMJs, besides standard T1W and T2W images, were assessed for bony and soft tissue signal intensity (SI), the amount of perceptible joint fluid, and contrast enhancement (CE). RESULTS Bone marrow SI and CE of the mandible were consistent with varying degrees of residual red marrow in 96% of joints. The mandibular condyles were mostly isointense to the ramus, but in 9% showed mild edema-like bone marrow SI and CE. Small amounts of intraarticular fluid were detected in 31% on T2W images without fat saturation and in 83% on T2W images with fat saturation as fine lines in the upper or lower joint compartment or as small dots in an articular recess. Seventy-nine percent of all TMJs showed intense joint enhancement on early images restricted to areas of intraarticular fluid. CONCLUSION Small amounts of joint fluid with intense CE are a common MRI finding in TMJs of children without JIA and therefore should not be considered diagnostic for early arthritis.
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Affiliation(s)
- Raimund Kottke
- Department of Diagnostic Imaging, University Children’s Hospital Zürich, Switzerland
| | | | - Michel M Schneider
- Division of Rheumatology, University Children’s Hospital Zürich, Switzerland
| | - Lukas Müller
- Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Switzerland
| | - Michael A Grotzer
- Department of Pediatric Oncology, University Children’s Hospital Zürich, Switzerland
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Abstract
Anterior cruciate ligament ruptures represent serious injuries for athletes which are often associated with accompanying injuries and lead to relevant kinematic alterations in the femorotibial roll-glide mechanism of the knee joint. Instability resulting in recurrent giving way events, as well as instability-related meniscal and cartilage lesions can cause functional long-term impairment that may limit the athlete's career. Anterior cruciate ligament replacement is therefore considered to be the gold standard for recovery of physical performance and to prevent secondary meniscal and cartilage damage. Continuous changes in the reconstruction of the anterior cruciate ligament have led to a variety of different methods, including graft choice, fixation devices and surgical techniques, which support the consideration of individual requirements of the athlete as well as sport-specific aspects. One of the main factors for restoring stability and the physiological kinematic roll-glide mechanism of the knee is an anatomical tunnel placement as well as a stable graft fixation in the tibia and femur. By achieving of these fundamental technical requirements an early functional rehabilitation and accelerated recovery of neuromuscular skills, strength and coordination can be achieved, so that an early return to sport activities is possible.
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Affiliation(s)
- S Shafizadeh
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Universität Witten/Herdecke am Klinikum Köln Merheim, Abteilung des Berufsgenossenschaftlichen Klinikums Bergmannsheil Bochum am Standort Köln, Ostmerheimerstr. 200, 51109, Köln, Deutschland,
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Klatte TO, Schneider MM, Citak M, Oloughlin P, Gebauer M, Rueger M, Gehrke T, Kendoff D. Infection rates in patients undergoing primary knee arthroplasty with pre-existing orthopaedic fixation-devices. Knee 2013; 20:177-80. [PMID: 23540939 DOI: 10.1016/j.knee.2013.02.004] [Citation(s) in RCA: 17] [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] [Received: 11/26/2012] [Accepted: 02/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prior knee surgery in the setting of knee arthroplasty (KA) can influence the overall outcome of the procedure and render the operation more technically challenging. The effects of residual fixation devices on subsequent procedures about the knee are ill-defined. Some authors claim an increase in periprosthetic infection in this cohort of patients. The objective of this study was to evaluate the overall incidence of periprosthetic infections in patients undergoing primary KA with pre-existing osteosynthetic hardware in situ. METHODS The current investigators retrospectively reviewed 124 patients undergoing knee arthroplasty and removal of orthopaedic fixation devices, due to prior high tibial osteotomies, fracture fixation or cruciate ligament reconstruction. The exclusion criterion was a prior history of infection of the fixation device. The mean follow-up time was 5.4 years (range 15 months to 9 years). Nine patients were lost to follow-up. RESULTS Joint aspiration was performed two weeks prior to surgery in 53 patients (42.4%) and intra-operative samples were obtained in 106 patients (84.8%), which did not show any bacterial growth. A subacute periprosthetic infection occurred after seven months in only one patient. CONCLUSION The results of the current study demonstrate that previously implanted osteosynthetic fixation devices do not significantly increase the risk of developing periprosthetic knee infections. A two-stage procedure with implant retrieval prior to total knee arthroplasty is not clinically indicated in the cohort described, amongst whom an infection rate of 0.9% was revealed.
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Affiliation(s)
- T O Klatte
- Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany.
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Schneider MM, Shows A, Giebl A, Schramm W. Haemophilia patients with HIV- and HCV-infection. Long term survival. Hamostaseologie 2011; 31 Suppl 1:S14-S19. [PMID: 22057841] [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] [Received: 03/17/2011] [Accepted: 05/13/2011] [Indexed: 05/31/2023] Open
Abstract
UNLABELLED At present (2010), we investigate in a long term study on psychosocial aspects of haemophilia at the Munich Haemophilia Centre factors which could be held responsible for the large number of still living HIV+ patients while many patients died from AIDS or from diseases caused by HCV during the 1990ies. PATIENTS, METHODS We retrospectively compare medical and psychosocial data of 15 HIV+ long term survivors (L-S), 15 HIV+ later on deceased patients and 15 HIV-, all of them deriving from the original investigation group from 1985 including 52 patients (30 HIV+, 22 HIV-). We prove the validity of our psychosocial factors by the SF 36 which currently serves as gold standard. The actual psychosocial factors and medical parameters of the 15 L-S are checked against the data of the 15 HIV- patients. RESULTS, CONCLUSION In 1985 already, we retrospectively found significantly higher values regarding psychosocial factors within the group of the L-S as opposed to the later on deceased ones. Highly significant are the facts that more than 90 % of HIV+ L-S have had a good relationship to their fathers and are still employed today in contrast to the deceased HIV+ patients. At present, the differences regarding psychosocial factors between HIV+ L-S and HIV-negative patients are vanishing.
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Affiliation(s)
- M M Schneider
- Facharzt für Psychosomatische Medizin, Psychotherapie Psychoanalyse, München.
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13
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Schneider MM, Schramm W. [A quarter century of psychosocial haemophilia-counseling]. Hamostaseologie 2010; 30 Suppl 1:S19-S22. [PMID: 21042670] [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: 05/30/2023] Open
Abstract
UNLABELLED With the development of clotting-factors in the seventies the haemophilia patients were released from being handicapped and began to live a quite normal life. Thus, psychosocial counselling did not seem to be necessary. But the impact of HIV-infection to the world of haemophilia was so intense that professional help was offered at the Munich Hemophilia Centre since 1985. During the preceeding 25 years we talked to about 120 patients and relatives every year in more than 10000 psychotherapeutic talks. 70 of our patients were HIV-infected. For about half of them we took care until they died on AIDS or of liver-disease. The other 50 patients (HIV-negative) were also distressed enormously. At the beginning the highlights in counselling were e. g. fear of manifestation of AIDS, dying and death, social stigma. Around 1993 with the decoding of HCV and the first useful HIV therapies the topics in counselling changed: New HIV-medical-treatment, menacing by HCV, wish for own children due to improved HIV medical care etc. CONCLUSION Our experiences have shown that self esteem and social integration of haemophilia patients have reached again normality. By our psychosocial counselling we would like to contribute.
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Affiliation(s)
- M M Schneider
- Abteilung für Hämostaseologie und Transfusionsmedizin, Medizinische Klinik Innenstadt, Universität München, Germany; Bluter Betreuung Bayern e.V.
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Schneider MM, Sprenger MJ, Hoepelman IM, van der Graaf Y, Borleffs JC. Antibody response to tetravalent influenza subunit vaccine in patients infected with human immunodeficiency virus type 1. Int J Antimicrob Agents 2010; 6:195-200. [PMID: 18611709 DOI: 10.1016/0924-8579(95)00038-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/1995] [Indexed: 10/27/2022]
Abstract
The capacity of patients infected with human immunodeficiency virus (HIV) to develop an adequate antibody response to influenza vaccination in relation to the CD4 cell count has been studied in a prospective study. A total of 73 subjects (54 HIV-infected patients and 19 healthy control persons) were vaccinated with influenza subunit vaccine containing 15 mug hemagglutinin of each of the following strains: A/Beijing/353/89(H3N2), A/Singapore/6/86(H1N1), B/Panama/45/90, and B/Beijing/1/87. Hemagglutinin inhibition (HI) antibody titers were determined prior to vaccination, 3 weeks afterwards, and at the end of the influenza season. The percentage of subjects with HI antibody titers above the assumed protective level was significantly lower in the HIV-infected patients for all 4 vaccine strains compared with those in the control group (7-26% and 42-74%, respectively). There was an association between CD4 cell count and antibody response to the B/Panama strain only. The serologic response to tetravalent subunit influenza vaccine is severely impaired in the majority of HIV-infected patients compared with control subjects. The results of this study challenges the recommendation to vaccinate HIV-infected patients.
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Affiliation(s)
- M M Schneider
- Department of Internal Medicine, Section of Clinical Immunology and Infectious Diseases, University Hospital Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Schneider MM, Berman JI, Baumer FM, Glass HC, Jeng S, Jeremy RJ, Esch M, Biran V, Barkovich AJ, Studholme C, Xu D, Glenn OA. Normative apparent diffusion coefficient values in the developing fetal brain. AJNR Am J Neuroradiol 2009; 30:1799-803. [PMID: 19556350 DOI: 10.3174/ajnr.a1661] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies of diffusion-weighted imaging (DWI) in fetuses are limited. Because of the need for normative data for comparison with young fetuses and preterm neonates with suspected brain abnormalities, we studied apparent diffusion coefficient (ADC) values in a population of singleton, nonsedated, healthy fetuses. MATERIALS AND METHODS DWI was performed in 28 singleton nonsedated fetuses with normal or questionably abnormal results on sonography and normal fetal MR imaging results; 10 fetuses also had a second fetal MR imaging, which included DWI. ADC values in the periatrial white matter (WM), frontal WM, thalamus, basal ganglia, cerebellum, and pons were plotted against gestational age and analyzed with linear regression. We compared mean ADC in different regions using the Tukey Honestly Significant Difference test. We also compared rates of decline in ADC with increasing gestational age across different areas by using the t test with multiple comparisons correction. Neurodevelopmental outcome was assessed. RESULTS Median gestational age was 24.28 weeks (range, 21-33.43 weeks). Results of all fetal MR imaging examinations were normal, including 1 fetus with a normal variant of a cavum velum interpositum. ADC values were highest in the frontal and periatrial WM and lowest in the thalamus and pons. ADC declined with increasing gestational age in periatrial WM (P = .0003), thalamus (P < .0001), basal ganglia (P = .0035), cerebellum (P < .0001), and pons (P = .024). Frontal WM ADC did not significantly change with gestational age. ADC declined fastest in the cerebellum, followed by the thalamus. CONCLUSIONS Regional differences in nonsedated fetal ADC values and their evolution with gestational age likely reflect differences in brain maturation and are similar to published data in premature neonates.
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Affiliation(s)
- M M Schneider
- Departments of Radiology and Biomedical Imaging, Department of Pediatrics, University of California, San Francisco, CA 94143-0628, USA
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Nieuwkerk PT, Sprangers MA, Burger DM, Hoetelmans RM, Hugen PW, Danner SA, van Der Ende ME, Schneider MM, Schrey G, Meenhorst PL, Sprenger HG, Kauffmann RH, Jambroes M, Chesney MA, de Wolf F, Lange JM. Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Arch Intern Med 2001; 161:1962-8. [PMID: 11525698 DOI: 10.1001/archinte.161.16.1962] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adherence to highly active antiretroviral therapy (HAART) for human immunodeficiency syndrome type 1 (HIV-1) infection is essential to sustain viral suppression and prevent drug resistance. We investigated adherence to HAART among patients in a clinical cohort study. METHODS Patients receiving HAART had their plasma concentrations of protease inhibitors or nevirapine measured and completed a questionnaire on adherence. We determined the percentage of patients who reported taking all antiretroviral medication on time and according to dietary instructions in the past week. Drug exposure was compared between patients reporting deviation from their regimen and fully adherent patients. Among patients who received HAART for at least 24 weeks, we assessed the association between adherence and virologic outcome. RESULTS A total of 224 of 261 eligible patients completed a questionnaire. Forty-seven percent reported taking all antiretroviral medication on time and according to dietary instructions. Patients who reported deviation from their regimen showed lower drug exposure compared with fully adherent patients (median concentration ratio, 0.81 vs 1.07; P =.001). Among those receiving HAART for at least 24 weeks, patients reporting deviation from their regimen were less likely to have plasma HIV-1 RNA levels below 500 copies/mL (adjusted odds ratio, 4.0; 95% confidence interval, 1.4-11.6) compared with fully adherent patients. CONCLUSIONS Only half of the patients took all antiretroviral medication in accordance with time and dietary instructions in the preceding week. Deviation from the antiretroviral regimen was associated with decreased drug exposure and a decreased likelihood of having suppressed plasma HIV-1 RNA loads. Patient adherence should remain a prime concern in the management of HIV-1 infection.
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Affiliation(s)
- P T Nieuwkerk
- Department of Medical Psychology (J4-410), Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, the Netherlands.
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Jambroes M, Weverling GJ, Reiss P, Danner SA, Jurriaans S, ten Veen JH, van der Ende ME, Schutten M, Schneider MM, Schuurman R, Mulder JW, Kroes AC, Lange JM, de Wolf F. [HIV-1 therapy in the Netherlands; virological and immunological response to antiretroviral therapy]. Ned Tijdschr Geneeskd 2001; 145:1591-7. [PMID: 11534377] [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: 02/21/2023]
Abstract
OBJECTIVE To evaluate the effect of treatment of HIV-1 infection with combination therapy consisting of since 1996 in the Netherlands available protease and reverse transcriptase inhibitors. DESIGN Prospective cohort study. METHODS In an observational clinical cohort of HIV-1-infected individuals, the short-term successful treatment end point of antiviral therapy including at least one antiretroviral drug licensed in the Netherlands since July 1, 1996 (protease inhibitors and reverse transcriptase inhibitors), was HIV-1 RNA plasma levels < or = 500 copies/ml (virological success). Cox proportional hazard models were used to identify prognostic markers for therapy success. The study included 2,148 infected individuals with a median follow-up of 135 weeks of treatment; 1,049 had been pre-treated with antiretroviral drugs before starting their new regimen and 1,099 were treatment naive. RESULTS Plasma HIV-1 RNA levels < or = 500 copies/ml at 24 weeks of treatment were seen in 61% of all patients. The chance of therapy success for naive patients was twice that for pre-treated patients (relative risk: 1.8; p < or = 0.001). Following the first 24 weeks, the chance of virological success was higher in the naive group (78% versus 63%; p < or = 0.001), and the number of naive patients failing therapy after initial success was smaller compared to pre-treated patients (22% versus 45%; p < or = 0.001). In the naive group, the CD4+ T-cell number increased from 239 to 440 (x 10(6) cells/l) in case of success, and decreased from 150 to 320 in case of treatment failure. HIV-1 related morbidity declined from 0.26 to 0.05 and mortality dropped from 0.07 to 0.03 per person-year of follow-up. Regimens were changed at least once in 76% of patients. Toxicity and therapy failure were the main reasons for regimen changes in naive and pre-treated patients, respectively. CONCLUSION A combination of antiretroviral drugs, including at least one of the drugs licensed since 1996, led to a drop in HIV-1 plasma concentrations. Morbidity and mortality also decreased. The chance of a better immunological and virological response to the new drug regimens was greatest in therapy-naive patients.
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Affiliation(s)
- M Jambroes
- Afd. Klinische Epidemiologie en Biostatistiek, Academisch Medisch Centrum, afd. Humane Retrovirologie en Nationaal AIDS Therapie Evaluatie Centrum (NATEC), Meibergdreef 15, 1105 AZ Amsterdam
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18
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Ledergerber B, Mocroft A, Reiss P, Furrer H, Kirk O, Bickel M, Uberti-Foppa C, Pradier C, D'Arminio Monforte A, Schneider MM, Lundgren JD. Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. Eight European Study Groups. N Engl J Med 2001; 344:168-74. [PMID: 11188837 DOI: 10.1056/nejm200101183440302] [Citation(s) in RCA: 105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection and a history of Pneumocystis carinii pneumonia are at high risk for relapse if they are not given secondary prophylaxis. Whether secondary prophylaxis against P. carinii pneumonia can be safely discontinued in patients who have a response to highly active antiretroviral therapy is not known. METHODS We analyzed episodes of recurrent P. carinii pneumonia in 325 HIV-infected patients (275 men and 50 women) in eight prospective European cohorts. Between October 1996 and January 2000, these patients discontinued secondary prophylaxis during treatment with at least three anti-HIV drugs after they had at least one peripheral-blood CD4 cell count of more than 200 cells per cubic millimeter. RESULTS Secondary prophylaxis was discontinued at a median CD4 cell count of 350 per cubic millimeter; the median nadir CD4 cell count had been 50 per cubic millimeter. The median duration of the increase in the CD4 cell count to more than 200 per cubic millimeter after discontinuation of secondary prophylaxis was 11 months. The median follow-up period after discontinuation of secondary prophylaxis was 13 months, yielding a total of 374 person-years of follow-up; for 355 of these person-years, CD4 cell counts remained at or above 200 per cubic millimeter. No cases of recurrent P. carinii pneumonia were diagnosed during this period; the incidence was thus 0 per 100 patient-years (99 percent confidence interval, 0 to 1.2 per 100 patient-years, on the basis of the entire follow-up period, and 0 to 1.3 per 100 patient-years, on the basis of the follow-up period during which CD4 cell counts remained at or above 200 per cubic millimeter). CONCLUSIONS It is safe to discontinue secondary prophylaxis against P. carinii pneumonia in patients with HIV infection who have an immunologic response to highly active antiretroviral therapy.
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Affiliation(s)
- B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.
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Dunne M, Fessel J, Kumar P, Dickenson G, Keiser P, Boulos M, Mogyros M, White AC, Cahn P, O'Connor M, Lewi D, Green S, Tilles J, Hicks C, Bissett J, Schneider MM, Benner R. A randomized, double-blind trial comparing azithromycin and clarithromycin in the treatment of disseminated Mycobacterium avium infection in patients with human immunodeficiency virus. Clin Infect Dis 2000; 31:1245-52. [PMID: 11073759 DOI: 10.1086/317468] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/1999] [Revised: 05/24/2000] [Indexed: 11/04/2022] Open
Abstract
Two hundred and forty-six patients infected with human immunodeficiency virus (HIV) who also had disseminated Mycobacterium avium complex received either azithromycin 250 mg every day, azithromycin 600 mg every day, or clarithromycin 500 mg twice a day, each combined with ethambutol, for 24 weeks. Samples drawn from patients were cultured and clinically assessed every 3 weeks up to week 12, then monthly thereafter through week 24 of double-blind therapy and every 3 months while on open-label therapy through the conclusion of the trial. The azithromycin 250 mg arm of the study was dropped after an interim analysis showed a lower rate of clearance of bacteremia. At 24 weeks of therapy, the likelihood of patients' developing 2 consecutive negative cultures (46% vs. 56%, P=.24) or 1 negative culture (59% vs. 61%, P=.80) was similar for azithromycin 600 mg (n=68) and clarithromycin (n=57), respectively. The likelihood of relapse was 39% versus 27% (P=.21) on azithromycin compared with clarithromycin, respectively. Of the 6 patients who experienced relapse, none of those randomized to receive azithromycin developed isolates resistant to macrolides, compared with 2 of 3 patients randomized to receive clarithromycin [corrected]. Mortality was similar in patients comprising each arm of the study (69% vs. 63%; hazard, 95.1% confidence interval, 1.1 [0.7, 1.7]). Azithromycin 600 mg, when given in combination with ethambutol, is an effective agent for the treatment of disseminated M. avium disease in patients infected with HIV.
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Affiliation(s)
- M Dunne
- Pfizer Central Research, Groton, CT 06340, USA.
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Abstract
The case history of a HIV patient with a pulmonary infect of Rhodococcus equi is presented. He recovered after prolonged treatment with antibiotics and lobectomy. The Rhodococcus equi infection was the presenting symptom of his impaired immune status caused by HIV infection.
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Affiliation(s)
- H P Hulsewé-Evers
- Department of Internal Medicine, Academic Hospital, Maastricht, The Netherlands
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Komijn RE, de Haas PE, Schneider MM, Eger T, Nieuwenhuijs JH, van den Hoek RJ, Bakker D, van Zijd Erveld FG, van Soolingen D. Prevalence of Mycobacterium avium in slaughter pigs in The Netherlands and comparison of IS1245 restriction fragment length polymorphism patterns of porcine and human isolates. J Clin Microbiol 1999; 37:1254-9. [PMID: 10203466 PMCID: PMC84743 DOI: 10.1128/jcm.37.5.1254-1259.1999] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [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: 11/20/2022] Open
Abstract
A significant increase in the incidence of caseous lesions in the lymph nodes of slaughter pigs prompted a large-scale investigation in five slaughterhouses in The Netherlands. In total, 158,763 pigs from 2,899 groups underwent gross examination. At least one pig with caseous lesions in the submaxillary and/or mesenteric lymph nodes was observed in each of 154 of the 2,899 groups examined (5%). In total, 856 pigs (0.5%) were affected. As many as five pigs in each of 141 of the 154 positive groups (91.5%) had lymph node lesions. Greater numbers of pigs with affected lymph nodes were found in 13 groups (8.5%). Four pigs had lesions in the kidneys, liver, or spleen. Acid-fast bacteria were detected by microscopic examination of 121 of 292 Ziehl-Neelsen-stained smears of caseous lesions (41%). In a follow-up study, Mycobacterium avium complex (MAC) bacteria were isolated from 219 of 402 affected lymph nodes (54.2%). Ninety-one of the isolated strains were analyzed by restriction fragment length polymorphism (RFLP) typing with insertion sequence IS1245 as a probe. All but 1 of these 91 strains contained IS1245 DNA, indicating that pigs in The Netherlands carried almost exclusively M. avium bacteria and no other bacteria of MAC. Only one pig isolate exhibited the bird-type RFLP pattern. MAC isolates from 191 human patients in The Netherlands in 1996 were also typed by RFLP analysis. Computer-assisted analysis showed that the RFLP patterns of 61% of the human isolates and 59% of the porcine isolates were at least 75% similar to the RFLP patterns of the other group of strains. This indicates that pigs may be an important vehicle for M. avium infections in humans or that pigs and humans share common sources of infection.
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Affiliation(s)
- R E Komijn
- National Inspection Service for Livestock and Meat, 2270 JA Voorburg, The Netherlands.
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Schneider MM, Borleffs JC, Stolk RP, Jaspers CA, Hoepelman AI. Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1-infected patients treated with highly active antiretroviral therapy. Lancet 1999; 353:201-3. [PMID: 9923876 DOI: 10.1016/s0140-6736(98)07204-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.4] [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: 10/17/2022]
Abstract
BACKGROUND Prophylactic drugs for Pneumocystis carinii pneumonia (PCP) are strongly recommended for HIV-1-infected patients with CD4 cell counts of less than 200 cells/microL. Because of the highly active antiretroviral therapy (HAART) currently available, we speculated that prophylaxis can be discontinued in patients with CD4 cell counts of more than 200 cells/microL. METHODS In this prospective observational study, PCP prophylaxis (primary or secondary) was discontinued in HIV-1-infected patients whose CD4 cell count had increased above 200 cells/microL (documented twice with an interval of at least 1 month) as a result of HAART. Patients and their CD4 cell counts were monitored every 3 months. The primary endpoint of the study was the occurrence or reoccurrence of PCP. FINDINGS 78 patients were enrolled: 62 patients were receiving prophylaxis for primary prevention of PCP and 16 patients for secondary prevention of PCP. At the time of discontinuation of prophylaxis, the mean CD4 cell count was 347 cells/microL, and HIV-1-RNA was not detectable in 61 patients. The lowest mean CD4 cell count during prophylaxis was 79 cells/microL. Patients stopped prophylaxis 9.8 (SD 6.4) months after they started HAART. The mean follow-up after discontinuation of prophylaxis was 12.7 (SD 7.6) months, and none of the patients developed PCP (97.5% one-sided CI 0-4.4%). INTERPRETATION The preliminary results of this study indicate that PCP prophylaxis can be stopped safely in HIV-1-infected patients whose CD4 cell counts have increased above 200 cells/microL after treatment with HAART.
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Affiliation(s)
- M M Schneider
- Department of Internal Medicine, University Hospital Utrecht, Netherlands.
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Schrijver RS, van Oirschot JT, Dekker A, Schneider MM, van Knapen F, Kimman TG. [Foot-and-mouth disease of cattle is not a zoonosis]. Ned Tijdschr Geneeskd 1999; 143:107-8. [PMID: 10086115] [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: 02/11/2023]
Abstract
In 1997 there was an outbreak of foot-and-mouth disease (FMD) among cattle in Turkey. People visiting that country were warned against importing animal products into the Netherlands. This had nothing to do with hazards to human health, as FMD virus is not a zoonotic virus, but with the risk of spread of the disease to livestock in the Netherlands, notably to cattle and pigs. A disease with similar clinical symptoms in pigs is swine vesicular disease (SVD), which is not a zoonosis either. FMD virus is an aphtovirus, SVD virus is an enterovirus. Hand-foot-and-mouth disease in humans is caused by other enteroviruses, i.e. Coxsackie virus and enterovirus 71.
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Affiliation(s)
- R S Schrijver
- Instituut voor Dierhouderij en Diergezondheid (ID-DLO), afd. Zoogdiervirologie, Lelystad
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Schrijver RS, van Oirschot JT, Dekker A, Schneider MM, van Knapen F, Kimman TG. [Foot and mouth disease is not a zoonosis]. Tijdschr Diergeneeskd 1998; 123:750. [PMID: 9879625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- R S Schrijver
- Instituut voor Dierhouderij en Diergezondheid, Afdeling Zoogdiervirologie, Postbus, Lelystad
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Borleffs JC, Schneider MM, Hoepelman IM. [A changed pattern of opportunistic infections and malignancies in HIV-seropositive patients after the introduction of intensive anti-HIV-combination therapy]. Ned Tijdschr Geneeskd 1998; 142:2395-9. [PMID: 9864534] [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: 02/09/2023]
Abstract
The application of potent combinations of antiretroviral drugs ('highly active antiretroviral therapy' (HAART)) makes effective therapy of HIV infection feasible. Consequently, the pattern of opportunistic infections and other secondary complications has changed. The incidence of infections and mortality due to aids has declined significantly. Further, the occurrence of other infections and syndromes, till now unknown in patients with aids, has been observed. It is thought that these are caused by HAART-induced inflammation, a phenomenon due to immune enhancement following HAART. An important issue is whether primary and secondary prophylaxis against opportunistic infections can be discontinued after improvement of the immune system: indeed, there are reports that discontinuation is safe in patients with persistent CD4+ cell counts above the critical level for that particular infection while CD4+ cell counts are monitored carefully.
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Affiliation(s)
- J C Borleffs
- Academisch Ziekenhuis, Afd. Interne Geneeskunde, Utrecht
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Borleffs JC, Bosschaert M, Vrehen HM, Schneider MM, van Strijp J, Small MK, Borkett KM. Effect of escalating doses of recombinant human granulocyte colony-stimulating factor (filgrastim) on circulating neutrophils in healthy subjects. Clin Ther 1998; 20:722-36. [PMID: 9737832 DOI: 10.1016/s0149-2918(98)80135-5] [Citation(s) in RCA: 39] [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: 11/19/2022]
Abstract
The safety profile, tolerability, pharmacodynamics, and pharmacokinetics of four doses of recombinant human granulocyte colony-stimulating factor (filgrastim) were assessed in healthy volunteers in a double-masked, placebo-controlled, parallel-group trial. Healthy subjects received subcutaneous injections of filgrastim 75 microg (n = 8), 150 microg (n = 4), 300 microg (n = 4), 600 microg (n = 8), or placebo (n = 6) daily for 10 consecutive days. Blood samples were drawn daily immediately before the injection and on days 1 and 10 serially throughout the day. Increased absolute neutrophil counts (ANCs) were seen within 90 minutes of drug administration in subjects in all dose groups, peaking approximately 12 hours after administration. This increase was dose related in subjects in the three lower dose groups. The time to peak ANC on day 10 was approximately 9 hours, with a daily ANC profile in all four dose groups that was similar to the profile on day 1. In all dose groups, ANCs were near baseline within 48 hours of discontinuation of filgrastim. Mild, reversible thrombocytopenia was reported in 4 of 10 subjects in the highest dose group. Two subjects in the filgrastim 600-microg group were withdrawn for adverse events. Filgrastim had a good safety profile and caused dose-related increases in ANC when administered to healthy volunteers for up to 10 days.
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Affiliation(s)
- J C Borleffs
- Department of Internal Medicine, University Hospital, Utrecht, The Netherlands
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Jeurissen FJ, Schneider MM, Borleffs JC. Is the combination of hepatitis and indinavir potentially dangerous? AIDS 1998; 12:441-2. [PMID: 9520177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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29
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Schneider MM, Reiss P, Borleffs JC, Rozenberg-Arska M, Hoepelman IM. [Mycobacterium avium infection in HIV-infected patients: epidemiology, diagnosis, prevention and treatment]. Ned Tijdschr Geneeskd 1997; 141:80-3. [PMID: 9036351] [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: 02/03/2023]
Abstract
The prevalence of infection with Mycobacterium avium complex (MAC) has increased since the outbreak of the HIV pandemic. This complex comprises two organisms: M. avium (mostly) and M. intracellulare (rarely). The source of MAC infection is not known. The principal risk factors for disseminated MAC infection in a patient with HIV infection are a low CD4 count and a previous opportunistic infection. The symptoms of disseminated MAC infection resemble those of HIV wasting; a positive culture of normally sterile tissue confirms a MAC infection. There is reserve with regard to routine prophylaxis in HIV-infected persons because of the possible development of resistance, interaction with other drugs used in AIDS, toxicity and possible absorption disorders which might cause prophylaxis to fail. For the treatment of disseminated MAC infection, a combination of at least two medicaments (macrolides and ethambutol) is recommended.
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Affiliation(s)
- M M Schneider
- Afd. Interne Geneeskunde, Academisch Ziekenhuis, Utrecht
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van Dooyeweert DA, Schneider MM, Borleffs JC, Hoepelman AI. The influence of PCP prophylaxis on bacteriuria incidence and resistance development to trimethoprim/sulfamethoxazole in HIV-infected patients. Neth J Med 1996; 49:225-7. [PMID: 8990860 DOI: 10.1016/s0300-2977(96)00061-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Earlier studies have shown that men infected with HIV-1 and a CD4+ cell count below 200 mm3 are at increased risk for bacteriuria. We studied the effect of 3 Pneumocystis carinii (PCP) prophylaxis regimens (low-dose TMP/SMZ, high-dose TMP/SMZ and pentamidine aerosol) on the incidence of bacteriuria and resistance development to TMP/SMZ. METHODS Retrospective analysis of 103 HIV-positive patients. RESULTS Nine patients using pentamidine had a positive culture (32%), compared to 9 patients using low-dose TMP/SMZ (17%) and 5 patients using high-dose TMP/SMZ (22%). These differences were not significant (P = 0.207). However, almost all episodes in patients using TMP/SMZ were due to infection with a resistant strain. CONCLUSION PCP prophylaxis with trimethoprim/sulfamethoxazole does not significantly influence the rate of bacteriuria, probably due to the development of resistance.
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Schneider MM, Nielsen TL, Nelsing S, Hoepelman AI, Eeftinck Schattenkerk JK, van der Graaf Y, Kolsters AF, Borleffs JC. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis 1995; 171:1632-6. [PMID: 7769306 DOI: 10.1093/infdis/171.6.1632] [Citation(s) in RCA: 44] [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: 01/27/2023] Open
Abstract
The efficacy and toxicity of trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis against Pneumocystis carinii pneumonia (PCP) for patients with human immunodeficiency virus (HIV) infection was assessed by comparing the effects of two dosages (480 or 960 mg once a day) of the drug. The multicenter trial involved 260 HIV-infected patients with CD4 cell counts < 0.2 x 10(9)/L and no history of PCP. Patients were randomly assigned to the treatment groups. After a median follow-up of 376 days (range, 1-1219), none of the patients developed PCP. Most adverse reactions that required discontinuation were seen within the first month of TMP-SMZ use and were seen more frequently and earlier in the 960-mg group (hazard ratio, 1.4; 95% confidence interval, 0.95-2.02; P = .007). For patients with HIV infection, 480 mg of TMP-SMZ is as efficacious as but less toxic than 960 mg of the drug for primary prophylaxis against PCP.
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Affiliation(s)
- M M Schneider
- Department of Internal Medicine (Section of Immunology and Infectious Diseases), University Hospital Utrecht, Netherlands
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Been-Tiktak AM, Vrehen HM, Schneider MM, van der Feltz M, Branger T, Ward P, Cox SR, Harry JD, Borleffs JC. Safety, tolerance, and pharmacokinetics of atevirdine mesylate (U-87201E) in asymptomatic human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 1995; 39:602-7. [PMID: 7793859 PMCID: PMC162591 DOI: 10.1128/aac.39.3.602] [Citation(s) in RCA: 6] [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: 01/27/2023] Open
Abstract
Atevirdine mesylate (U-87201E) is a new nonnucleoside (bisheteroarylpiperazine) inhibitor of human immunodeficiency virus type 1 reverse transcriptase. In a double-blind, escalating single-dose study the safety, tolerance, and pharmacokinetics of atevirdine mesylate were investigated in 24 asymptomatic human immunodeficiency virus-seropositive male patients. Each patient received one single oral dose of atevirdine mesylate and placebo separated by an interval of 1 to 3 weeks. For each dose level (400, 800, 1,200, and 1,600 mg) six patients received drug and placebo on separate occasions. Blood samples were collected before dosing and at intervals afterward for safety evaluation and estimation of atevirdine and metabolite levels. The concentrations of atevirdine and its principal metabolite (U-89255) in serum were determined by high-performance liquid chromatography. The results of the study showed that atevirdine mesylate is well tolerated at all dose levels. No clinically significant effects on vital signs, electrocardiograms, or laboratory tests were observed. Occasional headache and nausea were reported both in the drug group and in the placebo group. The times to peak values were relatively short (0.5 to 1.0 h), suggesting a rapid absorption. The maximum concentrations of drug in serum were 1.4 microM (400 mg), 4.2 microM (800 mg), 7.3 microM (1,200 mg), and 5.8 microM (1,600 mg). The values of the pharmacokinetic parameters for atevirdine were found to have relatively large intersubject variabilities, and consequently, the study had little power to detect dose-dependent changes in the values of the pharmacokinetic parameters. The oral clearance of atevirdine tended to increase by 90% as the atevirdine mesylate doses increased from 400 to 1,600 mg, but this change in oral clearance was not statistically significant. The values of the pharmacokinetic parameters determined in the study were similar to those found in a previous single-dose study in healthy volunteers.
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Affiliation(s)
- A M Been-Tiktak
- Department of Internal Medicine, University Hospital Utrecht, The Netherlands
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Borleffs JC, Schneider MM. Routine vaccination in HIV-infected patients: a review. Neth J Med 1994; 45:244-9. [PMID: 7838239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper reviews the literature from 1988 to November 1993 on the effectiveness of routine vaccination of HIV-infected adults. Data on the clinical benefit of vaccination in this particular group of patients are not available. In general, HIV-infected patients have suboptimal immunological responses to vaccines. In particular, an impaired responsiveness is found in patients with fewer than 200 x 10(6) CD4+ cells per litre. Consequently, it seems prudent to offer active immunization to HIV-infected subjects who are relatively immunocompetent. However, the usefulness of vaccination in those subjects who have a low CD4+ cell count is doubtful.
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Affiliation(s)
- J C Borleffs
- Department of Internal Medicine, Utrecht University Hospital, Netherlands
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Schneeberger PM, Kortbeek LM, Schneider MM, Geelen SP, van Leeuwen MS, Hoepelman IM. [Poor results of treatment of echinococcosis with albendazole in 7 patients]. Ned Tijdschr Geneeskd 1994; 138:460-3. [PMID: 8133947] [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: 01/29/2023]
Abstract
OBJECTIVE To assess the effect of treatment of echinococcal disease with albendazole, a drug recently licensed in the Netherlands for this treatment. SETTING The University Hospital Utrecht and the Wilhelmina Children's Hospital, Utrecht. DESIGN Follow-up study. METHOD Clinical symptoms, serology and size and morphology of cysts of all patients (n = 7) treated with albendazole with a therapeutical dose (10 mg/kg for adults and 6 mg/kg for children in two daily doses during three cycles of 28 days) were monitored for at least one year. RESULTS Two patients improved, two patients did not show any change, and the condition of three patients deteriorated. CONCLUSION The efficacy of albendazole treatment with this regimen for hydatid disease is disappointing. If patients are treated with albendazole, the total dose administered to adults should be more than 80 g.
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Affiliation(s)
- P M Schneeberger
- Academisch Ziekenhuis, Eijkman-Winkler Laboratorium voor Medische Microbiologie, Utrecht
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Ermann M, Peichl J, Pohl H, Schneider MM, Winkelmann Y. [Spontaneous awakening and dreams of patients with psychophysiologic sleep disorders]. Psychother Psychosom Med Psychol 1993; 43:333-40. [PMID: 8416104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The effect of dreaming on the formation of psycho-physiological sleep disorders is studied by an investigation of 26 patients and 15 control persons who were interviewed as to the occurrence of dream memory after spontaneous awaking and after being awaken systematically in the sleep laboratory. It turned out that the patients had less dream memory than the control persons after spontaneous awaking from REM sleep, but they did not differ after being awaken. In addition, dream reports after spontaneous awaking from REM sleep contained more abstract dream thoughts and less visible dream action. These findings are interpreted as a manifestation of disturbed "dream work" in patients with psychophysiological sleep disorders, i.e. disturbance of connecting thoughts and scenes from the unconscious. Thus, awaking in sleep disorder is interpreted to be a progression into awakeness as a matter of defense.
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Affiliation(s)
- M Ermann
- Abteilung für Psychotherapie und Psychosomatik, Psychiatrischen Universitätsklinik München
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Schneider MM, Hoepelman AI, Eeftinck Schattenkerk JK, Nielsen TL, van der Graaf Y, Frissen JP, van der Ende IM, Kolsters AF, Borleffs JC. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group. N Engl J Med 1992; 327:1836-41. [PMID: 1360145 DOI: 10.1056/nejm199212243272603] [Citation(s) in RCA: 171] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary prophylaxis against Pneumocystis carinii pneumonia (PCP) is recommended for patients with human immunodeficiency virus (HIV) infection if their CD4 cell counts are below 200 per cubic millimeter (0.2 x 10(9) per liter). Either aerosolized pentamidine or trimethoprim-sulfamethoxazole (co-trimoxazole) is commonly prescribed for prophylaxis, but the relative efficacy and toxicity of these agents are unknown. METHODS We conducted a multicenter trial involving 215 HIV-infected patients with no history of PCP but with CD4 cell counts below 200 per cubic millimeter. The patients were randomly assigned to one of three regimens: aerosolized pentamidine once a month, 480 mg of trimethoprim-sulfamethoxazole once a day (80 mg of trimethoprim and 400 mg of sulfamethoxazole), or 960 mg of trimethoprim-sulfamethoxazole once a day (160 mg and 800 mg, respectively). The cumulative incidence of PCP was estimated by Kaplan-Meier survival analysis. RESULTS After a mean follow-up of 264 days, 6 of the 71 patients in the pentamidine group had a confirmed first episode of PCP (11 percent), whereas none of the 142 patients in the two trimethoprim-sulfamethoxazole groups had PCP (P = 0.002). However, adverse events that required discontinuation of the medication were much more frequent in the trimethoprim-sulfamethoxazole groups (17 and 18 patients) than in the pentamidine group (2 patients). The adverse reactions occurred significantly sooner in the group given 960 mg of trimethoprim-sulfamethoxazole than in the group given 480 mg (mean time, 16 vs. 57 days; P = 0.02). CONCLUSIONS For patients with HIV infection, trimethoprim-sulfamethoxazole taken once a day is more effective as primary prophylaxis against PCP than aerosolized pentamidine administered once a month, although adverse drug reactions are more frequent with trimethoprim-sulfamethoxazole.
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Affiliation(s)
- M M Schneider
- Department of Internal Medicine, University Hospital Utrecht, The Netherlands
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Schneider MM, van de Wiel A, Wiersema Y, Kerckhaert JA, Hart HC. [A patient with disseminated Mycobacterium avium-complex infection and impaired immune system]. Ned Tijdschr Geneeskd 1988; 132:1160-2. [PMID: 3398945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Schneider MM, Hampp R, Ziegler H. Envelope Permeability to Possible Precursors of Carotenoid Biosynthesis during Chloroplast-Chromoplast Transformation. Plant Physiol 1977; 60:518-20. [PMID: 16660128 PMCID: PMC542654 DOI: 10.1104/pp.60.4.518] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
During the transformation of chloroplasts to chromoplasts in Capsicum annuum L., the permeability of the envelope membranes to possible precursors of carotenoid biosynthesis (acetate, mevalonate, citrate) was tested. The plastids were isolated by gel filtration, and the uptake of labeled compounds was measured by a filtering centrifugation technique, using silicone oil. The different ripening stages were characterized by the ratio of chlorophyll to carotenoid content. The chloroplast membranes were shown to be impermeable to all of the metabolites tested. During the transformation there was a sharp increase of membrane permeability. In the mature chromoplast, the permeability to mevalonate and acetate again decreased to about 20% of the maximum value and reached zero for citrate. The results give evidence that during the transformation of chloroplasts to chromoplasts, precursors for carotenoid biosynthesis are translocated from extraplastidic sites into the plastids, there being possibly incorporated into carotenoids.
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Affiliation(s)
- M M Schneider
- Institut für Botanik, Technische Universität München, Arcisstrasse 21, D-8000 München 2, West Germany
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