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Martín García A, Mitroi C, Mazón Ramos P, García Sanz R, Virizuela JA, Arenas M, Egocheaga Cabello I, Albert D, Anguita Sánchez M, Arrarte Esteban VI, Ayala de la Peña F, Bonanand Lozano C, Castro A, Castro Fernández A, Córdoba R, Cosín-Sales J, Chaparro-Muñoz M, Dalmau R, Drak Hernández Y, Deiros Bronte L, Díez-Villanueva P, Escobar Cervantes C, Fernández Redondo C, García Rodríguez E, Lozano T, Marco Vera P, Martínez Monzonis A, Mesa D, Oristrell G, Palma Gámiz JL, Pedreira M, Reinoso-Barbero L, Rodríguez I, Serrano Antolín JM, Toral B, Torres Royo L, Velasco Del Castillo S, Vicente-Herrero T, Zatarain-Nicolás E, Tamargo J, López Fernández T. Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC. ACTA ACUST UNITED AC 2021; 74:438-448. [PMID: 33712348 DOI: 10.1016/j.rec.2020.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).
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Affiliation(s)
- Ana Martín García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, USAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain.
| | - Cristina Mitroi
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pilar Mazón Ramos
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Ramón García Sanz
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC-ISCIII), Spain
| | | | - Meritxell Arenas
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | - Dimpna Albert
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Raúl Córdoba
- Servicio de Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Regina Dalmau
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Lucía Deiros Bronte
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Escobar Cervantes
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | | | - Teresa Lozano
- Servicio de Cardiología, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Pascual Marco Vera
- Servicio de Hematología y Hemoterapia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Amparo Martínez Monzonis
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gerard Oristrell
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Milagros Pedreira
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Isabel Rodríguez
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Belén Toral
- Servicio de Cardiología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Torres Royo
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | | | - Eduardo Zatarain-Nicolás
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Juan Tamargo
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Teresa López Fernández
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
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Bowles PFD, Reading J, Albert D, Nash R. Subglottic cysts: The Great Ormond Street experience in 105 patients. Eur Arch Otorhinolaryngol 2020; 278:2137-2141. [PMID: 32875392 DOI: 10.1007/s00405-020-06321-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. METHODS Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. RESULTS Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2 weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18 days (range = 1-176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO 2 laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594 Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6 months (SD ± 38.3). CONCLUSION SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise.
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Affiliation(s)
- P F D Bowles
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - J Reading
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - D Albert
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - R Nash
- Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
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Marcos-Alonso S, Gil N, García-Guereta L, Albert D, Tejero MÁ, Perez-Villa F, Gómez Bueno M, Blasco Peiró T, Cano A, Díaz Molina B, Rangel Sousa D. Impact of mechanical circulatory support on survival in pediatric heart transplantation. Pediatr Transplant 2020; 24:e13707. [PMID: 32212306 DOI: 10.1111/petr.13707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/18/2019] [Revised: 01/24/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
Evidence on the impact of MCS on pediatric heart transplant survival is still scarce related to congenital heart disease patients including univentricular physiology as well as the risk factors for complications. We performed a retrospective review of all urgent pediatric (aged ≤16 years) HT from 2004 to 2014 in the Spanish Pediatric Heart Transplant Registry Group. Patients were stratified into two groups: urgent 0 (MCS at HT) and urgent 1 (non-MCS at HT). The primary outcome measure was post-transplant survival; secondary outcome measures were complications and absence of infections and rejection during the first post-transplant year. One hundred twenty-one pediatric patients underwent urgent HT, 58 (47.9%) urgent 0 and 63 (52%) urgent 1. There were 30 (24.8%) deaths: 12 in the urgent 0 group and 18 in the urgent 1 group, P = n.s. Regarding the type of MCS, patients on ECMO had the highest rate of complications (80%) and mortality (40%). Patients in the urgent 1 group showed a higher risk of hospital re-admission for infection during the first year after transplantation (OR 2.31 [1.1-4.82]), P = .025. We did not identify a risk factor for mortality. MCS does not impact negatively on survival after HT. However, there is a significant increase in 30-day and 1-year mortality and complications in ECMO patients compared with VAD patients. Infants, congenital heart disease, and PediMACS were not found to be risk factors for mortality.
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Affiliation(s)
- Sonia Marcos-Alonso
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital Materno Infantil, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Nuria Gil
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Luis García-Guereta
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital La Paz, Madrid, Spain
| | - Dimpna Albert
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital Vall d´Hebrón, Barcelona, Spain
| | - María Ángeles Tejero
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital Reina Sofía, Córdoba, Spain
| | - Félix Perez-Villa
- Cardiology Department, Hospital Clinic i Provincial, Barcelona, Spain
| | | | | | - Ana Cano
- Pediatric Cardiology and Congenital Heart Disease Unit, Pediatric Department, Hospital La Fe, Valencia, Spain
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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Galloway C, Treiman D, Shreibati J, Schram M, Karbaschi Z, Valys A, Albert D, Stavrakis S. 5105A deep neural network predicts atrial fibrillation from normal ECGs recorded on a smartphone-enabled device. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Electrocardiographic predictors of atrial fibrillation (AF) from a non-AF ECG–such as p wave abnormalities and supraventricular ectopy–have been extensively documented. However, risk prediction tools for AF utilize little if any of the wealth of information available from the ECG. Better AF prediction from the ECG may improve efficiency of screening and performance of AF risk tools. Deep learning methods have the potential to extract an unlimited number of features from the ECG to improve prediction of AF.
Purpose
We hypothesize that a deep learning model can identify patterns predictive of AF during normal sinus rhythm. To test the hypothesis, we trained and tested a neural network to predict AF from normal sinus rhythm ambulatory ECG data.
Methods
We trained a deep convolutional neural network to detect features of AF that are present in single-lead ECGs with normal sinus rhythm, recorded using a Food and Drug Administration (FDA)-cleared, smartphone-enabled device. A cohort of 27,526 patients with at least 50 ECGs recorded between January 7, 2013, and September, 19, 2018, and the FDA-cleared automated findings of Normal and Atrial Fibrillation associated with those ECGs, were used for model development. Specifically, we trained the deep learning model on 1,984,581 Normal ECGs from 19,267 patients with 1) only Normal ECG recordings, or 2) at least 30% ECGs with AF. Of the 27,526 patients, an internal set of 8,259 patients with 841,776 Normal ECGs was saved for testing (validation).
Results
Among 8,259 patients in the test set, 3,467 patients had at least 30% of their ECGs with an automated finding of AF. When the deep learning model was run on 841,776 Normal ECGs, it was able to predict whether the ECG was from a patient with no AF or with 30% or more AF, with an area under the curve (AUC) of 0.80. Using an operating point with equal sensitivity and specificity, the model's sensitivity and specificity were 73.1%. Using an operating point with high specificity (90.0%), the model's sensitivity was 48.0%. When the model was applied to a randomly-selected, broader cohort of 15,000 patients (at least 50 ECGs recorded, any amount of AF), a positive, non-linear relationship between neural network output and AF burden per patient was observed (Figure).
Model Output vs AF Burden Per Patient
Conclusions
A deep learning model was able to predict AF from ECGs in normal sinus rhythm that were recorded on a smartphone-enabled device. The use of deep learning, if prospectively validated, may facilitate AF screening in patients with paroxysmal disease or warn patients who are at high risk for developing AF.
Acknowledgement/Funding
AliveCor
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Affiliation(s)
- C Galloway
- AliveCor, MOUNTAIN VIEW, United States of America
| | - D Treiman
- AliveCor, MOUNTAIN VIEW, United States of America
| | - J Shreibati
- AliveCor, MOUNTAIN VIEW, United States of America
| | - M Schram
- AliveCor, MOUNTAIN VIEW, United States of America
| | - Z Karbaschi
- AliveCor, MOUNTAIN VIEW, United States of America
| | - A Valys
- AliveCor, MOUNTAIN VIEW, United States of America
| | - D Albert
- AliveCor, MOUNTAIN VIEW, United States of America
| | - S Stavrakis
- University of Oklahoma, Oklahoma City, United States of America
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Launois P, Planas B, Pujol V, Gran F, Abella R, Albert D, Gómez-Garrido A. Functional results after a children's cardiac rehabilitation program after a heart transplant. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.687] [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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Guereta L, Camino M, Tejero M, Albert D, Marcos S, Cano A. Pediatric Heart Trasplantation in Spain. Data From the National Registry. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1022] [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: 10/17/2022] Open
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Sharma SD, Gupta S, Wyatt M, Albert D, Hartley B. Analysis of intensive care admissions among paediatric obstructive sleep apnoea referrals. Ann R Coll Surg Engl 2018; 100:67-71. [PMID: 29046100 PMCID: PMC5849202 DOI: 10.1308/rcsann.2017.0185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to identify the proportion of children referred to a paediatric tertiary referral centre who required admission to the paediatric intensive care unit (PICU) following surgery for obstructive sleep apnoea (OSA) and to establish risk factors for these admissions. Methods Retrospective review of case notes and the operative database was performed for all children undergoing adenotonsillectomy for sleep disordered breathing and OSA symptoms in Great Ormond Street Hospital over a 10-year period. Results Overall, 1,328 children underwent adenotonsillectomy for sleep disordered breathing and OSA. The mean age was 3.1 years (standard deviation [SD]: 1.7 years). A total of 37 (2.8%) were admitted to the PICU postoperatively (mean length of PICU stay: 1.2 days, standard deviation [SD]: 0.6 days) and 282 (21.2%) required nasopharyngeal airway (nasal prong) insertion intraoperatively. The mean length of stay on the ward following surgery was 1.4 days (SD: 0.8 days). Patients with severe OSA (apnoea-hypopnoea index [AHI] >10) and ASA (American Society of Anesthesiologists) grade ≥3 were more likely to require postoperative PICU admission (22/37 vs 381/1,291 [p<0.001] and 29/37 vs 660/1,291 [p=0.001] respectively). Severe OSA was also more common in children who required nasal prong insertion intraoperatively (186/282 vs 217/1,046, p<0.001). Conclusions Very few children referred to a paediatric tertiary referral centre actually require PICU admission following surgery. This may be in part due to the use of a nasopharyngeal airway in patients where postoperative obstruction is anticipated. In children with severe OSA (AHI >10) and an ASA grade of ≥3, nasopharyngeal airway insertion and potential admission to the PICU should be considered.
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Affiliation(s)
- S D Sharma
- Great Ormond Street Hospital for Children NHS Foundation Trust , UK
| | - S Gupta
- Great Ormond Street Hospital for Children NHS Foundation Trust , UK
| | - M Wyatt
- Great Ormond Street Hospital for Children NHS Foundation Trust , UK
| | - D Albert
- Great Ormond Street Hospital for Children NHS Foundation Trust , UK
| | - B Hartley
- Great Ormond Street Hospital for Children NHS Foundation Trust , UK
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Tamás G, Kelemen A, Albert D, Rózsa I, Csibri E, Entz L, Fabó D, Halász L, Rudas G, Barsi P, Golopencza P, Eröss L. EP 8. Motor outcome of the bilateral subthalamic stimulation in Parkinson’s disease, one-year follow-up results from the Neuromodulation Centre in Budapest. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.202] [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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Rodriguez O, Garrido E, Labrandero C, Blanco C, Grueso J, Mendoza A, Albert D, Del Cerro M. Pulmonary Vasodilatador Treatment in Failing Fontan: Data from the Spanish Registry for Pediatric Pulmonary Hypertension (REHIPED). Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571898] [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: 10/22/2022]
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Dreher M, Grawe A, Albert D, Beck G, Ferrari M. [Extended coronary dissection caused by severe polytrauma with contusio cordis : Venoarterial ECMO-assisted percutaneous coronary intervention]. Med Klin Intensivmed Notfmed 2015; 111:325-9. [PMID: 26153466 DOI: 10.1007/s00063-015-0049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
Treatment of a patient with acute cardiac failure due to a contusio cordis after polytrauma by an interdisciplinary team is reported. Shortly after admission to our shock room, the patient developed cardiogenic shock caused by an extended coronary dissection. After interim cardiopulmonary resuscitation, the patient was stabilized by venoarterial extracorporeal membrane oxygenation (ECMO) and subsequent complex coronary artery intervention in the heart catheter laboratory. Despite the increased left ventricular function which enabled partial weaning from the ECMO, the patient died of multiple organ failure 10 days after admission.
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Affiliation(s)
- M Dreher
- Klinik für Innere Medizin I, Kardiologie, konservative Intensivmedizin, Angiologie, HSK, Dr. Horst Schmidt Kliniken GmbH - Städtisches Klinikum der Landeshauptstadt Wiesbaden und der Helios-Kliniken GmbH, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland.
| | - A Grawe
- Klinik für Innere Medizin I, Kardiologie, konservative Intensivmedizin, Angiologie, HSK, Dr. Horst Schmidt Kliniken GmbH - Städtisches Klinikum der Landeshauptstadt Wiesbaden und der Helios-Kliniken GmbH, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland
| | - D Albert
- Anästhesiologie, Intensivmedizin und Schmerztherapie, HSK, Dr. Horst Schmidt Kliniken GmbH - Städtisches Klinikum der Landeshauptstadt Wiesbaden und der Helios-Kliniken GmbH, Wiesbaden, Deutschland
| | - G Beck
- Anästhesiologie, Intensivmedizin und Schmerztherapie, HSK, Dr. Horst Schmidt Kliniken GmbH - Städtisches Klinikum der Landeshauptstadt Wiesbaden und der Helios-Kliniken GmbH, Wiesbaden, Deutschland
| | - M Ferrari
- Klinik für Innere Medizin I, Kardiologie, konservative Intensivmedizin, Angiologie, HSK, Dr. Horst Schmidt Kliniken GmbH - Städtisches Klinikum der Landeshauptstadt Wiesbaden und der Helios-Kliniken GmbH, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland
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Hartley BEJ, Eze N, Trozzi M, Toma S, Hewitt R, Jephson C, Cochrane L, Wyatt M, Albert D. Nasal dermoids in children: a proposal for a new classification based on 103 cases at Great Ormond Street Hospital. Int J Pediatr Otorhinolaryngol 2015; 79:18-22. [PMID: 25481331 DOI: 10.1016/j.ijporl.2014.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Nasal dermoids are rare developmental anomalies seen in children. This study reports the largest case series of 103 patients seen in a quaternary specialist unit over a 10-year period. We report the surgical and radiological findings and propose a new classification system, which clearly describes the extent of the lesions, thus allowing better surgical planning. METHODS A retrospective review of case notes was conducted. Data collection included demographics, initial presentation, site of lesion, pre-operative CT and MRI imaging, surgical procedure, intraoperative findings (including depth of lesion), complications and recurrence. Surgical findings were correlated with radiological findings. RESULTS A total of 103 patients were included in the study. The mean age at presentation was 29 months. 89% of children presented with a naso-glabellar or columellar lesion and 11% had a medial canthal lesion. All the patients underwent preoperative imaging and were treated with surgical excision. 58 children had superficial lesions, 45 had subcutaneous tracts extending to varying depths. Of these, 38 had intraosseous extension into the frontonasal bones, eight extended intracranially but remained extradural and two had intradural extension. There was good correlation between radiological and surgical findings. The superficial lesions were locally excised. The lesions with intraosseous tracts were removed via open rhinoplasty and the frontonasal bones drilled for access. Intracranial extension was approached either via a bicoronal flap and frontal craniotomy or the less invasive anterior small window craniotomy. CONCLUSIONS This report describes the largest published cases series of nasal dermoids. The cases demonstrate the presenting features and the variable extent of the lesions. The new proposed classification; superficial, intraosseous, intracranial extradural and intracranial intradural, allows precise surgical planning. In the presence of intracranial extension, the low morbidity technique of using a brow incision and small window anterior craniotomy avoids the more invasive and commonly used bicoronal flap and frontal craniotomy.
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Affiliation(s)
| | - N Eze
- Great Ormond Street Hospital, United Kingdom.
| | - M Trozzi
- Great Ormond Street Hospital, United Kingdom
| | - S Toma
- Great Ormond Street Hospital, United Kingdom
| | - R Hewitt
- Great Ormond Street Hospital, United Kingdom
| | - C Jephson
- Great Ormond Street Hospital, United Kingdom
| | - L Cochrane
- Great Ormond Street Hospital, United Kingdom
| | - M Wyatt
- Great Ormond Street Hospital, United Kingdom
| | - D Albert
- Great Ormond Street Hospital, United Kingdom
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13
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Gran F, Albert D, Sanchez-de-Toledo J, Balcells J, Ferreres JC, Abella R. Trasplante cardiaco en pacientes pediátricos con hipertensión pulmonar. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.03.006] [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: 10/25/2022]
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14
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Gran F, Albert D, Sanchez-de-Toledo J, Balcells J, Ferreres JC, Abella R. Heart transplantation in pediatric patients with pulmonary hypertension. ACTA ACUST UNITED AC 2014; 67:669-70. [PMID: 25037549 DOI: 10.1016/j.rec.2014.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ferran Gran
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Dimpna Albert
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Sanchez-de-Toledo
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Balcells
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Carles Ferreres
- Servicio de Anatomía Patológica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Raúl Abella
- Servicio de Cirugía Cardiaca Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Gran F, Vega L, Castellote A, Albert D, Creus A, Sánchez-De-Toledo J. Role of magnetic resonance imaging in the diagnosis of myocarditis in children. ACTA ACUST UNITED AC 2014; 66:500-1. [PMID: 24776055 DOI: 10.1016/j.rec.2012.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Ferran Gran
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Laia Vega
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Amparo Castellote
- Servicio de Radiología Pediátrica, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dimpna Albert
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Anna Creus
- Unidad de Cuidados Intensivos Neonatales, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Sánchez-De-Toledo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron and Universidad Autónoma de Barcelona, Barcelona, Spain
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Gran F, Castellote A, Vega L, Albert D, Ferrer Q, Sanchez-De-Toledo J. Chest pain as the predominant symptom in myocarditis in children. ACTA ACUST UNITED AC 2014; 66:908-9. [PMID: 24774001 DOI: 10.1016/j.rec.2013.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Ferran Gran
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Amparo Castellote
- Servicio de Radiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Laia Vega
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dimpna Albert
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Queralt Ferrer
- Unidad de Cardiología Pediátrica, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joan Sanchez-De-Toledo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de la Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Gran F, Castellote A, Vega L, Albert D, Ferrer Q, Sanchez-De-Toledo J. Dolor precordial como forma de presentación de la miocarditis en niños. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.013] [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: 01/18/2023]
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Lau J, Lowres N, Neubeck L, Brieger D, Sy R, Galloway C, Albert D, Freedman S. Performance of an Automated iPhone ECG Algorithm to Diagnose Atrial Fibrillation in a Community AF Screening Program (SEARCH-AF). Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.488] [Citation(s) in RCA: 5] [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: 11/27/2022]
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Abstract
Duloxetine is a serotonin and norepinephrine reuptake inhibitor, which is mainly used to treat depression. This retrospective study describes the demographic and clinical effects of duloxetine ingestions reported to the National Poison Data System (NPDS). NPDS data were searched for duloxetine exposures between 2004 and 2010. A total of 11,373 patients were included and exposures were divided into three groups of ages ≤6 years old, 7–12 years and >12 years. Neurological clinical effects occurred in 6.1% of the patients aged ≤6 years, 13.0% of the patients aged 7–12 years and 24.6% of the patients aged >12 years. Cardiovascular effects occurred in 1.4% of the patients aged ≤6 years old, 2.5% of the patients aged 7–12 years and 11.6% of the patients aged >12 years. Gastrointestinal effects occurred in 4.1% of the patients aged ≤6 years old, 16.6% of the patients aged 7–12 years and 13.8% of the patients aged >12 years. Tachycardia, nausea, vomiting, agitation/irritability, dizziness/vertigo and drowsiness were among the most common clinical effects in all three groups. Overall, 61.4% of the patients aged ≤6 years and 77.5% of the patients aged 7–12 years were managed in a non–health care facility, while 55.8% of the patients aged >12 years were referred to or already in a health care facility. We conclude that the majority of ingestions are benign in both pediatrics and adults. Most symptomatic patients have neurologic, gastrointestinal and cardiovascular effects. Most pediatric patients will be able to be managed in a non–health care facility.
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Affiliation(s)
- J Jacob
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - D Albert
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
| | - K Heard
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA
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McGiven J, Taylor A, Duncombe L, Sayers R, Albert D, Banai M, Blasco JM, Elena S, Fretin D, Garin-Bastuji B, Melzer F, Muñoz PM, Nielsen K, Nicola A, Scacchia M, Tittarelli M, Dias IT, Walravens K, Stack J. The first International Standard anti-Brucella melitensis Serum. REV SCI TECH OIE 2011; 30:809-819. [PMID: 22435193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The World Organisation for Animal Health (OIE) requested an International Standard anti-Brucella melitensis Serum (ISaBmS) to standardise diagnostic tests and reagents for sheep and goats. The agreed criteria were the highest dilution (in negative serum) of the standard which must give a positive result and the lowest dilution (in negative serum) which must simultaneously give a negative result. The two dilutions for each assay were, respectively: indirect enzyme-linked immunosorbent assay (iELISA) 1/64 and 1/750, competitive ELISA (cELISA) 1/8 and 1/300, fluorescent polarisation assay (FPA) 1/16 and 1/200, Rose Bengal test (RBT) 1/16 and 1/200. The OIE International Standard Serum (OIEISS) will remain the primary standard for the RBT; the ISaBmS is an additional standard. It was impossible to set criteria for the complement fixation test, therefore the OIEISS will remain the primary standard. The ISaBmS can be used to standardise iELISA, cELISA and FPA to diagnose sheep and goat brucellosis. This standard should facilitate harmonisation of tests used for brucellosis surveillance and international trade in these species.
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Affiliation(s)
- J McGiven
- Animal Health Veterinary Laboratories Agency (OIE/FAO Reference Laboratory), Woodham Lane, Addlestone, Surrey KT15 3NB, United Kingdom
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Jiang F, Luo Y, Tapang P, Goh B, Wong C, Soo R, Albert D, McKee M, Ricker J, McKeegan E. 599 Antiangiogenic effects of linifanib (ABT-869) in xenograft models and patients with solid tumors. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)72306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Tuffnell DJ, Buchan PC, Albert D, Tyndale-biscoe S. Fetal heart rate responses to maternal exercise, increased maternal temperature and maternal circadian variation. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619009151222] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. Embarazo y cardiopatías congénitas. Rev Esp Cardiol 2008. [DOI: 10.1157/13116650] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. [Pregnancy and congenital heart disease]. Rev Esp Cardiol 2008; 61:236-243. [PMID: 18361896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. METHODS Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18-40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. RESULTS The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. CONCLUSIONS Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results.
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Affiliation(s)
- Begoña Manso
- Unidad de Cardiopatías Congénitas del Adolescente y del Adulto, Unidad de Embarazo de Alto Riesgo Obstétrico, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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Albert D, Dunham J, Khan S, Stansberry J, Kolasinski S, Tsai D, Pullman-Mooar S, Barnack F, Striebich C, Looney RJ, Prak ETL, Kimberly R, Zhang Y, Eisenberg R. Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus. Ann Rheum Dis 2008; 67:1724-31. [PMID: 18250115 DOI: 10.1136/ard.2007.083162] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the effects in systemic lupus erythaematosus (SLE) of B cell directed therapy with rituximab, a chimeric monoclonal antibody directed at CD20+ B cells, without concomitant immunosuppressive therapy in mild to moderate SLE. METHODS Patients (n=24) with active SLE and failure of >or=1 immunosuppressive were recruited from three university centres into this phase I/II prospective open-label study. Patients were followed for 1 year to assess safety, efficacy and biological effects. RESULTS In total, 18 of the patients scheduled to receive the full lymphoma dose of rituximab were evaluable for B cell levels in peripheral blood. Of these, 17 had effective CD19+ B cell depletion (<5 cells/microl). However, six of the depleted patients showed B cell return before 24 weeks. A total of 70% of patients improved by week 55, as defined by an SLE Disease Activity Index (SLEDAI) score improvement of >or=2 units from baseline. The degree of CD19+ B cell depletion was correlated with SLEDAI improvement at week 15 (r=0.84). In general, rituximab infusions were well tolerated. Approximately a third of the patients developed human anti-chimeric antibody (HACA) titres, which correlated with poor B cell depletion. Most patients (9 of 14) did not respond to immunisations with Pneumovax and tetanus toxoid. CONCLUSIONS Rituximab is a promising new therapy for SLE. The variability of responses in patients with SLE may be related to HACA formation. The failure to respond to immunisations is surprising, in view of the apparently low risk of infections. Better biological markers are necessary to follow these patients during treatment.
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Affiliation(s)
- D Albert
- Dartmouth Medical School, Hanover, New Hampshire, USA
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Albert D, Pergola C, Koeberle A, Dodt G, Steinhilber D, Werz O. The role of diacylglyceride generation by phospholipase D and phosphatidic acid phosphatase in the activation of 5-lipoxygenase in polymorphonuclear leukocytes. J Leukoc Biol 2008; 83:1019-27. [DOI: 10.1189/jlb.0807531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Ciuleanu T, Diculescu M, Hoepffner NM, Trojan J, Sailer V, Zalupski M, Herrmann T, Roth A, Chick J, Brock K, Albert D, Philip PA. A randomised phase II study of OSI-7904L versus 5-fluorouracil (FU)/leucovorin (LV) as first-line treatment in patients with advanced biliary cancers. Invest New Drugs 2007; 25:385-90. [PMID: 17364234 DOI: 10.1007/s10637-007-9040-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 02/08/2007] [Indexed: 12/31/2022]
Abstract
The prognosis of advanced biliary tract carcinoma is poor with chemotherapy limited to a palliative role. This randomised study was designed to evaluate the effectiveness of a new liposomal thymidylate synthase inhibitor (TSI), OSI-7904L, in parallel with a modified de Gramont regimen of 5-FU/LV in patients with advanced biliary cancer. Patients with previously untreated advanced or metastatic carcinoma of the biliary tract were randomised to receive either OSI-7904L 12 mg/m2 intravenously every 21 days or a modified de Gramont schedule of 5-FU/LV (intravenous l-LV 200 mg/m2, bolus 5-FU 400 mg/m2 and a 46-h infusion of 5-FU 2,400 mg/m2) every 14 days. Twenty-two patients were randomised, 11 to each group. No patients responded in the OSI-7904L arm, while one patient achieved a partial response in the 5-FU/LV arm. The rates of disease stabilisation were 4/11 (OSI-7904L) and 10/11 (5-FU/LV). Both treatment arms were generally well tolerated. These results show that the activity of OSI-7904L is below a level of clinical relevance in advanced biliary tract cancer, providing only a small degree of disease stabilisation. A simplified de Gramont schedule appears to have marginally more activity. Both treatments were well tolerated.
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Affiliation(s)
- T Ciuleanu
- Oncology Institute Ion Chiricuta, 34-36 Gh. Bilascu Street, 3400, Cluj-Napoca, Romania.
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Hore I, Bajaj Y, Denyer J, Martinez AE, Mellerio JE, Bibas T, Albert D. The management of general and disease specific ENT problems in children with Epidermolysis Bullosa--a retrospective case note review. Int J Pediatr Otorhinolaryngol 2007; 71:385-91. [PMID: 17145082 DOI: 10.1016/j.ijporl.2006.11.005] [Citation(s) in RCA: 23] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 11/01/2006] [Accepted: 11/01/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Epidermolysis Bullosa encompasses a group of inherited disorders characterized by excessive susceptibility of the skin and mucosa to separate from underlying tissues following mechanical trauma. Information in the literature and guidance on the management of Ear, Nose and Throat problems in such children is scarce. The aim of this study is to report the experience of an Ear, Nose and Throat department in a tertiary paediatric hospital linked to a national Epidermolysis Bullosa unit, describing how children have presented and the care that has been given including a theatre protocol aimed at reducing shearing forces. METHODS Retrospective case note review of Epidermolysis Bullosa patients referred to Otolaryngology over an 8-year period. RESULTS Reviewing notes of 307 EB patients identified 15 that had been referred to the ENT department. Four children with middle ear effusions were effectively treated by watchful waiting or grommets. Three children with otitis externa had some relief from careful microsuction but reinfection from ulcers on other parts of the children's bodies tended to occur. One child with profound sensorineural hearing loss benefited from cochlear implantation but later passed away from unrelated sepsis. One child with intrinsic rhinitis was treated with steroid and then a salt-water nasal spray. Five children had nasal crusting documented, although this was not a specific reason for referral. When severe this had been treated with topical steroids by the dermatology team. One patient with obstructive sleep aponea had tonsillectomy and examination of the post-nasal space. Of the five patients referred with glottic or supraglottic scarring, the management of four included a tracheostomy. When carried out tracheostomy sites healed well in each case. With repeated endoscopic procedures it was subsequently possible to remove the tracheostomy in the two of the children. Using a special theatre protocol no new ulcers were recorded as being precipitated by any of the procedures children underwent. CONCLUSIONS Optimal management depends on the support of a multidisciplinary team, including otolaryngologists, pediatricians, dermatologists, anaesthetists, and specialist nurses. Adherence to a protocol for theatre management can help avoid intraoperative complications.
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Affiliation(s)
- I Hore
- Otolaryngology Department, Great Ormond Street Hospital, London, UK.
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Falk S, Anthoney A, Eatock M, Van Cutsem E, Chick J, Glen H, Valle JW, Drolet DW, Albert D, Ferry D, Ajani J. Multicentre phase II pharmacokinetic and pharmacodynamic study of OSI-7904L in previously untreated patients with advanced gastric or gastroesophageal junction adenocarcinoma. Br J Cancer 2006; 95:450-6. [PMID: 16880795 PMCID: PMC2360664 DOI: 10.1038/sj.bjc.6603267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 06/14/2006] [Accepted: 06/14/2006] [Indexed: 12/15/2022] Open
Abstract
A two-stage Simon design was used to evaluate the response rate of OSI-7904L, a liposome encapsulated thymidylate synthase inhibitor, in advanced gastric and/or gastroesophageal adenocarcinoma (A-G/GEJA), administered intravenously at 12 mg m(-2) over 30 min every 21 days. Fifty patients were treated. Median age was 64 years (range 35-82), 62% were male and 89% had ECOG PS of 0/1. A total of 252 cycles were administered; median of 4 per patient (range 1-21). Twelve patients required dose reductions, mainly for skin toxicity. Investigator assessed response rate was 17.4% (95% CI 7.8-31.4) with one complete and seven partial responses in 46 evaluable patients. Twenty-one patients (42%) had stable disease. Median time to progression and survival were 12.4 and 36.9 weeks, respectively. NCI CTCAE Grade 3/4 neutropenia (14%) and thrombocytopenia (4%) were uncommon. The main G3/4 nonhaematological toxicities were skin-related 22%, stomatitis 14%, fatigue/lethargy 10%, and diarrhea 8%. Pharmacokinetic data showed high interpatient variability. Patients with higher AUC were more likely to experience G3/4 toxicity during cycle 1 while baseline homocysteine did not predict toxicity. Response did not correlate with AUC. Elevations in 2'-dU were observed indicating target inhibition. Analysis of TS genotype, TS protein and expression did not reveal any correlation with outcome. OSI-7904L has activity in A-G/GEJA similar to other active agents and an acceptable safety profile.
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Affiliation(s)
- S Falk
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK.
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Lilenbaum R, Axerold R, Thomas S, Dowlati A, Seigel L, Albert D, Van Duym C, Bodkin D. Randomized phase II trial of single agent erlotinib vs. standard chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) and performance status (PS) of 2. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7022] [Citation(s) in RCA: 9] [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: 11/20/2022] Open
Abstract
7022 Background: A previous CALGB trial suggested a benefit for carboplatin-paclitaxel (CP) over P alone in pts with PS 2. Erlotinib (E) has activity in previously treated pts with low PS but has not been formally tested in 1st line. Methods: In a multi-center randomized phase II trial, untreated pts with advanced NSCLC and PS 2 were randomized to E 150 mg daily or CP (AUC 6 and 200 mg/m2) for 4 cycles. Pts in CP who progressed, did not tolerate, or refused further therapy were allowed to cross over to E. The primary endpoint was progression-free survival (PFS). QoL analysis was performed in all pts and tumor samples were obtained whenever possible. Results: As of 12/05, 98 of 102 projected pts have been accrued. Results are reported for 88 (46 E; 42 CP). Demographics were balanced except for more females in E (59%) than CP (45%). Most pts had stage IV adenoca histology. Never-smokers comprised 13% and 7% of pts respectively. Response for E: 2% PR and 30% SD; for CP, 10% PR and 45% SD. Gr 2–4 toxicities for E: rash (34%) and diarrhea (11%); for CP: nausea (12%), neuropathy (14%) and fatigue (29%). Median PFS was 2.5 mo for E (95%CI 1.28 - 2.79) and 4.0 mo for CP (95%CI 2.66 - 4.86). Of 42 pts in CP, 21 have crossed over to E. Conclusions: This is the first randomized phase II trial of E in PS 2 patients. Based on preliminary results, PS 2 patients seemed to fare better with standard CP than single agent E as initial therapy. Mature survival and QoL data will be available in June. [Table: see text]
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Affiliation(s)
- R. Lilenbaum
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - R. Axerold
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - S. Thomas
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - A. Dowlati
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - L. Seigel
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - D. Albert
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - C. Van Duym
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
| | - D. Bodkin
- Mount Sinai Cancer Center, Miami Beach, FL; Thomas Jefferson University, Philadelphia, PA; Oncology/Hematology Associates of Central Illinois, Peoria, IL; Case Western Reserve University, Cleveland, OH; Holy Cross Hospital, Ft. Lauderdale, FL; OSI Pharmaceuticals, Boulder, CO; Sharp Clinical Oncology Research, San Diego, CA
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Zhou J, Pan M, Loh S, Xie Z, Lim Y, Lilly M, Glaser K, Albert D, Davidsen S, Chen CS. ABT-869, a novel multi-target receptor tyrosine kinase inhibitor (RTKI), combined with chemotherapy is synergistic in the therapy of acute myeloid leukemia cells with FLT3-ITD mutation (FLT3-AML). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.13064] [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
13064 Background: Internal tandem duplications (ITDs) of fms-like tyrosine kinase 3 (FLT3) receptor are identified in 20–25% of adult AML patients associated with poor prognosis. ABT-869 is active in FLT3-AML and is currently under clinical investigaton. We hypothesize that the combination of ABT-869 with chemotherapy can improve the therapeutic index in FLT3-AML. Methods: Using Calcusyn software, the additive, synergistic or antagonistic effect of ABT-869 with concurrent or sequential cytosine arabinoside (Ara-C) or doxorubicin (Dox) was measured in MV4–11 and MOLM-14 cells. The synergistic combination sequence was further tested in a MV4–11 xenograft model in four groups (10 mice/group) including control, Ara-C, ABT-869, and combination (Ara-C first for 4 days, then daily ABT-869). Cell cycle analysis and apoptosis and signal pathway assays were performed in vitro and in vivo. Results: ABT-869 induced dose- and time-dependent apoptosis on FLT3-AML cells resulting in down regulation of p-FLT3, p-STAT5, Bcl-XL and up regulation of p53 and BID. ABT-869 caused G1-phase arrest and the removal of cells in the S- and G2/M-phase mediated by reduction of cyclins D and E. We observed significant synergistic effect with Ara-C or Dox first, followed by ABT-869, as well as in concurrent treatment with ABT-869 and Dox. Simultaneous treatment with ABT-869 and Ara-C only achieved additive effect. Conversely, we found an antagonistic effect in the sequence of pretreatment of ABT-869 followed by chemotherapy. In a MV4–11 xenograft model, all mice succumbed to leukemia in the control and Ara-C groups (median survival = 53 and 55.5 days respectively). Combination therapy gave a faster reduction of tumor volume compared to ABT-869 treatment alone (p=0.03) without recurrence of leukemia in either group by day 67. In vivo immunohistochemistry (IHC) analysis revealed ABT-869 potently inhibited VEGF and phosphor-ERK. Conclusions: ABT-869 can be given after Ara-C or Dox to act synergistically. Our study suggests that combinations of RTKIs with chemotherapy should be carefully tested prior to clinical protocol development. A clinical trial of such combination therapy in FLT3-AML is warranted. No significant financial relationships to disclose.
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Affiliation(s)
- J. Zhou
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - M. Pan
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - S. Loh
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - Z. Xie
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - Y. Lim
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - M. Lilly
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - K. Glaser
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - D. Albert
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - S. Davidsen
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
| | - C. S. Chen
- National University of Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore; Oncology Research Institute, National University of Sinapore, Singapore; Loma Linda University School of Medicine, Loma Linda, CA; Abbott Laboratories, Chicago, IL
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Escobar MC, Gómez-Puerta JA, Albert D, Ferrer Q, Girona J. Recurrent congenital heart block in neonatal lupus. Clin Rheumatol 2006; 26:1161-3. [PMID: 16586043 DOI: 10.1007/s10067-006-0282-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 03/01/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
Congenital heart block (CHB) is the main complication of neonatal lupus (NL) and is strongly associated with the presence of anti-SSA/Ro and anti-SSB/La antibodies. The recurrence of CHB in subsequent pregnancies in mothers with these antibodies is uncommon, occurring in approximately 15% of cases. We describe here a case of recurrent CHB in a previously asymptomatic mother with Sjögren syndrome and discuss the current strategies for the prevention and treatment of CHB in NL.
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Affiliation(s)
- Maria C Escobar
- Pediatric Cardiology Unit, Hospital Vall d' Hebron, Barcelona, Spain
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Augeraud E, Haritchabalet I, Sauvanier M, Delhaye D, Albert D, De la Fournière F. P4-12 Guidance familiale de malade d’Alzheimer. Approche cognitive et comportementale de groupe. Rev Neurol (Paris) 2005. [DOI: 10.1016/s0035-3787(05)85411-6] [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: 10/22/2022]
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35
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Cvetnic Z, Spicic S, Curic S, Jukic B, Lojkic M, Albert D, Thiébaud M, Garin-Bastuji B. Isolation of Brucella suis
biovar 3 from horses in Croatia. Vet Rec 2005; 156:584-5. [PMID: 15866906 DOI: 10.1136/vr.156.18.584] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Z Cvetnic
- Croatian Veterinary Institute, Savska cesta 143, 10000 Zagreb, Croatia
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36
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Megid J, Albert D, Fagliari JJ, Paes AC, Listoni FP, Pinto MRA, Ribeiro MG, Thiébaud M, Ueno T, Garin-Bastuji B. Isolation of Brucella abortus from cattle and water buffalo in Brazil. Vet Rec 2005; 156:147-8. [PMID: 15715008 DOI: 10.1136/vr.156.5.147] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J Megid
- Department of Public Health, School of Veterinary Medicine, UNESP, CxP, 560, CEP- 18618-000, Botucatu-SP, Brazil
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Abstract
The objective of the present study was to review the presentation, management, outcome and morbidity of paediatric patients presenting to a single centre with rhabdomyosarcoma of the ear and temporal region. All patients diagnosed with rhabdomyosarcoma of the ear and temporal region between 1980 and 2000 were entered into this retrospective study. Fourteen patients were identified. The median age at presentation was 4.5 years with a mean time of onset of symptoms to diagnosis of 21 weeks. In many patients, the presentation mimicked that of chronic otitis media, delaying diagnosis. Histological subtype was embryonal in 13 patients and alveolar in 1. All patients underwent multimodality treatment. The 5-year disease-free survival rate was 81%. Regional post-treatment morbidity included chronic aural discharge (6/14), facial palsy (8/14), growth disturbance (4/14) and maxillo-facial deformity occurring in four children. From the results, we conclude that these patients should usually present to an ENT surgeon who should keep the diagnosis in mind when dealing with children with chronic otitis media as early diagnosis with referral to a specialist multidisciplinary team will optimize the chance of survival. Discharge, hearing loss and aural polyp, although commonly because of chronic otitis media, should prompt urgent investigation and biopsy, particularly if associated with facial palsy, lymphadenopathy or an obvious mass.
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Affiliation(s)
- D V Durve
- Departments of Oncology and Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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38
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Coulier B, Albert D, Ledent C. Reversible acute abdominal episode of hereditary angioneurotic edema. JBR-BTR 2004; 87:204. [PMID: 15487262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- B Coulier
- Department of Medical Imaging, Clinique St Luc, 5004 Bouge, Belgium
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39
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Eisenberg R, Albert D, Stansberry J, Tsai D, Kolasinski S, Khan S. Arthritis Res Ther 2003; 5:29. [DOI: 10.1186/ar830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Laryngomalacia is the most common congenital anomaly of the larynx and usually involves prolapse of the arytenoids, so-called 'posterior laryngomalacia'. Most cases resolve with growth of the child and maturation of the larynx, although, rarely, significant airway obstruction can be present. Severe laryngomalacia preventing intubation is rarely encountered. We report a case of a difficult emergency intubation secondary to 'anterior laryngomalacia' in a 4-month-old boy in whom the epiglottis prolapsed posteriorly and became trapped in the laryngeal introitus. The child was referred with a diagnosis of laryngeal atresia on the basis of the intubating laryngoscopic view of no apparent epiglottis or laryngeal inlet. The child was transferred with a tube in the oesophagus that kept the child oxygenated. At the time, oxygenation was felt to be due to a coexisting tracheo-oesophageal fistula, although this was eventually found not to be the case.
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Affiliation(s)
- F M Vaz
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK.
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41
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Mössner R, Dringen R, Persico AM, Janetzky B, Okladnova O, Albert D, Götz M, Benninghoff J, Schmitt A, Gerlach M, Riederer P, Lesch KP. Increased hippocampal DNA oxidation in serotonin transporter deficient mice. J Neural Transm (Vienna) 2002; 109:557-65. [PMID: 12111449 DOI: 10.1007/s007020200046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The serotonin transporter (5HTT) is the molecule responsible for the high-affinity reuptake of 5HT from the synaptic cleft. Mice lacking the 5HTT exhibit highly elevated extracellular concentrations of 5HT. We assessed whether the glutathione detoxification system is altered in 5HTT-deficient mice. While levels of reduced and oxidized glutathione were unchanged, glutathione metabolising enzymes showed a differential pattern of modulation. Glutathione peroxidase was reduced in frontal cortex, brainstem, and cerebellum of 5HTT-deficient mice, though not to a statistically significant extent, while a putative isoform of the detoxifying enzyme glutathione-S-transferase pi was decreased in a number of brain regions, especially in brainstem. At the level of the DNA, we found an increase of oxidative DNA adducts in the hippocampus of 5HTT-deficient mice. Given the importance of the hippocampus in learning and memory, this may be the most important neurochemical consequence of the absence of the 5HTT.
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Affiliation(s)
- R Mössner
- Department of Psychiatry and Psychotherapy, University of Würzburg, Federal Republic of Germany.
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Albert D, Syed N. Protocol for the examination of specimens from patients with retinoblastoma.1∗E-mail: www.cap.org. Am J Ophthalmol 2002. [DOI: 10.1016/s0002-9394(01)01346-0] [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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Kelberman D, Tyson J, Chandler DC, McInerney AM, Slee J, Albert D, Aymat A, Botma M, Calvert M, Goldblatt J, Haan EA, Laing NG, Lim J, Malcolm S, Singer SL, Winter RM, Bitner-Glindzicz M. Hemifacial microsomia: progress in understanding the genetic basis of a complex malformation syndrome. Hum Genet 2001; 109:638-45. [PMID: 11810276 DOI: 10.1007/s00439-001-0626-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [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: 07/13/2001] [Accepted: 09/14/2001] [Indexed: 10/28/2022]
Abstract
Hemifacial microsomia (HFM) is a common birth defect involving first and second branchial arch derivatives. The phenotype is extremely variable. In addition to craniofacial anomalies there may be cardiac, vertebral and central nervous system defects. The majority of cases are sporadic, but there is substantial evidence for genetic involvement in this condition, including rare familial cases that exhibit autosomal dominant inheritance. As an approach towards identifying molecular pathways involved in ear and facial development, we have ascertained both familial and sporadic cases of HFM. A genome wide search for linkage in two families with features of HFM was performed to identify the disease loci. In one family data were highly suggestive of linkage to a region of approximately 10.7 cM on chromosome 14q32, with a maximum multipoint lod score of 3.00 between microsatellite markers D14S987 and D14S65. This locus harbours the Goosecoid gene, an excellent candidate for HFM based on mouse expression and phenotype data. Coding region mutations were sought in the familial cases and in 120 sporadic cases, and gross rearrangements of the gene were excluded by Southern blotting. Evidence for genetic heterogeneity is provided by the second family, in which linkage was excluded from this region.
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Affiliation(s)
- D Kelberman
- Clinical and Molecular Genetics Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Armstrong K, Chen TM, Albert D, Randall TC, Schwartz JS. Cost-effectiveness of raloxifene and hormone replacement therapy in postmenopausal women: impact of breast cancer risk. Obstet Gynecol 2001; 98:996-1003. [PMID: 11755544 DOI: 10.1016/s0029-7844(01)01624-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the life expectancy and cost-effectiveness of hormone replacement therapy (HRT) and raloxifene therapy in healthy 50-year-old postmenopausal women. METHODS We performed a cost-effectiveness analysis using a Markov model, discounting the value of future costs and benefits to account for their time of occurrence. RESULTS Both HRT and raloxifene therapy increase life expectancy and are cost-effective relative to no therapy for 50-year-old postmenopausal women. For women at average breast cancer and coronary heart disease risk, lifetime HRT increases quality-adjusted life expectancy more (1.75 versus 1.32 quality-adjusted life years) and costs less ($3802 versus $12,968) than lifetime raloxifene therapy. However, raloxifene is more cost-effective than HRT for women at average coronary risk who have a lifetime breast cancer risk of 15% or higher or who receive 10 years or less of postmenopausal therapy. Raloxifene is also the more cost-effective alternative if HRT reduces coronary heart disease risk by less than 20%. CONCLUSIONS Assuming the benefit of HRT in coronary heart disease prevention from observational studies, long-term HRT is the most cost-effective alternative for women at average breast cancer and coronary heart disease risk seeking to extend their quality-adjusted life expectancy after menopause. However, raloxifene is the more cost-effective alternative for women at average coronary risk with one or more major breast cancer risk factors (first-degree relative, prior breast biopsy, atypical hyperplasia or BRCA1/2 mutation). These results can help inform decisions about postmenopausal therapy until the results of large scale randomized trials of these therapies become available.
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Affiliation(s)
- K Armstrong
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA.
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45
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Affiliation(s)
- D Albert
- Department of Ophthalmology, University of Wisconsin Hospital, Madison, USA
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46
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Affiliation(s)
- D Albert
- Department of Ophthalmology, University of Wisconsin Hospital, Madison, WI, USA
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47
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Abstract
Serotonin (5-HT) is an important mediator of interactions between the nervous and immune systems. 5-HT signaling is regulated by the 5-HT transporter (5-HTT), which determines the magnitude and duration of serotonergic responses. Due to this important role, regulation of the 5-HTT by cytokines has been the focus of recent interest. A number of proinflammatory cytokines, including interleukin-1beta, tumor necrosis factor-alpha, and interferon-gamma, have been shown to upregulate the 5-HTT. In the present study we investigated the influence of interleukin-4 (IL-4), which acts as an anti-inflammatory cytokine in the central nervous system, on the 5-HTT. As a model system we used immortalized B lymphocytes, which not only express the 5-HTT, but also allow testing the co-modulatory influence of a recently described polymorphism in the 5-HTT gene promoter (5-HTTLPR) that is associated with anxiety- and depression-related behavioral traits. The results show that IL-4 induces a dose-dependent reduction of 5-HT uptake. This effect is preferentially seen in cell lines homozygous for the long, high-activity allele of the 5-HTTLPR. In conclusion, a picture of differential modulation of the 5-HTT by proinflammatory and anti-inflammatory cytokines is emerging, which may represent a fine-tuned mechanism to communicate the state of an immune response to the central nervous system.
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Affiliation(s)
- R Mössner
- Department of Psychiatry, University of Würzburg, Germany
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48
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Mössner R, Albert D, Persico AM, Hennig T, Bengel D, Holtmann B, Schmitt A, Keller F, Simantov R, Murphy D, Seif I, Deckert J, Lesch KP. Differential regulation of adenosine A(1) and A(2A) receptors in serotonin transporter and monoamine oxidase A-deficient mice. Eur Neuropsychopharmacol 2000; 10:489-93. [PMID: 11115739 DOI: 10.1016/s0924-977x(00)00119-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The serotonin (5HT) transporter (5HTT) removes 5HT from the synaptic cleft and is thus critical to the control of serotonergic neurotransmission. Mice with a targeted inactivation of the 5HTT represent a novel and unique tool to study serotonergic system functioning. Because the release of 5HT is regulated by adenosine, we investigated 5HTT-deficient mice for possible adaptive changes of adenosine A(1) and A(2A) receptors. A(1) and A(2A) receptors were studied by means of quantitative autoradiography using the radioligands [3H]8-cyclopentyl-1,3-dipropylxanthine and [3H]CGS 21680, respectively. A comparison of 5HTT knockout versus control mice revealed upregulation of A(1) receptors in the dorsal raphe nucleus (DRN, +21%), but not in any of the serotonergic projection areas, and downregulation of A(2A) receptors in basal ganglia. The adaptive changes of A(1) and A(2A) receptors in 5HTT-deficient mice are likely to represent a compensatory neuroprotective effect mediated by the adenosinergic modulatory system. For comparison, these receptors were also studied in monoamine oxidase A (MAOA) knockout mice and in 5HTT/MAOA double knockout mice. 5HTT/MAOA double knockout mice showed adaptive changes of adenosine A(1) and A(2A) receptors similar to 5HTT knockout mice, while investigation of MAOA-deficient mice revealed an upregulation of A(2A) receptors, which may relate to a role of both MAOA and adenosine A(2A) receptors in anxiety.
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Affiliation(s)
- R Mössner
- Department of Psychiatry and Psychotherapy, University of Würzburg, Füchsleinstrasse 15, 97080, Würzburg, Germany
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Chung JB, Armstrong K, Schwartz JS, Albert D. Cost-effectiveness of prophylaxis against Pneumocystis carinii pneumonia in patients with Wegner's granulomatosis undergoing immunosuppressive therapy. Arthritis Rheum 2000; 43:1841-8. [PMID: 10943875 DOI: 10.1002/1529-0131(200008)43:8<1841::aid-anr21>3.0.co;2-q] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the incremental cost-effectiveness of 3 Pneumocystis carinii pneumonia (PCP) prophylaxis strategies in patients with Wegener's granulomatosis (WG) receiving immunosuppressive therapies: 1) no prophylaxis; 2) trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg 3 times a week, which is discontinued if patients experience an adverse drug reaction (ADR); and 3) TMP/SMX 160 mg/800 mg 3 times a week, which is replaced by monthly aerosolized pentamidine (300 mg) if patients experience an ADR. METHODS A Markov state-transition model was developed to follow a hypothetical cohort of WG patients over their lifetimes starting from the time of initial exposure to the immunosuppressive therapy. The effect of PCP prophylaxis on life expectancy, quality-adjusted life expectancy, average discounted lifetime cost (ADLC), and incremental cost-effectiveness was estimated based on data obtained from a literature review. Direct medical costs were examined from a societal perspective, and costs and benefits were discounted at 3% annually. RESULTS No prophylaxis resulted in a life expectancy of 13.36 quality-adjusted life years (QALY) at an ADLC of $4,538. In comparison, prophylaxis with TMP/ SMX alone increased the QALY to 13.54 and was cost saving, with an ADLC of $3,304. The addition of pentamidine in patients who had an ADR to TMP/SMX resulted in 13.61 QALY, with an ADLC of $7,428. Compared with TMP/SMX alone, TMP/SMX followed by pentamidine increased the QALY by 0.07 at an incremental cost of $58,037 per QALY. Both TMP/SMX alone and TMP/SMX followed by pentamidine prophylaxis strategies dominated the no prophylaxis strategy until the incidence of PCP fell below 0.2% and 2.25%, respectively. Institution of pentamidine therapy for patients with a TMP/SMX ADR increased quality-adjusted life expectancy compared with that with TMP/ SMX alone until the incidence of PCP rose above 7.5%. CONCLUSION Prophylaxis using TMP/SMX alone increased life expectancy and reduced cost for patients with WG receiving immunosuppressive therapy. Replacing TMP/SMX with monthly aerosolized pentamidine in cases of ADR further increased life expectancy, although at an increased cost.
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Affiliation(s)
- J B Chung
- University of Pennsylvania, Philadelphia, USA
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Albert D. Risk in cardiovascular disease. Absolute cardiovascular risk is not most appropriate measure to use. BMJ 2000; 321:175. [PMID: 10950541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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