1
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Malfertheiner SF, Brodie D, Burrell A, Taccone FS, Broman LM, Shekar K, Agerstrand CL, Serra AL, Fraser J, Malfertheiner MV. Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study. Perfusion 2022:2676591221090668. [PMID: 35549557 DOI: 10.1177/02676591221090668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries. METHODS A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Data were collected from six ECMO centers across three continents over a 10-year period. RESULTS A total of 60 pregnany/peripartal ECMO cases have been identified. Most frequent indications are acute respiratory distress syndrome (n = 30) and pulmonary embolism (n = 5). Veno-venous ECMO mode was applied more often (77%). ECMO treatment during pregnancy was performed in 17 cases. Maternal and fetal survival was high with 87% (n = 52), respectively 73% (n = 44). CONCLUSIONS Various emergency scenarios during pregnancy and at time of delivery may require ECMO treatment. Peripartal mortality in a well-resourced setting is rare, however emergencies in the labor room occur and knowledge of available rescue therapy is essential to improve outcome. Obstetricians and obstetric anesthesiologists should be aware of the availability of ECMO resource at their hospital or region to ensure immediate contact when needed.
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Affiliation(s)
- S Fill Malfertheiner
- Department of Obstetrics and Gynecology, Hospital St. Hedwig of the Order of St. John, Regensburg University, Regensburg, Germany
| | - D Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - A Burrell
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - F S Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - L M Broman
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - K Shekar
- Critical Care Research Group, 67567The Prince Charles Hospital, Brisbane, Australia
| | - C L Agerstrand
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - A L Serra
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - J Fraser
- Critical Care Research Group, 67567The Prince Charles Hospital, Brisbane, Australia
| | - M V Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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3
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Leinweber N, Dziunycz PJ, French LE, Wüthrich R, Serra AL, Hofbauer GFL. Considerable loss of information on skin cancer occurrence and non-adherence to clinical practice guideline in renal transplant recipients. J Eur Acad Dermatol Venereol 2016; 30:1399-401. [PMID: 26887638 DOI: 10.1111/jdv.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Leinweber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - P J Dziunycz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - R Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - A L Serra
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - G F L Hofbauer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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4
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Calliada F, Gilja OH. EFSUMB statement on medical student education in ultrasound [short version]. Ultraschall Med 2016; 37:100-102. [PMID: 26871409 DOI: 10.1055/s-0035-1566959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Dept. "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Dept. of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - F Calliada
- Department of Radiology. Policlinico San Matteo, University Hospital, Pavia, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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Su Z, Wang X, Gao X, Liu Y, Pan C, Hu H, Beyer RP, Shi M, Zhou J, Zhang J, Serra AL, Wüthrich RP, Mei C. Excessive activation of the alternative complement pathway in autosomal dominant polycystic kidney disease. J Intern Med 2014; 276:470-85. [PMID: 24494798 DOI: 10.1111/joim.12214] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The complement system is involved in many immune complex-mediated kidney diseases, yet its role in the pathogenesis of autosomal dominant polycystic kidney disease (ADPKD) has not been examined in detail. METHODS AND RESULTS Screening of the glycoproteome of urine samples from ADPKD patients revealed that levels of complement factor B (CFB), serpin peptidase inhibitor, complement component 1 inhibitor (SERPING1) and complement component 9 (C9) increased, whereas complement component 1, r subcomponent-like (C1RL), CD55 and CD59 levels decreased with disease progression. Immunostaining and Western blot analysis confirmed the enhanced expression of CFB and C9 in cystic kidneys from ADPKD patients. Immunostaining also showed that the expressions of CFB and C9 in renal biopsy tissues from patients with other types of chronic kidney disease were lower than in tissues from ADPKD patients. The effect of the complement inhibitor rosmarinic acid (RMA) was evaluated in Pkd1(-/-) mice and Han:SPRD Cy/+ rats. Compared with vehicle-treated Pkd1(-/-) animals, RMA-treated mice had significantly lower serum creatinine (-50%) and blood urea nitrogen (-78%) levels, two kidneys/body weight ratio (-60%) and renal cystic index (-60%). Similar results were found in Cy/+ rats. Lower numbers of Ki67-positive nuclei and inflammatory cells and reduced fibrosis were observed in both animal models upon treatment with RMA. CONCLUSIONS These results suggest that excessive activation of the alternative complement pathway is associated with ADPKD progression, probably mediated by cyst-lining epithelial cell proliferation, tubulointerstitial inflammatory cell infiltration and fibrosis. Targeting the complement system might represent a new therapeutic strategy for ADPKD.
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Affiliation(s)
- Z Su
- Kidney Institute, Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
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Bouwes Bavinck JN, Harwood CA, Genders RE, Wisgerhof HC, Plasmeijer EI, Mitchell L, Olasz EB, Mosel DD, Pokorney MS, Serra AL, Feldmeyer L, Baumann Conzett K, Piaserico S, Belloni Fortina A, Jahn K, Geusau A, Gerritsen MJP, Seckin D, Gulec AT, Cetkovska P, Ricar J, Imko-Walczuk B, Proby CM, Hofbauer GFL. Pain identifies squamous cell carcinoma in organ transplant recipients: the SCOPE-ITSCC PAIN study. Am J Transplant 2014; 14:668-76. [PMID: 24730051 DOI: 10.1111/ajt.12587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTR) are at high risk for cutaneous squamous cell carcinomas (SCC). We aimed to define clinically meaningful patient-reported warning signals predicting the presence of invasive SCC.Patient-reported signs and symptoms of 812 consecutively biopsied skin lesions from 410 OTR were determined by questionnaire and physical examination and related to the subsequent biopsy-proven diagnoses. Receiver-operating characteristic (ROC) curve analyses were used as a measure of distinction between the predictive values of patient-reported warning signals and the occurrence of SCC. Pain was an independent predictive patient-reported warning signal for a biopsy-proven invasive SCC. The odds ratio from the fully adjusted model predicting SCC was 4.4(95% confidence interval: 2.4–8.2). Higher scores on the visual analog scale (VAS) for pain were associated witha greater likelihood for the presence of SCC compared to none or mild pain. The for scores on the VAS from 1to 3, 4 to 6 and 7 to 10 were 4.9 (2.2–10.5), 2.3 (0.96–5.5)and 16.5 (3.6–75.8), respectively. Pain is the most powerful patient-reported warning signal for invasive cutaneous SCC in OTR. Empowerment of patients by education could accelerate diagnosis and treatment of cutaneous SCC.
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7
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Bonani M, Brockmann J, Cohen CD, Fehr T, Nocito A, Schiesser M, Serra AL, Blum M, Struker M, Frey DF, Wuthrich RP, Kim YW, Park SJ, Kim TH, Kim YH, Kang SW, Webb L, Casula A, Tomson C, Ben-Shlomo Y, Webb L, Casula A, Ben-Shlomo Y, Tomson C, Mansour H, Akl A, Wafa E, El Shahawy M, Palma R, Swaminathan S, Irish AB, Kolonko A, Chudek J, Wiecek A, Vanrenterghem Y, Kuypers D, Katrien DV, Evenepoel P, Claes K, Bammens B, Meijers B, Naesens M, Kolonko A, Chudek J, Wiecek A, Lo S, Chan CK, Yong D, Wong PN, Kwan TH, Cheng YL, Fung KS, Choy BY, Chau KF, Leung CB, Ebben J, Liu J, Chen SC, Collins A, Ho YW, Abelli M, Ferrario DI Torvajana A, Ticozzelli E, Maiga B, Ferrario DI Torvajana A, Patane A, Albrizio P, Gregorini M, Libetta C, Rampino T, Albrizio P, Geraci P, Dal Canton A, Rotter MT, Jacobi J, Pressmar K, Amann K, Eckardt KU, Weidemann A, Muller K, Stein M, Diezemann C, Sefrin A, Babel N, Reinke P, Schachtner T, Costa C, Touscoz GA, Sidoti F, Sinesi F, Mantovani S, Simeone S, Balloco C, Piasentin Alessio E, Messina M, Segoloni G, Cavallo R, Sharma R.K, Kaul DA, Gupta RK, Gupta A, Prasad N, Bhadhuria D, Suresh KJ, Benaboud S, Prie D, Thervet E, Urien S, Legendre C, Souberbielle JC, Hirt D, Friedlander G, Treluyer JM, Courbebaisse M, Arias M, Arias M, Campistol J, Pascual J, Grinyo JM, Hernandez D, Morales JM, Pallardo LM, Seron D, Senecal L, Boucher A, Dandavino R, Boucher A, Colette S, Vallee M, Lafrance JP, Tung-Min Y, Min-Ju W, Cheng-Hsu C, Chi-Hung C, Kuo-Hsiung S, Mei-Chin W, Direkze S, Khorsavi M, Khorsavi M, Stuart S, Goode A, Jones G, Chudek J, Kolonko A, Wiecek A, Massimetti C, Napoletano I, Imperato G, Muratore MT, Fazio S, Pessina G, Brescia F, Feriozzi S, Tanaka K, Sakai K, Futaki A, Hyoudo Y, Muramatsu M, Kawamura T, Shishido S, Hara S, Kushiyama A, Aikawa A, Jankowski K, Gozdowska J, Lewandowska D, Kwiatkowski A, Durlik M, Pruszczyk P, Obi Y, Ichimaru N, Kato T, Okumi M, Kaimori J, Yazawa K, Nonomura N, Isaka Y, Takahara S, Aimele M, Christophe R, Geraldine D, Eric R, Alexandre H, Masson I, Nicolas M, Ivan T, Acil J, Lise T, Aoumeur HA, Laurence D, Pierre D, Etienne C, Lionel R, Nassim K, Emmanuel M, Eric A, Christophe M, Webb L, Casula A, Tomson C, Ben-Shlomo Y, Alexandre K, Pierre B, Jean-Philippe H, Dominique P, Christophe L, Alexei G, Michel D, Shah P, Kute VB, Vanikar A, Gumber M, Modi P, Trivedi H, GoIebiewska J, Debska-Slizien A, Rutkowski B, Domanski L, Dutkiewicz G, Kloda K, Pawlik A, Ciechanowicz A, Binczak-Kuleta A, Rozanski J, Myslak M, Safranow K, Ciechanowski K, Aline CS, Basset T, Delavenne X, Alamartine E, Mariat C, Kloda K, Domanski L, Pawlik A, Bobrek-Lesiakowska K, Wisniewska M, Romanowski M, Safranow K, Kurzawski M, Rozanski J, Myslak M, Ciechanowski K, De Borst M, Baia L, Navis G, Bakker S, Ranghino A, Tognarelli G, Basso E, Messina M, Manzione AM, Daidola G, Segoloni GP, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Kim JH, Kim SS, Han DJ, Park SK, Randhawa G, Gumber M, Kute VB, Shah P, Patel H, Vanikar A, Modi P, Trivedi H, Taheri S, Goker-Alpan O, Ibrahim J, Nedd K, Shankar S, Lein H, Barshop B, Boyd E, Holida M, Hillman R, Ibrahim J, Mardach R, Wienreb N, Rever B, Forte R, Desai A, Wijatyk A, Chang P, Martin R. Transplantation - clinical I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs230] [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] Open
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8
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Hofbauer GFL, Attard NR, Harwood CA, McGregor JM, Dziunycz P, Iotzova-Weiss G, Straub G, Meyer R, Kamenisch Y, Berneburg M, French LE, Wüthrich RP, Karran P, Serra AL. Reversal of UVA skin photosensitivity and DNA damage in kidney transplant recipients by replacing azathioprine. Am J Transplant 2012; 12:218-25. [PMID: 21943390 DOI: 10.1111/j.1600-6143.2011.03751.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [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: 01/25/2023]
Abstract
Azathioprine is associated with enhanced skin photosensitivity to ultraviolet A (UVA) and leads to incorporation of 6-thioguanine (6-TG) into DNA of dividing cells. Unlike canonical DNA, 6-TG DNA is damaged by UVA, which comprises more than 90% of the ultraviolet reaching earth. Skin photosensitivity to UVA and UVB was measured in 48 kidney transplant patients immunosuppressed either by azathioprine (n = 32) or mycophenolate (n = 16). In 23 patients, azathioprine was subsequently replaced by mycophenolate and skin photosensitivity, DNA 6-TG content in peripheral blood mononuclear cells, and susceptibility to UVA-induced DNA damage were monitored for up to 2 years. The mean minimal erythema dose to UVA on azathioprine was twofold lower than on mycophenolate. Three months after replacing azathioprine by mycophenolate mofetil, the minimal erythema dose to UVA had increased from 15 to 25 J/cm(2) (p < 0.001) accompanied by reduced DNA 6-TG content. P53 protein expression in irradiated skin indicated reduced susceptibility to UVA-induced DNA damage. 6-TG DNA in peripheral blood mononuclear cells remained measurable for over 2 years. Replacing azathioprine selectively reduced the skin photosensitivity to UVA, attenuated UVA-induced skin DNA damage, and is likely based on incorporated 6-TG in DNA.
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Affiliation(s)
- G F L Hofbauer
- Department of Dermatology, University Hospital Zürich, Switzerland.
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Wanner C, Germain DP, Linthorst G, Marodi L, Mauer M, Mignani R, Oliveira J, Ortiz A, Serra AL, Svarstad E, Vujkovac B, Waldek S, Warnock DG, West M, Schiffmann R, Mehta A, Amato D, Nair N, Zahrieh D, Huertas P, Bonatti F, Maritati F, Alberici F, Oliva E, Sinico RA, Moroni G, Leoni A, Gregorini G, Jeannin G, Possenti S, Tumiati B, Grasselli C, Brugnano R, Salvarani C, Fraticelli P, Pavone L, Pesci A, Guida G, Neri TM, Buzio C, Malerba G, Martorana D, Vaglio A, Oda A, Kitamura K, Mizumoto T, Eguchi K, Anzai N, Tomita K, Arsali M, Athanasiou Y, Demosthenous P, Voskarides K, Deltas C, Pierides A. Genetic diseases / Molecular mechanisms. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.5] [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: 11/15/2022] Open
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Serra AL, Kistler AD, Poster D, Krauer F, Senn O, Raina S, Pavik I, Rentsch K, Regeniter A, Weishaupt D, Wuthrich RP. Safety and tolerability of sirolimus treatment in patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2009; 24:3334-42. [DOI: 10.1093/ndt/gfp280] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Hofbauer GFL, Marcollo-Pini A, Corsenca A, Kistler AD, French LE, Wüthrich RP, Serra AL. The mTOR inhibitor rapamycin significantly improves facial angiofibroma lesions in a patient with tuberous sclerosis. Br J Dermatol 2008; 159:473-5. [PMID: 18547304 DOI: 10.1111/j.1365-2133.2008.08677.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder with an incidence of approximately one in 6000. It arises from a genetic abnormality involving either the TSC1 gene on chromosome 9 or the TSC2 gene on chromosome 16. The protein product of TSC1 is hamartin and that of TSC2 is tuberin. In cells, hamartin and tuberin form a complex which inhibits the mammalian target of rapamycin (mTOR), a central controller of cell growth and proliferation. Angiofibroma affects 70-80% of patients with TSC, typically on the face. We report a patient with TSC with recurrent life-threatening haemorrhage from both kidneys due to extensive angiomyolipoma formation leading to bilateral nephrectomy and renal transplantation. Immunosuppressive treatment with rapamycin, a specific mTOR inhibitor, initiated because of renal transplantation, reduced facial angiofibroma dramatically.
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Affiliation(s)
- G F L Hofbauer
- Department of Dermatology, University Hospital, Zurich, Switzerland.
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12
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Serra AL, Braun SC, Starke A, Savoca R, Hersberger M, Russmann S, Corti N, Wüthrich RP. Pharmacokinetics and pharmacodynamics of cinacalcet in patients with hyperparathyroidism after renal transplantation. Am J Transplant 2008; 8:803-10. [PMID: 18318784 DOI: 10.1111/j.1600-6143.2007.02136.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cinacalcet is a calcimimetic drug for the treatment of secondary hyperparathyroidism (HPT). In a sequential open-label study, ten patients with persistent HPT after renal transplantation received first 30 and then 60 mg oral cinacalcet once daily over 2 weeks each. Cinacalcet steady state oral clearance was 131.1 +/- 20.9 l/h and 92.8 +/- 9.5 l/h (mean +/- SE) after 30 and 60 mg, respectively. Cinacalcet and parathyroid hormone (PTH) concentrations showed an inverse correlation and were fitted to a simple E(max) model (E(max) = 80% reduction vs. baseline, EC(50) = 13 ng/mL). A once daily administration of cinacalcet lowered serum calcium over 24 h without fluctuations. The 8-h fractional urinary excretion of calcium was increased after 60 mg cinacalcet (baseline 0.85 +/- 0.17%, 30 mg 1.53 +/- 0.35%, 60 mg 1.92 +/- 0.37%). Renal function remained stable. Cinacalcet pharmacokinetics and pharmacodynamics showed a pronounced interindividual variability. We conclude that the once daily administration of cinacalcet in patients with secondary HPT after renal transplantation effectively reduced iPTH and serum calcium. The transient calciuria could potentially favor nephrocalcinosis and reduce bone mineral density, suggesting that higher doses of cinacalcet need to be used with caution in renal transplant recipients with severe persistent hyperparathyroidism.
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Affiliation(s)
- A L Serra
- Clinic for Nephrology, University Hospital, Rämistrasse 100, Zurich, Switzerland.
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13
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Rippin SJ, Serra AL, Marti HP, Wüthrich RP. Six-year follow-up of azathioprine and mycophenolate mofetil use during the first 6 months of renal transplantation. Clin Nephrol 2007; 67:374-80. [PMID: 17598373 DOI: 10.5414/cnp67374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Long-term follow-up examination to test whether therapy with mycophenolate mofetil (MMF) or azathioprine (AZA) during the first year translates into different graft or patient survival and graft function is important. Therefore, 6-year follow-up data of a group of 80 consecutive renal transplant recipients were analyzed. The first group of 40 patients was treated with AZA, cyclosporine and prednisone and the second group with MMF, cyclosporine and prednisone for the first 6 months. Graft failure rates were compared during follow-up. Creatinine, inverse slope of creatinine (delta/creatinine) and 24-hour proteinuria at 6 years post transplantation were compared. The Kaplan-Meier analyses for death-censored and non-censored graft failure showed no difference between the groups. Creatinine values at 6 years for the AZA Group were 139 +/- 36 micromol/l (95% CI 125.9-151.2 micromol/l) and for the MMF Group 149 +/- 52 micromol/l (95% CI 133.9-164.9 micromol/l). Delta/creatinine and 24-hour proteinuria at 6 years did not differ between the two groups. We conclude that an initial 6-month treatment with MMF as opposed to AZA reduced the early rejection rate, but did not result in superior long-term graft function or survival after 6 years of follow-up observation.
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Affiliation(s)
- S J Rippin
- Clinic for Nephrology, University Hospital, Zürich, Switzerland
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Geiser M, Serra AL, Cruz-Orive LM, Baumann M, Im Hof V, Gehr P. Efficiency of airway macrophage recovery by bronchoalveolar lavage in hamsters: a stereological approach. Eur Respir J 1995; 8:1712-8. [PMID: 8586127 DOI: 10.1183/09031936.95.08101712] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Macrophages play a central role in the defence of the respiratory tract against deposited particles. In addition to the well-studied alveolar macrophages, airway macrophages have been recognized as an important clearance factor. Bronchoalveolar lavage (BAL) has been used for functional and morphological investigations of macrophages in vitro, assuming that all macrophages are removed with equal probability from the lung surface. Airway macrophages have been found in close contact with the epithelial cells. These macrophages may not be easily removed by lavage, and they might constitute a functionally different macrophage population. We have tested the hypothesis that there exists a population of macrophages in the conducting airways that resists removal by lavage. We lavaged the lungs of four hamsters and fixed the lungs, thereafter, by intravascular perfusion. The number of macrophages in the intrapulmonary conducting airways was estimated with an unbiased stereological technique, the fractionator, and compared to the number of macrophages in the airways of four hamsters whose lungs had not been lavaged prior to fixation. This in situ study revealed that, in hamster lungs, 42% of the airway macrophages were not removed by BAL and that about 5% of all macrophages in the BAL fluid were airway macrophages. Additionally, ultrastructural alterations of the airway epithelium were found. It is concluded that there exists a population of airway macrophages that resists lavage. This is an aspect which has to be considered in studies performed with macrophages obtained by BAL, since they could represent a functionally different macrophage population.
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Affiliation(s)
- M Geiser
- Institute of Anatomy, University of Bern, Switzerland
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