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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Herzog C, Homøe P, Koch A, Niclasen J, Dammeyer J, Lous J, Kørvel-Hanquist A. Effects of early childhood otitis media and ventilation tubes on psychosocial wellbeing - A prospective cohort study within the Danish National Birth Cohort. Int J Pediatr Otorhinolaryngol 2020; 133:109961. [PMID: 32169775 DOI: 10.1016/j.ijporl.2020.109961] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM. METHODS This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors. RESULTS Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity. CONCLUSION Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.
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Affiliation(s)
- C Herzog
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - A Koch
- Center for Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark
| | - J Niclasen
- Steno Diabetes Center, Copenhagen, Denmark
| | - J Dammeyer
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J Lous
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
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Herzog C, Best D, Dolan J, Donnelly L, Patel M, Sung H. Demographic Analysis of the Current Oral and Maxillofacial Surgery Applicant/Resident Cohorts. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.131] [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: 11/24/2022]
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Best D, Herzog C, Braun T, Ward B, Moe J. Lichen Planus-Associated Oral Squamous Cell Carcinoma is Associated with Increased Risk of Recurrence and Improved Survival. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.109] [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: 11/29/2022]
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Baumann J, Herzog C, Spanier M, Grötzsch D, Lühl L, Witte K, Jonas A, Günther S, Förste F, Hartmann R, Huth M, Kalok D, Steigenhöfer D, Krämer M, Holz T, Dietsch R, Strüder L, Kanngießer B, Mantouvalou I. Laboratory Setup for Scanning-Free Grazing Emission X-ray Fluorescence. Anal Chem 2017; 89:1965-1971. [PMID: 28105807 DOI: 10.1021/acs.analchem.6b04449] [Citation(s) in RCA: 15] [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: 11/30/2022]
Abstract
Grazing incidence and grazing emission X-ray fluorescence spectroscopy (GI/GE-XRF) are techniques that enable nondestructive, quantitative analysis of elemental depth profiles with a resolution in the nanometer regime. A laboratory setup for soft X-ray GEXRF measurements is presented. Reasonable measurement times could be achieved by combining a highly brilliant laser produced plasma (LPP) source with a scanning-free GEXRF setup, providing a large solid angle of detection. The detector, a pnCCD, was operated in a single photon counting mode in order to utilize its energy dispersive properties. GEXRF profiles of the Ni-Lα,β line of a nickel-carbon multilayer sample, which displays a lateral (bi)layer thickness gradient, were recorded at several positions. Simulations of theoretical profiles predicted a prominent intensity minimum at grazing emission angles between 5° and 12°, depending strongly on the bilayer thickness of the sample. This information was used to retrieve the bilayer thickness gradient. The results are in good agreement with values obtained by X-ray reflectometry, conventional X-ray fluorescence and transmission electron microscopy measurements and serve as proof-of-principle for the realized GEXRF setup. The presented work demonstrates the potential of nanometer resolved elemental depth profiling in the soft X-ray range with a laboratory source, opening, for example, the possibility of in-line or even in situ process control in semiconductor industry.
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Affiliation(s)
- J Baumann
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany.,Humboldt University of Berlin , School of Analytical Sciences Adlershof (IRIS-Building), Unter den Linden 6, D-10099 Berlin, Germany
| | - C Herzog
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - M Spanier
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - D Grötzsch
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - L Lühl
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - K Witte
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - A Jonas
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - S Günther
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - F Förste
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - R Hartmann
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - M Huth
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - D Kalok
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - D Steigenhöfer
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany
| | - M Krämer
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - T Holz
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - R Dietsch
- AXO DRESDEN GmbH , Gasanstaltstraße 8b, D-01237 Dresden, Germany
| | - L Strüder
- PNSensor GmbH , Otto-Hahn-Ring 6, D-81739 München, Germany.,University of Siegen , Department of Physics, Walter-Flex-Straße 3, D-57068 Siegen, Germany
| | - B Kanngießer
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
| | - I Mantouvalou
- Technical University of Berlin , Institute of Optics and Atomic Physics, Hardenbergstraße 36, D-10587 Berlin, Germany
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Spanier M, Herzog C, Grötzsch D, Kramer F, Mantouvalou I, Lubeck J, Weser J, Streeck C, Malzer W, Beckhoff B, Kanngießer B. A flexible setup for angle-resolved X-ray fluorescence spectrometry with laboratory sources. Rev Sci Instrum 2016; 87:035108. [PMID: 27036820 DOI: 10.1063/1.4943253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/20/2016] [Indexed: 06/05/2023]
Abstract
X-ray fluorescence (XRF) analysis is one of the standard tools for the analysis of stratified materials and is widely applied for the investigation of electronics and coatings. The composition and thickness of the layers can be determined quantitatively and non-destructively. Recent work showed that these capabilities can be extended towards retrieving stratigraphic information like concentration depth profiles using angle-resolved XRF (ARXRF). This paper introduces an experimental sample chamber which was developed as a multi-purpose tool enabling different measurement geometries suited for transmission measurements, conventional XRF, ARXRF, etc. The chamber was specifically designed for attaching all kinds of laboratory X-ray sources for the soft and hard X-ray ranges as well as various detection systems. In detail, a setup for ARXRF using an X-ray tube with a polycapillary X-ray lens as source is presented. For such a type of setup, both the spectral and lateral characterizations of the radiation field are crucial for quantitative ARXRF measurements. The characterization is validated with the help of a stratified validation sample.
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Affiliation(s)
- M Spanier
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - C Herzog
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - D Grötzsch
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - F Kramer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - I Mantouvalou
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - J Lubeck
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - J Weser
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - C Streeck
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - W Malzer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - B Beckhoff
- Physikalisch-Technische Bundesanstalt, Abbestraße 2-12, 10587 Berlin, Germany
| | - B Kanngießer
- Institute for Optics and Atomic Physics, Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
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Hayes-Jordan A, CLopez, Green HL, Xiao LC, Huh W, Herzog C. Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Pediatric Ovarian Tumors: A Novel Treatment Approach. Pediatr Surg Int 2016; 32:71-3. [PMID: 26500075 PMCID: PMC5098267 DOI: 10.1007/s00383-015-3814-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Accepted: 10/09/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used in adults with ovarian carcinoma proving overall survival benefit in randomized trials, but measured in months. Diffuse peritoneal disease from pediatric type ovarian tumors is rare. We applied CRS and HIPEC to pediatric girls with diffuse peritoneal disease as part of a clinical trial. METHODS In all patients complete cytoreduction was followed by HIPEC using 100 mg/m2 of cisplatin for 90 min in a closed technique. All received neoadjuvant chemotherapy. Patients with disease outside of the abdominal cavity were excluded. RESULTS Of 101 pediatric CRS and HIPEC operations, 8 had ovarian primary tumors and multifocal peritoneal disease. There were three yolk sac tumors (germ cell, mixed teratoma), one Sertoli–Leydig, one PNET of the ovary, one choriocarcinoma, one juvenile granulosa cell tumor and one adenocarcinoma. Age ranged 4–18 years. Three of the 8 (37 %) recurred and died. The remaining 63 % are disease free 2–6 years post HIPEC. Overall survival and relapse-free survival in this cohort was 64 and 62 %, respectively [CI 0.64 (0.34, 1); 0.62 (0.37, 1)]. CONCLUSIONS This is the first report of CRS and HIPEC in pediatric ovarian tumors. HIPEC may be effective in pediatric-type ovarian tumors. More study is needed in a larger cohort.
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Affiliation(s)
- A Hayes-Jordan
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology/Pediatric Surgical Oncology, Houston, Texas, USA
| | - CLopez
- University of Texas Houston Health Sciences Center
| | - HL Green
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology/Pediatric Surgical Oncology, Houston, Texas, USA
| | - LC Xiao
- University of Texas MD Anderson Cancer Center, Department of Biostatistics
| | - W Huh
- University of Texas MD Anderson Cancer Center, Division of Pediatrics
| | - C Herzog
- University of Texas MD Anderson Cancer Center, Division of Pediatrics
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Godmann L, König U, Stratis A, Cromme C, Neugebauer K, Herzog C, Korb-Pap A, Niederreiter B, Dankbar B, Redlich K, Echtermeyer F, Pap T, Bertrand J. A4.22 Syndecan-4 controls interleukin (IL)-1 receptor trafficking and IL-1 signalling in chronic destructive arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wheeler DC, Abdalla S, Chertow G, Parfrey P, Herzog C, Mikolasevic I, Racki S, Lukenda V, Milic S, Devcic B, Orlic L, Suttorp MM, Hoekstra T, Ocak G, Van Diepen ATN, Ott I, Mittelman M, Rabelink TJ, Krediet RT, Dekker FW, Simone S, Dell'Oglio MPS, Ciccone M, Corciulo R, Castellano G, Balestra C, Grandaliano G, Gesualdo L, Pertosa G, Nishida M, Ando M, Karasawa K, Iwamoto Y, Tsuchiya K, Nitta K, Krzanowski M, Janda K, Gajda M, Dumnicka P, Fedak D, Lis G, Ja kowski P, Litwin JA, Su owicz W, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, Castro MC, Oliverira RB, Moyses RM, Elias RM, Silva BC, Tekce H, Ozturk S, Aktas G, Kin Tekce B, Erdem A, Ozyasar M, Taslamacioglu Duman T, Yazici M, Kirkpantur A, Balci MM, Turkvatan A, Afsar B, Alkis M, Mandiroglu F, Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A, An WS, Kim SE, Son YK, Oh YJ, Gelev S, Toshev S, Trajceska L, Selim G, Dzekova P, Shikole A, Park J, Lee JS, Shin ES, Ann SH, Kim SJ, Chung HC, Janda K, Krzanowski M, Gajda M, Dumnicka P, Fedak D, Lis G, Litwin JA, Sulowicz W, Elewa U, Bichari W, Abo-Seif K, Seferi S, Rroji M, Likaj E, Spahia N, Barbullushi M, Thereska N, Kopecky CM, Genser B, Maerz W, Wanner C, Saemann MD, Weichhart T, Sezer S, Gurlek Demirci B, Tutal E, Bal Z, Erkmen Uyar M, Ozdemir Acar FN, Macunluoglu B, Atakan A, Ari Bakir E, Georgianos P, Sarafidis PA, Stamatiadis DN, Liakopoulos V, Zebekakis PE, Papagianni A, Lasaridis AN, Eftimovska - Otovic N, Babalj-Banskolieva E, Kostadinska-Bogdanoska S, Grozdanovski R, Aono M, Sato Y, El Amrani M, Asserraji M, Benyahia M, Lee YK, Choi SR, Cho A, Kim JK, Choi MJ, Kim SJ, Yoon JW, Koo JR, Kim HJ, Noh JW, Inagaki H, Yokota N, Sato Y, Chiyotanda S, Fukami K, Fujimoto S, Kendi Celebi Z, Kutlay S, Sengul S, Nergizoglu G, Erturk S, Ates K, Vishnevskii KA, Rumyantsev AS, Zemchenkov AY, Smirnov AV, Reinhardt B, Knaup R, Esteve Simo V, Carneiro Oliveira J, Moreno Guzman F, Fulquet Nicolas M, Pou Potau M, Saurina Sole A, Duarte Gallego V, Ramirez De Arellano Serna M, Turkmen K, Demirtas L, Akbas EM, Bakirci EM, Buyuklu M, Timuroglu A, Georgianos PI, Sarafidis PA, Karpetas A, Liakopoulos V, Stamatiadis DN, Papagianni A, Lasaridis AN, Taira T, Nohtomi K, Takemura T, Chiba T, Hirano T, Chang CT, Huang CC, Chen CJ, El Amrani M, Mohamed A, Benyahia M, Kanai H, Tamura Y, Kaizu Y, Kali A, Yayar O, Erdogan B, Eser B, Ercan Z, Buyukbakkal M, Merhametsiz O, Haspulat A, Yildirim T, Bozkurt B, Ayli MD, Bal Z, Erkmen Uyar M, Gokustun D, Gurlek Demirci B, Tutal E, Sezer S, Markaki A, Grammatikopoulou M, Fragkiadakis G, Stylianou K, Venyhaki M, Chatzi V, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Gelev S, Petronievic Z, Sikole A, Moyseyenko V, Nykula T, Fernandes RT, Barreto DV, Rodrigues GGC, Misael A, Branco-Martins CT, Barreto FC, Yayar O, Ercan Z, Eser B, Merhametsiz O, Haspulat A, Buyukbakkal M, Erdogan B, Yildirim T, Bozkurt B, Ayli MD. DIALYSIS CARDIOVASCULAR COMPLICATIONS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu155] [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: 11/13/2022] Open
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Anderson P, Meyers P, Kleinerman E, Venkatakrishnan K, Hughes D, Herzog C, Huh W, Sutphin R, Vyas YM, Shen V, Warwick A, Yeager N, Oliva C, Wang B, Liu Y, Chou A. Mifamurtide in metastatic and recurrent osteosarcoma: a patient access study with pharmacokinetic, pharmacodynamic, and safety assessments. Pediatr Blood Cancer 2014; 61:238-44. [PMID: 23997016 PMCID: PMC4533988 DOI: 10.1002/pbc.24686] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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] [Received: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE This non-randomized, patient-access protocol, assessed both safety and efficacy outcomes following liposomal muramyl-tripeptide-phosphatidylethanolamine (L-MTP-PE; mifamurtide) in patients with high-risk, recurrent and/or metastatic osteosarcoma. METHODS Patients received mifamurtide 2 mg/m(2) intravenously twice-weekly ×12 weeks, then weekly ×24 weeks with and without chemotherapy. Serum concentration-time profiles were collected. Adverse events within 24 hours of drug administration were classified as infusion-related adverse events (IRAE); other AEs and overall survival (OS) were assessed. RESULTS The study began therapy in January 2008; the last patient completed therapy in October 2012. Two hundred five patients were enrolled; median age was 16.0 years and 146/205 (71%) had active disease. Mifamurtide serum concentrations declined rapidly in the first 30 minutes post-infusion, then in a log-linear manner 2-6 hours post-dose; t1/2 was 2 hours. There were no readily apparent relationships between age and BSA-normalized clearance, half-life, or pharmacodynamic effects, supporting the dose of 2 mg/m(2) mifamurtide across the age range. Patients reported 3,679 IRAE after 7,482 mifamurtide infusions. These were very rarely grade 3 or 4 and most commonly included chills + fever or headache + fatigue symptom clusters. One- and 2-year OS was 71.7% and 45.9%. Patients with initial metastatic disease or progression approximated by within 9 months of diagnosis (N = 40) had similar 2-year OS (39.9%) as the entire cohort (45.9%) CONCLUSIONS Mifamurtide had a manageable safety profile; PK/PD of mifamurtide in this patient access study was consistent with prior studies. Two-year OS was 45.9%. A randomized clinical trial would be required to definitively determine impact on patient outcomes.
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Affiliation(s)
- P.M. Anderson
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - P. Meyers
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - E. Kleinerman
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | - D.P. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - C. Herzog
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - W. Huh
- University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | | | | | - V. Shen
- Childrens Hospital of Orange County, Orange CA USA
| | - A. Warwick
- Uniformed Services University, Bethesda MD, USA
| | - N. Yeager
- Nationwide Children’s Hospital, Ohio State University Columbus OH, USA
| | | | - B. Wang
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - Y. Liu
- Millennium: The Takeda Oncology Company, Cambridge, MA, USA
| | - A. Chou
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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12
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Ferrario M, Buckel E, Astorga C, Godoy J, Aguiló J, González G, Ormazábal J, Cámbara Á, Derosas C, Herzog C, Calabrán L. Results in Laparoscopic Living Donor Nephrectomy: A Multicentric Experience. Transplant Proc 2013; 45:3716-8. [DOI: 10.1016/j.transproceed.2013.08.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Louis C, Ramos C, Kalra M, Glisson B, Liu H, Herzog C, Gee A, Heslop H, Brenner M, Rooney C, Gottschalk S. A Phase II study of carboplatin and docetaxel followed by epstein-barr virus specific cytotoxic T Lymphocytes for refractory/relapsed EBV-positive nasopharyngeal carcinoma. Cytotherapy 2013. [DOI: 10.1016/j.jcyt.2013.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Herzog C, Peter M, Pritsch K, Günthardt-Goerg MS, Egli S. Drought and air warming affects abundance and exoenzyme profiles of Cenococcum geophilum associated with Quercus robur, Q. petraea and Q. pubescens. Plant Biol (Stuttg) 2013; 15 Suppl 1:230-237. [PMID: 22686410 DOI: 10.1111/j.1438-8677.2012.00614.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The present study aimed to elucidate the influence of drought and elevated temperature on relative abundance and functioning of the ectomycorrhizal fungus Cenococcum geophilum on three oak species differing in adaptation to a warm and dry climate. The experiment QUERCO comprised three Quercus species (Q. robur, Q. petraea, Q. pubescens) grown for 3 years under four treatments: elevated air temperature, drought, a combination of the two, and control. Fine root samples were analysed for relative abundance and potential extracellular enzyme activities of ectomycorrhizae of C. geophilum, a fungal species known to be drought resistant. The relative abundance of C. geophilum on the roots of the oak species was significantly increased by temperature, decreased by drought, but unchanged in the combined treatment compared to the control. Although the extent of treatment effects differed among oak species, no significant influence of tree species on relative abundance of C. geophilum was detected. Exoenzyme activities of C. geophilum on Q. robur and Q. petraea (but not Q. pubescens) significantly increased in the combined treatment, but for all oak species were reduced under drought and air warming alone compared to the control. There was a significant negative correlation between abundance of C. geophilum and its leucine aminopeptidase activity. As this enzyme is not frequent among ectomycorrhizal fungi, this emphasises the functional importance of C. geophilum in the ectomycorrhizal community. Our results indicate that increased temperature and drought will influence the relative abundance and enzyme activity of C. geophilum. However, both the Quercus species and C. geophilum tolerated warming and strong drought.
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Affiliation(s)
- C Herzog
- Swiss Federal Research Institute WSL, Zürcherstrasse 111, Birmensdorf, Switzerland.
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15
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Kerl JM, Bauer RW, Herzog C, Schoepf UJ, Vogl TJ. Detektion signifikanter Koronararterienstenosen mit 64-Teilen CT- Ein Interobserververgleich auf patienten- und segmentbasierter Ebene von Radiologen mit verschiedenen Erfahrungsleveln. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Kerl JM, Bauer RW, Schell B, Schoepf UJ, Vogl TJ, Herzog C. Ein Verbesserter Referenzstandart zur Beurteilung von Koronararterienstenosen: Ein Vergleich zwischen CT und konventioneller Koronarangiographie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Mahajan A, Anderson P, McAleer M, Sulman E, Pinnix C, Woo S, Herzog C, Hayes-Jordan A. Multidisciplinary Management with Whole Abdominal IMRT of Desmoplastic Small Round Cell Tumor. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1382] [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: 11/28/2022]
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18
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Alba A, Morales J, Fierro A, Zehnder C, Cao C, Orozco R, Herzog C, Calabrán L, Contreras L, Buckel E. Evaluation of late immunologic parameters among renal transplant recipients induced with Campath-1H. Transplant Proc 2010; 42:253-6. [PMID: 20172322 DOI: 10.1016/j.transproceed.2009.12.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Organ transplantation success depends principally on avoiding rejection, a purpose almost accomplished with immunosuppressant therapy. Nevertheless, drug side effects have promoted the search for other mechanisms to restrain alloresponses. T-regulatory cells (Treg) might exert that function. Campath 1H (C1H) induces Treg proliferation in the period subsequent to T-cell depletion following C1H administration. In the present study, the status of Treg and de novo HLA antibody production was determined posttransplantation when T-cell repopulation had been completed. In 14 patients, the following parameters were analyzed: renal function, rejection, Treg, panel-reactive antibody (PRA), and HLA antibodies. Patient and graft survivals were 100%. At the moment of Treg determination (20 months following transplant) the mean tacrolimus level was 8.4 ng/mL. One patient experienced an antibody-mediated rejection at 15 months after transplantation while having 3.2% Treg, with excellent treatment responses. Mean leukocyte and lymphocyte counts were 5752 and 1183 cells/mm(3); the mean peripheral blood percentage of Treg of 7.1% +/- 5.9% was not different from that observed in subjects without induction (mean 5.5% +/- 2.5%). Three patients (21%) showed Treg greater than 8.0%. In seven patients, we compared Treg at 4 and 20 months posttransplant, observing a decline from a mean of 19.9% to 5.9% (P = .05). In seven recipients, posttransplant PRA was determined; five of them became "de novo" sensitized, three with a mean class I PRA of 16% and two with a mean class II PRA of 37%. In conclusion, patient and graft survivals were excellent, mean Treg percentage was not elevated with results lower than in the early posttransplant period. Rejection incidence was negligible. Late "de novo" sensitization occurred in 70% showing that B cell-mediated alloresponses were only partially controlled among recipients induced with C1H even when associated with sustained anticalcineurin treatment.
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Affiliation(s)
- A Alba
- Centro de Trasplante, Clínica Las Condes, Santiago, Chile
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19
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Uribe M, Alba A, Hunter B, Valverde C, Godoy J, Ferrario M, Buckel E, Cavallieri S, Rebolledo R, Herzog C, Calabrán L, Flores L, Soto P. Chilean experience in liver transplantation for acute liver failure in children. Transplant Proc 2010; 42:293-5. [PMID: 20172334 DOI: 10.1016/j.transproceed.2009.12.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Acute liver failure (ALF) in children is a life-threatening condition, associated with high mortality, and in almost one third of the cases, with no other therapeutic option than orthotopic liver transplant (OLT). The aim of this study was to present our experience with OLT for ALF in pediatric patients in Chile. Patients fulfilling the criteria for ALF who were transplanted in our centers were prospectively included in an excel Microsoft database. We analyzed demographics, etiology, surgical techniques, complications, and long-term results. PATIENTS AND METHODS Between 1994 and 2009, we transplanted 52 pediatric patients with ALF. The most frequent known etiology was acute hepatitis A in 9 cases (18%), but in 26 cases (50%) it was impossible to determine the etiology. Thirty- one patients were males (63%). The overall mean age was 7.5 years and the mean weight, 28.1 kg. Thirty-five (67%) received a cadaveric graft. Among them in 18 cases (34%) the liver had to be reduced but 17 (33%) received whole livers. There were 17 (33%) recipients of living-related livers. Twenty-two patients needed reoperation, including 13 due to surgical complications (59%) and 9 (41%) as planned interventions. Ten patients were retransplanted. RESULTS Actuarial survival of patients at 1 year was 80% and at 5 and 10 years, 72%. Graft survival at 1 year was 79%, at 5 years 69%, and at 10 years 50%. CONCLUSION We have reported a series of pediatric liver transplant patients due to ALF whose results were comparable to other reported series. Living donor transplantation for ALF should be considered and offers a low morbidity rate without mortality.
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Affiliation(s)
- M Uribe
- Centro de Trasplante Clinica Las Condes and the Hospital Luis Calvo, Santiago, Chile.
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20
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Echtermeyer F, Betrand J, Meinecke I, Neugebauer K, Herzog C, Lee YJ, Song YW, Dreier R, Pap T. Syndecan-4 regulates cartilage degradation in osteoarthritis. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129593u] [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: 11/04/2022]
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21
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Silva E, Alba A, Castro A, Carrascal M, Buckel E, Aguiló J, Herzog C, Calabrán L, Morales J, Fierro J. Evaluation of HLA Matchmaker Compatibility as Predictor of Graft Survival and Presence of Anti-HLA Antibodies. Transplant Proc 2010; 42:266-9. [DOI: 10.1016/j.transproceed.2009.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Morales J, Bono MR, Fierro A, Iñiguez R, Zehnder C, Rosemblatt M, Calabran L, Herzog C, Benavente D, Aguiló J, Pefaur J, Alba A, Ferrario M, Simon W, Contreras L, Buckel E. Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells. Transplant Proc 2009; 40:3223-8. [PMID: 19010240 DOI: 10.1016/j.transproceed.2008.03.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.
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Affiliation(s)
- J Morales
- Centro de Trasplante, Clínica Las Condes, Laboratoric de Inmunologia, Facutad de Ciencìas, Universidad Andrés Bello and Fundación Ciencìa para la Vida, Santiago, Santiago, Chile.
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23
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Zangos S, Müller C, Mayer F, Naguib NN, Nour-Eldin NEA, Hansmann ML, Herzog C, Hammerstingl RM, Thalhammer A, Mack M, Vogl TJ, Eichler K. [Retrospective 5-year analysis of MR-guided biopsies in a low-field MR system]. ROFO-FORTSCHR RONTG 2009; 181:658-63. [PMID: 19517340 DOI: 10.1055/s-0028-1109349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and clinical value of MR-guided biopsies in an open 0.2 T low-field system. MATERIALS AND METHODS A total of 322 patients with suspicious lesions of different body regions were biopsied in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T 1-weighted Flash sequences (TR/TE = 100/9; 70 degrees). The lesions were repeatedly biopsied using the coaxial technique with a 15-gauge (diameter 2 mm) puncture needle. Complications and biopsy findings were analyzed retrospectively. RESULTS In all cases the biopsy procedures were successfully performed with MR guidance. In 298 patients diagnosis was able to be confirmed on the basis of the probes. The clinical follow-up showed that in 24 patients the lesions were missed by MR-guided biopsy. From this a sensitivity of 86%, a specificity of 87% and an accuracy of 93% were calculated. In two patients major complications were observed (morbidity rate 0.6 %). CONCLUSION MR-guided biopsy can be performed safely and precisely in a low-field MR system and are a supplement to US or CT-guided biopsies.
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Affiliation(s)
- S Zangos
- Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität Frankfurt.
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24
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Vidal C, Herzog C, Haeberle A, Bombarde C, Miquel M, Carimalo J, Launay J, Mouillet-Richard S, Lasmézas C, Dormont D, Kellermann O, Bailly Y. Early dysfunction of central 5-HT system in a murine model of bovine spongiform encephalopathy. Neuroscience 2009; 160:731-43. [DOI: 10.1016/j.neuroscience.2009.02.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 12/16/2022]
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25
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Hughes DP, Crutchley M, Douglas WI, Munsell MF, Vaporciyan AA, Herzog C, Tsai FW, Huh W. Incidence, detection, and management of cardiac metastasis in pediatric sarcoma patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10060 Background: Sarcoma metastasizing to the heart is a difficult and complicated clinical problem, yet local control is feasible and effective for select patients with cardiac metastasis. Diligence is required to detect these lesions while still amenable to treatment, and echocardiogram remains the best tool for detecting cardiac disease. Methods: We reviewed all echocardiograms (1330) performed on 307 pediatric sarcoma patients treated at UT M. D. Anderson Cancer Center between 1997 and 2008. Measures of cardiac function and pathology (including size of ventricles and atria, function of ventricles and valves, presence of metastasis, and presence of pericardial effusion) were assigned numerical values. Fisher's exact test and the Wilcoxon rank-sum test compared clinical characteristics of patients with and without cardiac metastases. Results: The prevalence of cardiac metastases was 1.6% (5/307) with 95% confidence interval 0.5% to 3.8%. The presence of cardiac metastasis positively correlated with pericardial effusion (p = 0.001) and tricuspid valve insufficiency (p = 0.014). The probability of a patient with pericardial effusion having a cardiac metastasis was 28.6% (95% CI: 3.7%-71%). Of the 5 patients with documented sarcoma metastasis to the heart, 3 had widespread refractory disease, were given no cardiac-specific therapy, and rapidly died from disease. One patient who had widespread disease controlled with chemotherapy and radiation had open resection of 2 cardiac metastases which resulted in site-specific disease control for 6 months before succumbing to progressive extra-cardiac disease. Another patient had isolated cardiac metastasis, treated with open resection of 2 metastases followed by adjuvant chemotherapy, and has been without recurrent cardiac metastases for 5 years and 9 months. Conclusions: Durable local control for sarcoma metastasizing to the heart is possible and effective for select patients. Pericardial effusion merits evaluation for potential associated cardiac metastasis. Echocardiogram monitoring of sarcoma patients remains important, and should include screening for possible cardiac metastasis. No significant financial relationships to disclose.
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Affiliation(s)
- D. P. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - M. Crutchley
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - W. I. Douglas
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - M. F. Munsell
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - A. A. Vaporciyan
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - C. Herzog
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - F. W. Tsai
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - W. Huh
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
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26
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Bakker ABH, Python C, Kissling CJ, Pandya P, Marissen WE, Brink MF, Lagerwerf F, Worst S, van Corven E, Kostense S, Hartmann K, Weverling GJ, Uytdehaag F, Herzog C, Briggs DJ, Rupprecht CE, Grimaldi R, Goudsmit J. First administration to humans of a monoclonal antibody cocktail against rabies virus: safety, tolerability, and neutralizing activity. Vaccine 2008; 26:5922-7. [PMID: 18804136 DOI: 10.1016/j.vaccine.2008.08.050] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 07/22/2008] [Accepted: 08/31/2008] [Indexed: 11/25/2022]
Abstract
Immediate passive immune prophylaxis as part of rabies post-exposure prophylaxis (PEP) often cannot be provided due to limited availability of human or equine rabies immunoglobulin (HRIG and ERIG, respectively). We report first clinical data from two phase I studies evaluating a monoclonal antibody cocktail CL184 against rabies. The studies included healthy adult subjects in the USA and India and involved two parts. First, subjects received a single intramuscular dose of CL184 or placebo in a double blind, randomized, dose-escalation trial. Second, open-label CL184 (20IU/kg) was co-administered with rabies vaccine. Safety was the primary objective and rabies virus neutralizing activity (RVNA) was investigated as efficacy parameter. Pain at the CL184 injection site was reported by less than 40% of subjects; no fever or local induration, redness or swelling was observed. RVNA was detectable from day 1 to day 21 after a single dose of CL184 20 or 40IU/kg. All subjects had adequate (>0.5IU/mL) RVNA levels from day 14 onwards when combined with rabies vaccine. CL184 appears promising as an alternative to RIG in PEP.
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Abstract
In recent years MR imaging has played an increasingly important role in the diagnosis and treatment of prostate cancer. MR imaging of the prostate allows a clear delineation of the anatomic structures and prostate tumors when performing interventions such as biopsies, brachytherapy or thermal therapy of the prostate gland. MRI robotic assistance will improve the accuracy of the interventions. Due to the advantages of MR imaging MR-guided prostate interventions will play an increasing role in future.
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Affiliation(s)
- S Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
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28
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Burkhard T, Herzog C, Linzbach S, Spyridopoulos I, Hübner F, Vogl T. Cardiac 31P-MRS compared to echocardiographic findings in patients with hypertensive heart disease without overt systolic dysfunction – preliminary results. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Burkhard T, Herzog C, Linzbach S, Spyridopoulos I, Vogl T. Impaired diastolic function in hypertension: cardiac MRI flow measurement compared to echocardiography. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Morales J, Fierro A, Benavente D, Zehnder C, Ferrario M, Contreras L, Herzog C, Buckel E. Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria. Transplant Proc 2007; 40:587-9. [PMID: 17445551 DOI: 10.1016/j.transproceed.2007.12.026] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.
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Affiliation(s)
- J Morales
- Unidad de Trasplante, Clinica Las Condes, Santiago, Chile.
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Morales J, Fierro A, Benavente D, Zehnder C, Ferrario M, Contreras L, Herzog C, Buckel E. Conversion from a calcineurin inhibitor-based immunosuppressive regimen to everolimus in renal transplant recipients: effect on renal function and proteinuria. Transplant Proc 2007; 39:591-3. [PMID: 17445551 DOI: 10.1016/j.transproceed.2006.12.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
New immunosuppressive agents are being actively researched to avoid complications of chronic allograft nephropathy (CAN), calcineurin inhibitor (CNI) nephrotoxicity, and posttransplantation cancer. The family of mTOR inhibitors offers a unique immunosuppressive opportunity to avoid CNI toxicity and reduce the incidence of malignancy. Nevertheless, increasing data have demonstrated that sirolimus (SRL), the first mTOR introduced in the treatment of solid organ transplant recipients, induces proteinuria, an adverse event that could produce deterioration of long-term renal function. In this short-term study of patients followed for 1 to 16 months, we examined changes in renal function and proteinuria among renal transplant recipients converted from a CNI-based regimen to an everolimus (EVL)-based one, a recently introduced mTOR inhibitor. Our data showed that renal function can be optimized after conversion to EVL by up to 42% in recipients showing CAN grade 1 or 2, or CNI nephrotoxicity. Importantly, patients who improved their creatinine clearance did not show increased proteinuria measured in a voided specimen as the ratio of urinary protein and creatinine concentration (P/C). These results, if confirmed with long-term follow-up and a larger number of patients, would allow us to consider EVL as a promising agent for maintenance immunosuppressive regimens in kidney transplantation.
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Affiliation(s)
- J Morales
- Unidad de Trasplante, Clinica Las Condes, Santiago, Chile.
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Loutan L, Bovier P, Herzog C. Immunogenicity and safety of a virosomal hepatitis A vaccine in HIV-positive patients. Vaccine 2007; 25:6310-2. [PMID: 17640777 DOI: 10.1016/j.vaccine.2007.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/11/2007] [Accepted: 06/11/2007] [Indexed: 01/13/2023]
Abstract
This short report presents results of an open uncontrolled single centre study which evaluated immunogenicity and safety of a virosome-formulated hepatitis A vaccine (Epaxal) in 14 HIV-positive adult patients and 64 healthy adults receiving a primary immunisation and a booster dose 12 months later. Seroconversion rates (> or =20 mIU/mL), geometric mean concentration (GMC) of anti-HAV antibodies, local and systemic adverse events (AEs) were assessed at baseline and at Months 1, 6, 12, and 13. The seroconversion rate was 63.6% at Month 1 and 91.7% at Month 13 in HIV-positive patients versus 93.8 and 100% in healthy adults. The booster dose increased GMCs from 25.5 to 659.2 mIU/mL in HIV-positive patients versus 104 and 2986 mIU/mL in healthy adults. Epaxal was well tolerated by the HIV-positive patients and was at least as immunogenic as reported for aluminium-adsorbed vaccines. In conclusion, Epaxal can be considered an immunogenic and safe hepatitis A vaccine in HIV-positive patients.
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Affiliation(s)
- L Loutan
- Travel and Migration Medicine Unit, Geneva University Hospitals, rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
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Gore L, Kuttesch J, Hunger SP, Herzog C, Narendaren A, Boklan J, Foreman NK, Ivy SP, Boucher N, Trippett TM. A phase Ib study of oxaliplatin in combination with fluorouracil (5FU) and leucovorin (LV) in pediatric patients (pts) with advanced solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9548 Background: Platinums have significant activity in a wide variety of pediatric tumors, and oxaliplatin exhibits synergy with 5FU and LV in adults with colorectal cancer in FOLFOX regimens. The primary objectives of this study are to determine the maximum tolerated dose (MTD) of the modified FOLFOX6 regimen in pediatric tumors. Secondary objectives include safety, PK pharmacokinetic (PK) and PET scan efficacy analyses. Methods: Pts age <21 years with advanced cancers and adequate organ function are eligible. Patients are stratified by tumor type (CNS or non-CNS) to better delineate the potential neurotoxicity in patients with altered neurologic function. Pts received oxaliplatin starting at 85 mg/m2 and LV 400 mg/m2 over 2 hours on day 1 followed by a 5FU bolus of 400 mg/m2 then 2,400 mg/m2 continuous infusion over 46 hours, every 2 weeks (3 courses = 1 cycle), with integrated PK sampling in a limited dose escalation design. Standard 3+3 dose escalation, definitions of dose limiting toxicity (DLT), and dose modification for toxicity are implemented. The MTD is expanded to 15 patients to confirm and further characterize tolerability and toxicity. Results: To date, 15 very heavily pre-treated patients (7 M, 8 F) have received 25 cycles (range 1–4, median 2) of treatment at 2 dose levels. One of 8 pts at dose level 2 (oxaliplatin 100 mg/m2) developed DLT (delay in repeat treatment > 14 days due to grade 3 platelets). Treatment has been well tolerated. The most frequently reported related grade 3–4 adverse events (AEs) are reversible leukocytes (29%), neutropenia (43%), platelets (35%) and lymphopenia (21%). 31 of 90 courses (34%) have been delayed for neutropenia and thrombocytopenia. Anti-tumor activity to date includes a confirmed partial response lasting 15 weeks in a patient with osteosarcoma, and prolonged stable disease in 5 other pts with brain tumors (2), hepatoblastoma (2) and sarcoma (1). Conclusions: The modified FOLFOX6 regimen has significant but reversible myelosuppression in heavily pre-treated pediatric patients, but is tolerable and has promising activity in several tumor types. Cohort expansion continues at 100 mg/m2 of oxaliplatin. PET scan and pharmacokinetic analyses will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- L. Gore
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Kuttesch
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. P. Hunger
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Herzog
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Narendaren
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Boklan
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. K. Foreman
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. P. Ivy
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - N. Boucher
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T. M. Trippett
- UCHSC At Fitzsimons, Aurora, CO; Vanderbilt University Medical Center, Nashville, TN; University of Florida Shands Cancer Center, Gainesville, FL; University of Texas, MD Anderson Cancer Center, Houston, TX; University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Phoenix Children's Hospital, Phoenix, AZ; National Cancer Institute, Rockville, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
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Trippett TM, Kuttesch J, Herzog C, Boklan J, Bagatell R, Hunger S, Arceci R, Lu H, Langer C, Gore L. A phase I study of cetuximab and irinotecan in pediatric patients (pts) with refractory solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9547 Background: Irinotecan has shown antitumor activity in a number of pediatric tumors. In adults with colorectal cancer, combining irinotecan with cetuximab enhances clinical activity as compared to treatment with irinotecan alone. We implemented this first-in- pediatrics phase I study to determine the maximum tolerated dose (MTD) and recommended Phase II dose (RP2D) of cetuximab and irinotecan in pediatric patients. Methods: 35 heavily pre-treated pts with refractory solid tumors were enrolled: brainstem glioma/astrocytoma (16), hepatoblastoma (4), neuroblastoma (2), other (13). Weekly cetuximab was escalated in 3 sequential dose levels: 75, 150 or 250mg/m2; Irinotecan was given at 16 or 20 mg/m2/day over 1 hour [daily × 5] for two weeks, every 21 days. Correlative EGFR expression (immunohistochemistry and FISH) and/or mutations, pharmacokinetics (PK) of and immune response to cetuximab were performed. Results: Pts were treated in two age cohorts (ages 1–12 yrs = Group A, and 13–18 yrs = Group B). PK analyses show linearity, with similar t1/2, clearance, and volume of distribution between groups. Irinotecan-related DLT in 2/6 pts in Group A/dose 2 necessitated dose de-escalation. Three pts experienced Grade 3 hypersensitivity infusion reaction and were discontinued. A pt with an EGFR-negative high-grade glioma (dose level 1) achieved a >70% reduction in tumor size and remains on study for 16+ months (24 cycles). A pt with ependymoma experienced a partial response (PR) and continues on cycle 12+. 9 pts received ≥4 cycles of therapy. 16 pts had a best response of stable disease or PR (mean 17 wks, range 5–66+ wks) for a clinical benefit rate of 45%. Conclusions: The combination of cetuximab and irinotecan is well-tolerated over multiple repeat cycles without cumulative toxicity in children with refractory CNS and non-CNS solid tumors. Promising preliminary anti-cancer activity was observed in a variety of pediatric solid tumors. Detailed biologic correlative and PK data will be presented. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. M. Trippett
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - J. Kuttesch
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - C. Herzog
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - J. Boklan
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - R. Bagatell
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - S. Hunger
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - R. Arceci
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - H. Lu
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - C. Langer
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
| | - L. Gore
- Memorial Sloan-Kettering Cancer Center, New York, NY; Vanderbilt Children's Hospital, Nashville, TN; MD Anderson Cancer Center, Houston, TX; Phoenix Children's Hospital, Phoenix, AZ; University of Arizona Health Sciences Center, Tucson, AZ; University of Florida, Gainesville, FL; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Bristol-Myers Squibb, Wallingford, CT; University of Colorado Health Sciences Center, Denver, CO
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Abstract
Meprins are zinc-dependent metalloproteinases that are highly expressed in the brush-border membranes of both the kidney and the intestines. Meprins are capable of proteolytically degrading extracellular matrix proteins, proteolytically processing bioactive proteins, and play a role in inflammatory processes. In this study, the function of meprin A in the acute kidney injury (AKI) model of cisplatin nephrotoxicity was examined. Normal linear localization of meprin A in the brush border membranes of proximal tubules was altered in AKI. The meprin A alpha-subunit was detected in the urine of both control and cisplatin-treated mice. A cleaved product of the meprin A beta-subunit, undetected in the urine of control mice, was found to be significantly increased in the urine during the progression of cisplatin nephrotoxicity. The excretion of this beta-fragment was found to be before the rise in serum creatinine and blood urea nitrogen (BUN) suggesting usefulness as a biomarker for AKI. Pretreatment of mice with a meprin A inhibitor afforded protection from cisplatin nephrotoxicity as reflected by significant decreases in serum creatinine, BUN, and the excretion of kidney injury molecule-1. These decreases in serum and urine biomarkers were accompanied by significant decreases in histologic markers such as leukocyte infiltration and apoptosis. Meprin A appears to be an important therapeutic target and urinary excretion appears to be a potential biomarker of AKI.
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Affiliation(s)
- C Herzog
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Herzog C. [Coblations-tonsillectomy]. HNO 2007; 55:333; author reply 333-6. [PMID: 17406844 DOI: 10.1007/s00106-006-1449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Uribe M, Buckel E, Ferrario M, Hunter B, Godoy J, González G, Cavallieri S, Iñiguez R, Calabrán L, Herzog C. Pediatric Liver Retransplantation: Indications and Outcome. Transplant Proc 2007; 39:609-11. [PMID: 17445556 DOI: 10.1016/j.transproceed.2006.12.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Liver transplantation is the only treatment for end-stage liver disease. Not all patients have a favorable outcome. Graft failure secondary to primary nonfunction, vascular complications, or chronic rejection among other problems may lead to retransplantation. Retransplantation represents 8% to 29% of liver transplantations in the pediatric population. The aim of this study was to present our experience with retransplanted children by analyzing the indications and the results. METHODS All patients were prospectively included in our database, including 125 children. We included the indications for retransplantation, complications, and mortality. Kaplan-Meier curves were used for survival analysis. RESULTS Since 1994, 125 patients were transplanted and 25 were retransplanted (20%), including 5 who received a third graft. Primary nonfunction represented 30% of the indications for retransplantation and hepatic artery thrombosis, 20%. Six of 25 patients who received a first retransplantation and 2 of 5 who received a second retransplantation died. The most frequent cause of death was multiorgans failure. The survivals at 1 and 5 years were 82% and 76% for children receiving a first retransplantation, and 60% at 1 and 5 years for those who received a second retransplantation. CONCLUSIONS Organ failure after liver transplantation was a common event in pediatric transplantation. Survival was similar between patients transplanted once and those who received one retransplantation. Survival decreased among patients who received a third graft but was maintained at 60%, which is better than most published results for first retransplanted patients. Retransplantation is a valid option with good results for selected pediatric cases.
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Affiliation(s)
- M Uribe
- Liver Transplant Program, Clínica Las Condes-Hospital Luis Calvo Mackenna, Santiago, Chile.
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Vogl TJ, Herzog C, Zangos S, Lindemayr S. Transpulmonale Chemoembolisation (TPCE) als palliatives Behandlungskonzept bei primären Lungentumoren. ROFO-FORTSCHR RONTG 2007; 179:300-7. [PMID: 17325997 DOI: 10.1055/s-2007-962921] [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: 10/23/2022]
Abstract
PURPOSE To evaluate transpulmonary chemoembolization (TPCE) as a symptomatic palliative method for treating inoperable primary lung tumors. MATERIALS AND METHOD From 2002 to 2005, 17 patients (17 males, 3 females; average age: 64.5 years) suffering from primary lung tumors were treated in 3.6 sessions (range: 2 to 8) using TPCE. The patients had the following primary tumors: adenocarcinoma (n = 6), pleural mesothelioma (n = 2), squamous cell carcinoma (n = 1), small cell carcinoma (n = 1), and non-small cell carcinoma (n = 7). After femoral vein puncture, tumor-supplying pulmonary arteries were selectively explored, and 5 - 10 mg mitomycin C and 5 - 10 mL lipiodol and microsphere particles (Spherex) (20 - 70 microm in diameter) were applied with balloon protection. Diagnosis and follow-up were performed in 4-week intervals with unenhanced and contrast-enhanced computed tomography (CT). The mean follow-up was 11.3 months. RESULTS Treatment was well tolerated by all patients with no major side effects or complications. The laboratory parameters were not significantly influenced. 11.8 % of the patients (n = 2) showed high or moderate lipiodol uptake, and 76.5 % (n = 13) showed low lipiodol uptake. After evaluation of morphologic criteria, a mean volume regression of 12.1 ml (40.4 %) of the embolized areas was achieved in four patients (23.5 %), while a constant value was identified during follow-up for seven patients (41.2 %). In six patients (35.3 %), progression of the treated lung tumors was recorded. The tumor increased by a mean of 38.37 ml (165.38 %). CONCLUSION TPCE is a well-tolerated palliative treatment option for patients with primary lung tumors.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, J. W. Goethe-Universität Frankfurt.
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Ludwig RJ, Herzog C, Rostock A, Ochsendorf FR, Zollner TM, Thaci D, Kaufmann R, Vogl TJ, Boehncke WH. Psoriasis: a possible risk factor for development of coronary artery calcification. Br J Dermatol 2007; 156:271-6. [PMID: 17223866 DOI: 10.1111/j.1365-2133.2006.07562.x] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [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: 01/20/2023]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disorder affecting about 2% of white-skinned individuals. Epidemiological data on the prevalence and degree of coronary artery calcification (CAC) as an indicator for cardiovascular diseases in patients with psoriasis are contradictory. OBJECTIVES To study the prevalence and degree of CAC as an indicator for cardiovascular diseases in 32 patients with psoriasis matched for age, sex and risk factors to an equally sized control population. METHODS Noncontrast-enhanced 16-row spiral computed tomography was performed in patients and controls. RESULTS We found a significantly increased prevalence (59.4% vs. 28.1%, P = 0.015) and severity (CAC score according to Agatston 3.7 vs. 0.0, P = 0.019) of CAC in patients with psoriasis. Multiple linear regression calculations identified psoriasis as a likely independent risk factor for CAC. CONCLUSIONS Our results point towards the potentially systemic nature of the inflammatory processes underlying the pathogenesis of psoriasis, which may therefore be considered a potentially severe systemic disease.
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Affiliation(s)
- R J Ludwig
- Department of Dermatology and Department of Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany
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Herzog C, Zwerner PL, Doll JR, Savino G, Zangos S, Lehnert T, Schoepf UJ, Vogl TJ. Detektion und Auschluss signifikanter Koronarstenosen mittels 64-Zeilen Mehrschicht Spiral CT. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bisdas S, Baghi M, Chambron-Pinho N, Smolarcz A, Hübner F, Balzer JO, Herzog C, Mack MG, Vogl TJ. Wertigkeit der Protonen MR-Spektroskopie von extrakraniellen Kopf- und Hals-Tumoren: in vivo Studie. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bisdas S, Gurung J, Konstantinou G, Lehnert T, Herzog C, Balzer JO, Mack MG, Koh TS, Vogl TJ. Akuter Schlaganfall: Effekt der Arteriellen Input Funktion auf Perfusionwerte und Ischämievolumetrie in der Perfusions-CT. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Korkusuz H, Eichler K, Zangos S, Herzog C, Balzer JO, Gholami A, Vogl TJ. Transarterielle Chemoembolisation (TACE) von Lebermetastasen bei malignen Uveamelanomen: lokale Tumorausdehnung und Überlebenszeit. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bisdas S, Baghi M, Chambron-Pinho N, Smolarcz A, Knecht R, Herzog C, Mack MG, Koh TS, Vogl TJ. Perfusions-CT bei Kopfhalstumoren: Quantitative Perfusion- und Permeabilitätsmessungen bei Oropharynxkarzinomen, Oropharynxrezidiv und Lymphknotenmetastasen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zangos S, Eichler K, Mack MG, Sadighi C, Lehnert T, Herzog C, Vogl TJ. MR-kompatibles Assistenzsystem für Punktionen im Hochfeld-MRT: Technik und erste Ergebnisse. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Herzog C, Bux R, Krug D, Zangos S, Eichler K, Lehnert T, Ackermann H, Vogl TJ. CT-Dichteverteilungskurven – ein neuer Ansatz zur Differenzierung fortgeschrittener atherosklerotischer Plaques? ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Müller C, Hübner F, Bisdas S, Herzog C, Hammerstingl RM, Ackermann H, Vorbuchner M, Vogl TJ. [In vivo proton MR spectroscopy of normal liver parenchyma: technique and results]. ROFO-FORTSCHR RONTG 2006; 178:1128-36. [PMID: 17128381 DOI: 10.1055/s-2006-927136] [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: 12/20/2022]
Abstract
PURPOSE To analyze the proton magnetic resonance spectroscopic data ( (1)H MRS) of normal liver parenchyma with regard to age, sex, body mass index and location in the liver. MATERIALS AND METHODS 45 healthy volunteers age 24 to 65 years were examined with an optimized single-voxel (1)H MRS using a 1.5-T scanner. A spin echo sequence with a TR of 1500 ms and a TE of 135 ms was used, allowing in-phase detection of the choline signal. Weak water suppression was achieved using a chemical shift selective suppression (CHESS) technique. Each examination included the measurement of three voxels with a voxel size of 18 x 18 x 18 mm (3) in different areas of the liver. The volunteers were divided into different age-based groups (young: < or = 44 years; older: > or = 44 years), BMI (normal weighted: < 25 kg/m (2); obese: > 25 kg/m (2)) and sex. RESULTS In the acquired spectra different lipid (e. g. [CH (2)] (n)), choline, glutamine, glutamate and glycogen-glucose-complex resonances were detected. The analysis of the spectra, however, only focused on the concentrations of choline and (CH (2)) (n) and the relative concentrations of the choline-to-(CH (2)) (n)-ratios. In the older volunteers the relative concentration of the choline-to-(CH (2)) (n)-ratio was significantly decreased by 0.213 +/- 0.193 in comparison to the younger subjects (p = 0,031). Further statistical analysis confirmed a significant decrease of the choline-to-(CH (2)) (n)-ratio by 0.223 +/- 0.180 in obese volunteers compared to volunteers of a standard weight (p = 0,016). The significant difference between the choline-to-(CH (2)) (n)-ratio in female versus male volunteers was calculated with an increase of 0.483 +/- 0.172 (p = 0,000). The location of the voxel in the liver parenchyma did not yield a significant difference in the choline-to-(CH (2)) (n)-ratio. CONCLUSION The analysis of the proton liver MRS of healthy volunteers indicated a significant difference in the choline-to-(CH (2)) (n)-ratio depending on age, sex, and BMI with a confidence interval of 95 %. The different choline-to-(CH (2)) (n)-ratio could be the result of the body fat distribution depending on age and sex and also of the increased fat portion of the body in obese volunteers.
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Affiliation(s)
- C Müller
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt/Main.
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Abstract
Back pain associated with a herniated disk has become an important and increasing general health problem in Germany and other industrialized countries. After all methods of conservative treatment have been exhausted, nucleolysis may be a minimally invasive alternative to surgery. In nucleolysis, chondrolytic substances or other substances, which reduce the pressure within the disk by other means, are injected into the nucleus pulposus under CT guidance. Among various substances, which have been employed for nucleolysis, an ozone-oxygen mixture appears to be very promising. The water-binding capacity of ozone results in a reduction of pain for several months. Moreover, it has an anti-inflammatory effect and results in an increase of perfusion. Ozone is converted into pure oxygen in the body and has a low allergic potential. Recent minimally invasive therapeutic methods such as percutaneous nucleotomy or laser treatment do not result in superior results compared with nucleolysis.
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Affiliation(s)
- T Lehnert
- Institut für Diagnostische und interventionelle Radiologie, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main.
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Savino G, Herzog C, Costello P, Schoepf UJ. 64 slice cardiovascular CT in the emergency department: concepts and first experiences. Radiol Med 2006; 111:481-96. [PMID: 16779535 DOI: 10.1007/s11547-006-0044-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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: 03/17/2005] [Accepted: 10/18/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate contrast-enhanced electrocardiogram (ECG)-gated 64-slice computed tomography (CT) angiography of the thorax as a triage tool in patients with acute equivocal chest pain. MATERIAL AND METHODS Technical principles and diagnostic algorithms for using a single ECG-gated 64-slice CT scan for triple rule-out of acute pulmonary embolism, aortic dissection, acute coronary syndromes and other diseases of the chest are introduced. Our experience using this test in 23 patients are reviewed and exemplary cases are illustrated. The total length of hospitalisation and charges for Emergency Department care at the time of discharge were compared with a matched control population that underwent catheter angiography for emergent cardiac workup. Statistical analyses were performed with an independent Student's t test. Mann-Whitney rank sum test was also used on variables that did not have equal variance. RESULTS Of the 23 patients, 11 presented without pathological findings, two with extensive pulmonary embolism, two with definite coronary artery disease (CAD) but stenosis <50% and eight with significant CAD (>50% stenosis). Catheter angiography was performed in the latter group, confirming the CT findings in all cases. Nine patients without CT findings were discharged on the same day. In comparison with the control group, length of hospitalisation (p=0.009) and total hospital charges (p<0.001) were significantly reduced. CONCLUSIONS Our initial experience shows that ECG-gated 64- slice CT angiography of the entire thorax is technically feasible and enables rapid triage of patients to determine underlying cardiac and noncardiac reasons for chest pain. This test may thus help to significantly reduce costs and length of hospitalisation. Prospective studies involving larger groups of patients are required to confirm these findings.
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Affiliation(s)
- G Savino
- Dipartimento di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
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Zangos S, Mayer F, Towari M, Eichler K, Herzog C, Hammerstingl R, Schwarz W, Mack M, Vogl TJ. MR-gesteuerte Punktionen in einem Niedrigfeld-System: Eine Alternative für CT-gesteuerte Interventionen? ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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