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Goretzki SC, van der Linden M, Itzek A, Hühne T, Adelmann RO, Ala Eldin F, Albarouni M, Becker JC, Berghäuser MA, Boesing T, Boeswald M, Brasche M, Brevis Nuñez F, Camara R, Deibert C, Dohle F, Dolgner J, Dziobaka J, Eifinger F, Elting N, Endmann M, Engelmann G, Frenzke H, Gappa M, Gharavi B, Goletz C, Hahn E, Heidenreich Y, Heimann K, Hensel KO, Hoffmann HG, Hoppenz M, Horneff G, Klassen H, Koerner-Rettberg C, Längler A, Lenz P, Lohmeier K, Müller A, Niemann F, Paulussen M, Pentek F, Perez R, Pingel M, Repges P, Rothoeft T, Rübo J, Schade H, Schmitz R, Schonhoff P, Schwade JN, Schwarz T, Seiffert P, Selzer G, Spille U, Thiel C, Thimm A, Urgatz B, van den Heuvel A, van Hop T, Giesen V, Wirth S, Wollbrink T, Wüller D, Felderhoff-Müser U, Dohna-Schwake C, Lâm TT, Claus H, Bruns N. Outbreak of severe community-acquired bacterial infections among children in North Rhine-Westphalia (Germany), October to December 2022. Infection 2024:10.1007/s15010-023-02165-x. [PMID: 38366304 DOI: 10.1007/s15010-023-02165-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/21/2023] [Indexed: 02/18/2024]
Abstract
PURPOSE In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. METHODS Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016-2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. RESULTS In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). DISCUSSION The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae. Improved precautionary measures are needed to attenuate future outbreaks.
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Affiliation(s)
- Sarah C Goretzki
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark van der Linden
- German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Itzek
- German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom Hühne
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Roland O Adelmann
- Department of General Pediatrics, Klinikum Oberberg, Kreiskrankenhaus Gummersbach, Gummersbach, Germany
| | - Firas Ala Eldin
- Department of General Pediatrics, Helios Hospital Schwelm, Schwelm, Germany
| | - Mohamed Albarouni
- Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Martin A Berghäuser
- Division of Pediatric Intensive Care, Department of Pediatrics, Florence Nightingale Hospital Kaiserswerth, Düsseldorf, Germany
| | - Thomas Boesing
- Division of Pediatric Intensive Care, Department of Pediatrics, Protestant Hospital Bethel, University of Bielefeld, Bielefeld, Germany
| | - Michael Boeswald
- Department of Pediatrics, Sankt Franziskus Hospital Münster, Münster, Germany
| | - Milian Brasche
- Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
| | - Francisco Brevis Nuñez
- Division of Pediatric Intensive Care, Department of Pediatrics, Sana Hospitals Duisburg, Duisburg, Germany
| | - Rokya Camara
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, GFO Hospital Bonn, Bonn, Germany
| | - Clara Deibert
- Department of General Pediatrics, DRK Hospital Kirchen, Kirchen, Germany
| | - Frank Dohle
- Department of Pediatrics, Pediatric Intensive Care Medicine, St. Vinzenz Hospital Paderborn, Paderborn, Germany
| | - Jörg Dolgner
- Department of General Pediatrics, GFO Hospital Dinslaken, Dinslaken, Germany
| | - Jan Dziobaka
- Department of Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Eifinger
- Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital, University of Cologne, Cologne, Germany
| | - Natalie Elting
- Department of General Pediatrics, Evangelical Hospital Oberhausen, Oberhausen, Germany
| | - Matthias Endmann
- Department of General Pediatrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
| | - Guido Engelmann
- Department of General Pediatrics, Lukas-Hospital Neuss, Neuss, Germany
| | - Holger Frenzke
- Department of General Pediatrics, Märkisch Hospital Lüdenscheid, Lüdenscheid, Germany
| | - Monika Gappa
- Department of General Pediatrics, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Bahman Gharavi
- Department of General Pediatrics, Marien-Hospital Witten, Witten, Germany
| | - Christine Goletz
- Department of General Pediatrics, Städtische Kliniken Mönchengladbach, Elisabeth-Hospital Rheydt, Mönchengladbach, Germany
| | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Sankt Agnes Hospital, Bocholt, Germany
| | | | - Konrad Heimann
- Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
| | - Kai O Hensel
- Division of Pediatric Intensive Care, Department of Pediatrics, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | | | - Marc Hoppenz
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital, Amsterdamer Str., Cologne, Germany
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
| | - Helene Klassen
- Department of Pediatrics and Adolescent Medicine, Hochsauerland Hospital, Arnsberg, Germany
| | | | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Pascal Lenz
- Department of General Pediatrics, Hospital Leverkusen GmbH, Leverkusen, Germany
| | - Klaus Lohmeier
- Division of Neonatology and Pediatric Cardiology, Department of General Pediatrics, Heinrich Heine University, Düsseldorf, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Frank Niemann
- Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Michael Paulussen
- Division of Oncology and Haematology, Department of General Pediatrics, Hospital of Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
| | - Falk Pentek
- Department of Pediatrics, Elisabeth-Hospital Essen, Essen, Germany
| | - Ruy Perez
- Division of Pediatric Intensive Care, Department of Pediatrics, Helios Hospital Krefeld, Krefeld, Germany
| | - Markus Pingel
- Department of General Pediatrics, DRK Hospital Siegen gGmbH, Siegen, Germany
| | - Philip Repges
- Department of General Pediatrics, Porz, Cologne, Germany
| | - Tobias Rothoeft
- Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Jochen Rübo
- Department of General Pediatrics, St. Antonius Hospital Kleve, Kleve, Germany
| | - Herbert Schade
- Department of General Pediatrics, Hospital Mechernich GmbH, Mechernich, Germany
| | - Robert Schmitz
- Department of Pediatrics, Helios Clinic Duisburg, Duisburg, Germany
| | - Peter Schonhoff
- Department of Pediatrics, Clemenshospital Münster, Münster, Germany
| | - Jan N Schwade
- Department of General Pediatrics, Evangelical Hospital Lippstadt, Lippstadt, Germany
| | - Tobias Schwarz
- Department of General Pediatrics, Municipal Hospital Solingen, Solingen, Germany
| | - Peter Seiffert
- Department of Pediatrics, Helios Clinic Duisburg, Duisburg, Germany
| | - Georg Selzer
- Division of Neonatology and Pediatric Intensive Care, Evangelical Hospital Hamm, Hamm, Germany
| | - Uwe Spille
- Department of General Pediatrics, Herford, Germany
| | - Carsten Thiel
- Department of Pediatrics, St.-Clemens-Hospital Geldern, Geldern, Germany
| | - Ansgar Thimm
- Department of General Pediatrics, Sana-Hospital Remscheid, Remscheid, Germany
| | | | - Alijda van den Heuvel
- Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital Münster, Münster, Germany
| | - Tan van Hop
- Department of General Pediatrics, Hospital Oberhausen Sterkrade gGmbH, Oberhausen, Germany
| | - Verena Giesen
- Department of General Pediatrics, Bethanien Hospital Moers, Moers, Germany
| | - Stefan Wirth
- Department of Pediatrics, Helios Medical Center Niederberg, Velbert, Germany
| | - Thomas Wollbrink
- Division of Pediatric Intensive Care, Department of Pediatrics, Bergmannsheil Pediatric Hospital Gelsenkirchen Buer, Gelsenkirchen, Germany
| | - Daniel Wüller
- Department of Pediatrics and Adolescent Medicine, Christophorus Hospital, Coesfeld, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thiên-Trí Lâm
- German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Heike Claus
- German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Nora Bruns
- Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Engelmann G, van den Bruck R. 12/w mit starken Oberbauchschmerzen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01558-w] [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: 11/30/2022]
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Teufel-Schäfer U, Flechtenmacher C, Fichtner A, Hoffmann GF, Schenk JP, Engelmann G. Transient elastography correlated to four different histological fibrosis scores in children with liver disease. Eur J Pediatr 2021; 180:2237-2244. [PMID: 33704581 PMCID: PMC8195947 DOI: 10.1007/s00431-021-04001-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 12/17/2022]
Abstract
Currently, liver histology is the gold standard for the detection of liver fibrosis. In recent years, new methods such as transient elastography (TE) have been introduced into clinical practice, which allow a non-invasive assessment of liver fibrosis. The aim of the present study was to investigate the predictive value of TE for higher grade fibrosis and whether there is any relevance which histologic score is used for matching. For this purpose, we compared TE with 4 different histologic scores in pediatric patients with hepatopathies. Furthermore, we also determined the aspartate aminotransferase-to-platelet ratio (APRI) score, another non-invasive method, to investigate whether it is equally informative. Therefore, liver fibrosis in 75 children was evaluated by liver biopsy, TE and laboratory values. Liver biopsies were evaluated using four common histological scoring systems (Desmet, Metavir, Ishak and Chevalier's semi-quantitative scoring system). The median age of the patients was 12.3 years. TE showed a good correlation to the degree of fibrosis severity independent of the histological scoring system used. The accuracy of the TE to distinguish between no/minimal fibrosis and severe fibrosis/cirrhosis was good (p = 0.001, AUC-ROCs > 0.81). The optimal cut-off value for the prediction of severe fibrosis was 10.6 kPa. In contrast, the APRI score in our collective showed no correlation to fibrosis.Conclusion: TE shows a good correlation to the histological findings in children with hepatopathy, independent of the used histological scoring system. What is Known: • The current gold standard for detecting liver fibrosis is liver biopsy. Novel non-invasive ultrasound-based methods are introduced to clinical diagnostics. • Most histological scores have been developed and evaluated in adult populations and for only one specific liver disease. What is New: • Transient elastography (TE) in children showed a good correlation to fibrosis severity irrespective of the utilized histological scoring system. • The aspartate aminotransferase-to-platelet ratio (APRI) showed no correlation with different stages of liver fibrosis in children.
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Affiliation(s)
- Ulrike Teufel-Schäfer
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Center, University of Freiburg, Mathildenstr. 1, 79106 Freiburg, Germany
- Division of Pediatric Gastroenterology and Hepatology, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Christa Flechtenmacher
- Department of Pathology, University Medical Centre, University of Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Alexander Fichtner
- Division of Pediatric Gastroenterology and Hepatology, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Georg Friedrich Hoffmann
- Division of Pediatric Gastroenterology and Hepatology, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Jens Peter Schenk
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Medical Centre, University of Heidelberg, Heidelberg, Germany
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4
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Li DK, Khan MR, Wang Z, Chongsrisawat V, Swangsak P, Teufel-Schäfer U, Engelmann G, Goldschmidt I, Baumann U, Tokuhara D, Cho Y, Rowland M, Mjelle AB, Ramm GA, Lewindon PJ, Witters P, Cassiman D, Ciuca IM, Prokop LD, Haffar S, Corey KE, Murad MH, Furuya KN, Bazerbachi F. Normal liver stiffness and influencing factors in healthy children: An individual participant data meta-analysis. Liver Int 2020; 40:2602-2611. [PMID: 32901449 DOI: 10.1111/liv.14658] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Although transient elastography (TE) is used to determine liver stiffness as a surrogate to hepatic fibrosis, the normal range in children is not well defined. We performed a systematic review and individual participant data (IPD) meta-analysis to determine the range of liver stiffness in healthy children and evaluate the influence of important biological parameters. METHODS We pooled data from 10 studies that examined healthy children using TE. We divided 1702 children into two groups: ≥3 years (older group) and < 3 years of age (younger group). Univariate and multivariate linear regression models predicting liver stiffness were conducted. RESULTS After excluding children with obesity, diabetes, or abnormal liver tests, 652 children were analysed. Among older children, mean liver stiffness was 4.45 kPa (95% confidence interval 4.34-4.56), and increased liver stiffness was associated with age, sedation status, and S probe use. In the younger group, the mean liver stiffness was 4.79 kPa (95% confidence interval 4.46-5.12), and increased liver stiffness was associated with sedation status and Caucasian race. In a subgroup analysis, hepatic steatosis on ultrasound was significantly associated with increased liver stiffness. We define a reference range for normal liver stiffness in healthy children as 2.45-5.56 kPa. CONCLUSIONS We have established TE-derived liver stiffness ranges for healthy children and propose an upper limit of liver stiffness in healthy children to be 5.56 kPa. We have identified increasing age, use of sedation, probe size, and presence of steatosis on ultrasound as factors that can significantly increase liver stiffness.
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Affiliation(s)
- Darrick K Li
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Muhammad Rehan Khan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, IL, USA
| | - Zhen Wang
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Voranush Chongsrisawat
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Panida Swangsak
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ulrike Teufel-Schäfer
- Department of Pediatrics and Adolescent Medicine, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Imeke Goldschmidt
- Division of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Ulrich Baumann
- Division of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany.,Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Daisuke Tokuhara
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuki Cho
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Marion Rowland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Anders B Mjelle
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Grant A Ramm
- Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Peter J Lewindon
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Peter Witters
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - David Cassiman
- Department of Gastroenterology-Hepatology and Metabolic Center, University of Leuven, Leuven, Belgium
| | - Ioana M Ciuca
- Pediatrics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Larry D Prokop
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Samir Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - Kathleen E Corey
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M H Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Katryn N Furuya
- Department of Pediatrics, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Hütter C, Lanner M, Aigmüller T, Simon K, Hofmann P, Kratky M, Engelmann G, Mutz-Eckhart C, Blatt-Gunegger M, Klammer S, Berger G, Bermann C, Resetarits K, Huber A, Lang P, Lessiak V, Tamussino K. Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Hütter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | - M Lanner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | | | - K Simon
- LKH Hochsteiermark, Standort Leoben
| | - P Hofmann
- LKH Weststeiermark, Standort Deutschlandsberg
| | - M Kratky
- LKH Weststeiermark, Standort Deutschlandsberg
| | - G Engelmann
- LKH Murtal, Standort Judenburg
- LKH Rottenmann
| | | | | | | | | | | | | | | | - P Lang
- Krankenhaus der Barmherzigen Brüder Graz
| | - V Lessiak
- Krankenhaus der Barmherzigen Brüder Graz
| | - K Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
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Hütter C, Lanner M, Aigmüller T, Simon K, Hofmann P, Kratky M, Engelmann G, Mutz-Eckhart C, Blatt-Gunegger M, Klammer S, Berger G, Bermann C, Resetarits K, Huber A, Lang P, Lessiak V, Tamussino K. Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Hütter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | - M Lanner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | | | - K Simon
- LKH Hochsteiermark, Standort Leoben
| | - P Hofmann
- LKH Weststeiermark, Standort Deutschlandsberg
| | - M Kratky
- LKH Weststeiermark, Standort Deutschlandsberg
| | | | | | | | | | | | | | | | | | - P Lang
- Krankenhaus der Barmherzigen Brüder Graz
| | - V Lessiak
- Krankenhaus der Barmherzigen Brüder Graz
| | - K Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
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7
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Schatz SB, Jüngst C, Keitel‐Anselmo V, Kubitz R, Becker C, Gerner P, Pfister E, Goldschmidt I, Junge N, Wenning D, Gehring S, Arens S, Bretschneider D, Grothues D, Engelmann G, Lammert F, Baumann U. Phenotypic spectrum and diagnostic pitfalls of ABCB4 deficiency depending on age of onset. Hepatol Commun 2018; 2:504-514. [PMID: 29761167 PMCID: PMC5944585 DOI: 10.1002/hep4.1149] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 12/27/2022] Open
Abstract
Genetic variants in the adenosine triphosphate-binding cassette subfamily B member 4 (ABCB4) gene, which encodes hepatocanalicular phosphatidylcholine floppase, can lead to different phenotypes, such as progressive familial intrahepatic cholestasis (PFIC) type 3, low phospholipid-associated cholelithiasis, and intrahepatic cholestasis of pregnancy. The aim of this multicenter project was to collect information on onset and progression of this entity in different age groups and to assess the relevance of this disease for the differential diagnosis of chronic liver disease. Clinical and laboratory data of 38 patients (17 males, 21 females, from 29 families) with homozygous or (compound) heterozygous ABCB4 mutations were retrospectively collected. For further analysis, patients were grouped according to the age at clinical diagnosis of ABCB4-associated liver disease into younger age (<18 years) or adult age (≥18 years). All 26 patients diagnosed in childhood presented with pruritus (median age 1 year). Hepatomegaly and splenomegaly were present in 85% and 96% of these patients, respectively, followed by jaundice (62%) and portal hypertension (69%). Initial symptoms preceded diagnosis by 1 year, and 13 patients received a liver transplant (median age 6.9 years). Of note, 9 patients were misdiagnosed as biliary atresia, Alagille syndrome, or PFIC type 1. In the 12 patients with diagnosis in adulthood, the clinical phenotype was generally less severe, including intrahepatic cholestasis of pregnancy, low phospholipid-associated cholelithiasis, or (non)cirrhotic PFIC3. Conclusion: ABCB4 deficiency with onset in younger patients caused a more severe PFIC type 3 phenotype with the need for liver transplantation in half the children. Patients with milder phenotypes are often not diagnosed before adulthood. One third of the children with PFIC type 3 were initially misdiagnosed, indicating the need for better diagnostic tools and medical education. (Hepatology Communications 2018;2:504-514).
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Affiliation(s)
- Stephanie Barbara Schatz
- Hannover Medical School, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannoverGermany
| | - Christoph Jüngst
- Department of Medicine IISaarland University Medical CenterHomburgGermany
| | - Verena Keitel‐Anselmo
- University Hospital, Heinrich Heine University Düsseldorf, Department of Gastroenterology, Hepatology and Infectious DiseasesDüsseldorfGermany
| | - Ralf Kubitz
- University Hospital, Heinrich Heine University Düsseldorf, Department of Gastroenterology, Hepatology and Infectious DiseasesDüsseldorfGermany
| | - Christina Becker
- Department of Medicine IISaarland University Medical CenterHomburgGermany
| | - Patrick Gerner
- Division of Pediatric Gastroenterology, Clinic for Pediatrics IIUniversity Hospital, University EssenEssenGermany
| | - Eva‐Doreen Pfister
- Hannover Medical School, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannoverGermany
| | - Imeke Goldschmidt
- Hannover Medical School, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannoverGermany
| | - Norman Junge
- Hannover Medical School, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannoverGermany
| | - Daniel Wenning
- Department of General PediatricsUniversity HospitalHeidelbergGermany
| | - Stephan Gehring
- Department of PediatricsUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Stefan Arens
- Klinikum KasselPediatric GastroenterologyKasselGermany
| | | | - Dirk Grothues
- KUNO University Children's HospitalRegensburgGermany
| | | | - Frank Lammert
- Department of Medicine IISaarland University Medical CenterHomburgGermany
| | - Ulrich Baumann
- Hannover Medical School, Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic DiseasesHannoverGermany
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUnited Kingdom
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8
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Pitzer M, Engelmann G, Stammschulte T. [Tardive movement disorders with antipsychotics – a case of aripirazole-induced tardive dystonia and review of the literature]. Z Kinder Jugendpsychiatr Psychother 2017; 45:325-334. [PMID: 28682214 DOI: 10.1024/1422-4917/a000460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Extrapyramidal adverse events (EPS) occur less frequently with second-generation antipsychotics (SGAs) than with first-generation antipsychotics (FGAs). Tardive dyskinesia (TD), but not tardive dystonia (TDt), also seems to occur less often in adults. TD was found to occur less frequently in children and adolescents treated with FGAs than in adults. No data are available on TDt, and the data pertaining to SGAs are limited and conflicting. SGAs differ in their profile of adverse events. Aripiprazole is less frequently associated with adverse metabolic or cardiac events, but more often with EPS, at least in children and adolescents. To date, there are several case reports of TD or TDt with aripiprazole in adults. Symptomatology, differential diagnosis, pathophysiology, prevalence, and therapy of TDt are presented here based on a case report of TDt during aripiprazole therapy in a 13-year-old girl. During medication with SGAs, the occurrence of EPS, including tardive movement disorders, should be considered and regularly monitored.
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Affiliation(s)
- Martina Pitzer
- 1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Städtisches Klinikum Karlsruhe.,2 Arzneimittelkommission der Deutschen Ärzteschaft (AkdÄ), Berlin
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9
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Engelmann G, Quader J, Teufel U, Schenk JP. Limitations and opportunities of non-invasive liver stiffness measurement in children. World J Hepatol 2017; 9:409-417. [PMID: 28357028 PMCID: PMC5355763 DOI: 10.4254/wjh.v9.i8.409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Changes in liver structure are an important issue in chronic hepatopathies. Until the end of the 20th century, these changes could only be determined by histological analyses of a liver specimen obtained via biopsy. The well-known limitations of this technique (i.e., pain, bleeding and the need for sedation) have precluded its routine use in follow-up of patients with liver diseases. However, the introduction of non-invasive technologies, such as ultrasound and magnetic resonance imaging, for measurement of liver stiffness as an indirect marker of fibroses has changed this situation. Today, several non-invasive tools are available to physicians to estimate the degree of liver fibrosis by analysing liver stiffness. This review describes the currently available tools for liver stiffness determination that are applicable to follow-up of liver fibrosis/cirrhosis with established clinical use in children, and discusses their features in comparison to the “historical” tools.
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10
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Kubitz R, Dröge C, Kluge S, Stindt J, Stross C, Häussinger D, Flechtenmacher C, Wenning D, Teufel U, Schmitt CP, Engelmann G. High affinity anti-BSEP antibodies after liver transplantation for PFIC-2 - Successful treatment with immunoadsorption and B-cell depletion. Pediatr Transplant 2016; 20:987-993. [PMID: 27368585 DOI: 10.1111/petr.12751] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 01/22/2023]
Abstract
PFIC due to BSEP mutations (PFIC type 2) often necessitates OLT. It has recently been recognized that some PFIC-2 patients develop phenotypic disease recurrence post-OLT due to the appearance of anti-BSEP antibodies. Here, we describe a boy who became cholestatic four yr after OLT during modification of immunosuppression. Canalicular antibody deposits were detected in biopsies of the transplant and antibodies specifically reacting with BSEP were identified at high titers in his serum. These antibodies bound extracellular epitopes of BSEP and inhibited BS transport and were assumed to cause disease recurrence. Consequently, anti-BSEP antibody depletion was pursued by IA and B-cell depletion by anti-CD20 antibodies (rituximab) along with a switch of immunosuppression. This treatment resulted in prolonged relief of symptoms. Depletion of pathogenic anti-BSEP antibodies causing AIBD after OLT in PFIC-2 patients should be considered as a central therapeutic goal.
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Affiliation(s)
- Ralf Kubitz
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Carola Dröge
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefanie Kluge
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Stindt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Claudia Stross
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Daniel Wenning
- Department of General Paediatrics, Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Teufel
- Department of General Paediatrics, Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Department of General Paediatrics, Centre for Paediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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11
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Stindt J, Kluge S, Dröge C, Keitel V, Stross C, Baumann U, Brinkert F, Dhawan A, Engelmann G, Ganschow R, Gerner P, Grabhorn E, Knisely AS, Noli KA, Pukite I, Shepherd RW, Ueno T, Schmitt L, Wiek C, Hanenberg H, Häussinger D, Kubitz R. Bile salt export pump-reactive antibodies form a polyclonal, multi-inhibitory response in antibody-induced bile salt export pump deficiency. Hepatology 2016; 63:524-37. [PMID: 26516723 DOI: 10.1002/hep.28311] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED Progressive familial intrahepatic cholestasis type 2 (PFIC-2) is caused by mutations in ABCB11, encoding the bile salt export pump (BSEP). In 2009, we described a child with PFIC-2 who developed PFIC-like symptoms after orthotopic liver transplantation (OLT). BSEP-reactive antibodies were demonstrated to account for disease recurrence. Here, we characterize the nature of this antibody response in 7 more patients with antibody-induced BSEP deficiency (AIBD). Gene sequencing and immunostaining of native liver biopsies indicated absent or strongly reduced BSEP expression in all 7 PFIC-2 patients who suffered from phenotypic disease recurrence post-OLT. Immunofluorescence, western blotting analysis, and transepithelial transport assays demonstrated immunoglobulin (Ig) G-class BSEP-reactive antibodies in these patients. In all cases, the N-terminal half of BSEP was recognized, with reaction against its first extracellular loop (ECL1) in six sera. In five, antibodies reactive against the C-terminal half also were found. Only the sera recognizing ECL1 showed inhibition of transepithelial taurocholate transport. In a vesicle-based functional assay, transport inhibition by anti-BSEP antibodies binding from the cytosolic side was functionally proven as well. Within 2 hours of perfusion with antibodies purified from 1 patient, rat liver showed canalicular IgG staining that was absent after perfusion with control IgG. CONCLUSIONS PFIC-2 patients carrying severe BSEP mutations are at risk of developing BSEP antibodies post-OLT. The antibody response is polyclonal, targeting both extra- and intracellular BSEP domains. ECL1, a unique domain of BSEP, likely is a critical target involved in transport inhibition as demonstrated in several patients with AIBD manifest as cholestasis.
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Affiliation(s)
- Jan Stindt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie Kluge
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Carola Dröge
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Claudia Stross
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ulrich Baumann
- Pediatric Gastroenterology and Hepatology, Department for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Florian Brinkert
- Pediatric Hepatology and Liver Transplantation, Transplantation Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anil Dhawan
- Pediatric Liver Center, King's College Hospital, London, United Kingdom
| | - Guido Engelmann
- Department of General Pediatrics, Heidelberg University Hospital, Heidelberg, Germany.,Pediatric Clinic, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Rainer Ganschow
- Pediatric Hepatology and Liver Transplantation, Transplantation Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinic of General Pediatrics, University Hospital, Bonn, Germany
| | - Patrick Gerner
- Department for Pediatric Nephrology, Gastroenterology, Endocrinology and Transplant Medicine, Clinic for Pediatrics II, University Children's Hospital Essen, University Duisburg-Essen, Essen, Germany.,Children's Hospital, Albert Ludwigs University, Freiburg, Germany
| | - Enke Grabhorn
- Pediatric Hepatology and Liver Transplantation, Transplantation Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A S Knisely
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Khalid A Noli
- Clinical Laboratory Services Division, Dhahran Health Center, Dhahran, Saudi Arabia
| | - Ieva Pukite
- Latvian Center of Pediatric Gastroenterology/Hepatology, University Children's Hospital, Riga, Latvia
| | - Ross W Shepherd
- Texas Children's Hospital Liver Center, Baylor College of Medicine, Gastroenterology, Houston, TX
| | - Takehisa Ueno
- Pediatric Surgery/Pediatric Liver and GI Transplant, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Lutz Schmitt
- Institute of Biochemistry, Heinrich Heine University, Düsseldorf, Germany
| | - Constanze Wiek
- Department of Otorhinolaryngology (ENT), Heinrich Heine University School of Medicine, Düsseldorf, Germany
| | - Helmut Hanenberg
- Department of Otorhinolaryngology (ENT), Heinrich Heine University School of Medicine, Düsseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ralf Kubitz
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Medical Clinic I, Bethanien Hospital, Moers, Germany
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12
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Teufel U, Peccerella T, Engelmann G, Bruckner T, Flechtenmacher C, Millonig G, Stickel F, Hoffmann GF, Schirmacher P, Mueller S, Bartsch H, Seitz HK. Detection of carcinogenic etheno-DNA adducts in children and adolescents with non-alcoholic steatohepatitis (NASH). Hepatobiliary Surg Nutr 2016; 4:426-35. [PMID: 26734629 DOI: 10.3978/j.issn.2304-3881.2015.12.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Carcinogenic exocyclic-DNA adducts like 1,N(6)-etheno-2'-deoxyadenosine (εdA) are formed through reactive intermediates of 4-hydroxynonenal (4-HNE) or other lipid peroxidation (LPO) products with the DNA bases A, C, methyl-C and G. High levels of hepatic etheno-DNA adducts have been detected in cancer prone liver diseases including alcoholic liver disease (ALD). In ALD εdA levels correlated significantly with cytochrome P-450 2E1 (CYP2E1) expression which is also induced in non-alcoholic steatohepatitis (NASH). We investigated the occurrence of εdA adducts in children with NASH as a DNA damage marker. METHODS Liver biopsies from 21 children/adolescents with histologically proven NASH were analysed for hepatic fat content, inflammation, and fibrosis. εdA levels in DNA, CYP2E1-expression and protein bound 4-hydroxynonenal (HNE) were semi-quantitatively evaluated by immunohistochemistry. RESULTS Among 21 NASH children, εdA levels in the liver were high in 3, moderate in 5, weak in 9 and not elevated in 4 patients. There was a positive correlation between CYP2E1 and protein-bound 4-HNE (r=0.60; P=0.008) and a trend for a positive relationship for CYP2E1 vs. staining intensity of εdA (r=0.45; P=0.06). Inflammatory activity and fibrosis correlated significantly (r=0.49, P=0.023). CONCLUSIONS Our results demonstrate for the first time the presence of elevated carcinogenic etheno-DNA lesions (εdA) in the majority (17/21) of liver biopsies from young NASH patients. Our data suggest that LPO-derived etheno-adducts are implicated in NASH. Whether these adducts may serve as predictive risk markers in NASH children to develop hepatocellular cancer later in life remains to be investigated.
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Affiliation(s)
- Ulrike Teufel
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Teresa Peccerella
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Guido Engelmann
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Thomas Bruckner
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Christa Flechtenmacher
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Gunda Millonig
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Felix Stickel
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Georg F Hoffmann
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Peter Schirmacher
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Sebastian Mueller
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Helmut Bartsch
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Helmut K Seitz
- 1 Department of Paediatrics, University of Heidelberg, Heidelberg, Germany ; 2 Alcohol Research Centre, University of Heidelberg and Department of Medicine (Gastroenterology & Hepatology), Salem Medical Centre, Heidelberg, Germany ; 3 Institute of Medical Biometry and Informatics, 4 Department of Pathology, University of Heidelberg, Heidelberg, Germany ; 5 Hepatology Unit, Clinic Beau-Site Hirslanden, Bern, Switzerland ; 6 Erstwhile: Division of Toxicology and Cancer Risk Factors, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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13
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Engelmann G, Quader J, Esser A, Lawrenz K. Giant Pseudopolyp as a Cause of Life-Threatening Anemia and Colocolic Intussusception in an Infant: A Case Report and Review of the Literature. J Pediatr Rev 2015. [DOI: 10.17795/jpr-2002] [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: 11/25/2022] Open
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14
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Engelmann G, Wenning D, Herebian D, Sander O, Dröge C, Kluge S, Kubitz R. Two Case Reports of Successful Treatment of Cholestasis With Steroids in Patients With PFIC-2. Pediatrics 2015; 135:e1326-32. [PMID: 25847799 DOI: 10.1542/peds.2014-2376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 02/06/2023] Open
Abstract
Mutations in the gene encoding the canalicular bile salt export pump (BSEP) can result in progressive familial intrahepatic cholestasis type 2 (PFIC-2). Treatment options are limited, and PFIC-2 often necessitates liver transplantation. We report on a young woman and a boy who clinically presented with PFIC-2 phenotypes and dramatically improved with steroid treatment. Gene sequencing of ABCB11 encoding for BSEP revealed 2 relevant mutations in both patients. The young woman was compound heterozygous for p.T919del and p.R1235X. At the age of 5 years, partial biliary diversion was performed and rescued liver function but left serum bile salt levels elevated. At age 23 she developed systemic lupus erythematosus. Unexpectedly, steroid therapy normalized serum bile salt levels, with a strong correlation with the steroid dose. She is currently in clinical remission. The boy was compound heterozygous for the ABCB11 mutations c.150+3A>C and p.R832C and presented with intractable pruritus. When he developed colitis, he was treated with steroids. The pruritus completely disappeared and relapsed when steroids were withdrawn. To date, with low-dose budesonide, the boy has been symptom-free for >3 years. In conclusion, the clinical courses suggest that patients with BSEP deficiency and residual BSEP activity may benefit from steroid-based therapy, which represents a new treatment option.
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Affiliation(s)
| | - Daniel Wenning
- Department of General Pediatrics, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Diran Herebian
- Departments of General Pediatrics, Neonatology and Pediatric Cardiology
| | | | - Carola Dröge
- Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; and
| | - Stefanie Kluge
- Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; and
| | - Ralf Kubitz
- Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; and Medical Clinic I, Bethanien Hospital, Moers, Germany
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15
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Hammans J, Engelmann G, Wentzell R, Dübbers M. Ausgeprägte Kopfschwartenfehlbildung beim Neugeborenen. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3300-9] [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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16
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Schenk JP, Alzen G, Klingmüller V, Teufel U, El Sakka S, Engelmann G, Selmi B. Measurement of real-time tissue elastography in a phantom model and comparison with transient elastography in pediatric patients with liver diseases. Diagn Interv Radiol 2015; 20:90-9. [PMID: 24317333 DOI: 10.5152/dir.2013.13116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to determine the comparability of real-time tissue elastography (RTE) and transient elastography (TE) in pediatric patients with liver diseases. MATERIALS AND METHODS RTE was performed on the Elasticity QA Phantom Model 049 (Computerized Imaging Reference Systems Company Inc., Norfolk, Virginia, USA), which has five areas with different levels of stiffness. RTE measurements of relative stiffness (MEAN [mean value of tissue elasticity], AREA [% of blue color-coded stiffer tissue]) in the phantom were compared with the phantom stiffness specified in kPa (measurement unit of TE). RTE and TE were performed on 147 pediatric patients with various liver diseases. A total of 109 measurements were valid. The participants had following diseases: metabolic liver disease (n=25), cystic fibrosis (n=20), hepatopathy of unknown origin (n=11), autoimmune hepatitis (n=12), Wilson's disease (n=11), and various liver parenchyma alterations (n=30). Correlations between RTE and TE measurements in the patients were calculated. In addition, RTE was performed on a control group (n=30), and the RTE values between the patient and control groups were compared. RESULTS The RTE parameters showed good correlation in the phantom model with phantom stiffness (MEAN/kPa, r=-0.97; AREA/kPa, r=0.98). However, the correlation of RTE and TE was weak in the patient group (MEAN/kPa, r=-0.23; AREA/kPa, r=0.24). A significant difference was observed between the patient and control groups (MEAN, P = 5.32 e-7; AREA, P = 1.62 e-6). CONCLUSION In the phantom model, RTE was correlated with kPa, confirming the presumed comparability of the methods. However, there was no direct correlation between RTE and TE in patients with defined liver diseases under real clinical conditions.
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Affiliation(s)
- Jens-Peter Schenk
- From the Division of Pediatric Radiology (J-P.S., S.E.S., B.S. e-mail: ), Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; the Department of Pediatric Radiology (G.A., V.K.), University Clinic Giessen & Marburg, Giessen, Germany; the Department of General Pediatrics (U.T., G.E.), University Hospital of Heidelberg, Germany
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17
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Engelmann G, Erhard D, Petersen M, Parzer P, Schlarb AA, Resch F, Brunner R, Hoffmann GF, Lenhartz H, Richterich A. Health-related quality of life in adolescents with inflammatory bowel disease depends on disease activity and psychiatric comorbidity. Child Psychiatry Hum Dev 2015; 46:300-7. [PMID: 24838299 DOI: 10.1007/s10578-014-0471-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 12/11/2022]
Abstract
Adolescent patients with inflammatory bowel disease (IBD) show an increased risk for behavioral and emotional dysfunction. Health-related quality of life (HRQoL) is influenced by medical illnesses, as well as by psychiatric disorders, but for adolescents with IBD, the extent to which HRQoL is influenced by these two factors is unclear. For 47 adolescent IBD patients, we analyzed disease activity, HRQoL and whether or not a psychiatric disorder was present. Disease activity was estimated using pediatric Ulcerative Colitis Activity Index and pediatric Crohn's Disease Activity Index. The IMPACT-III and the EQ-5D were used to measure HRQoL and QoL, respectively. In addition, patient and parent diagnostic interviews were performed. 55.3 % patients fulfilled DSM-IV criteria for one or more psychiatric disorders. In all patients, psychiatric comorbidity together with disease activity contributed to a reduction in quality of life. Adolescents with IBD are at a high risk for clinically relevant emotional or behavioral problems resulting in significantly lower HRQoL. We conclude that accessible, optimally structured psychotherapeutic and/or psychiatric help is needed in adolescent patients with IBD.
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Affiliation(s)
- G Engelmann
- Department of Pediatrics, Lukas Hospital, 41464, Neuss, Germany,
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Engelmann G, Wenning D, Fertig E, Lenhartz H, Hoffmann GF, Teufel U. Antibiotic prophylaxis in the management of percutaneous endoscopic gastrostomy in infants and children. Pediatr Int 2015; 57:295-8. [PMID: 25243971 DOI: 10.1111/ped.12508] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/30/2014] [Accepted: 09/11/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND In randomized controlled trials in adult patients the use of prophylactic broad-spectrum antibiotic reduces the number of insertion site and systemic infections, associated with placement of percutaneous endoscopic gastrostomy (PEG) tubes. For pediatric patients no such trials exist. The aim of this study was to assess the value of antibiotic prophylaxis in PEG placement in pediatric patients. METHODS In a retrospective chart review PEG placement in infants and children performed in a tertiary care center was analyzed. All PEG procedures were performed by an experienced pediatric gastroenterologist using the pull-through technique under general anesthesia. RESULTS A total of 103 procedures were analyzed; 33 patients received antibiotic prophylaxis and 70 did not. Two (6%) of the patients receiving prophylaxis developed local or systemic infections after PEG placement, whereas seven (10%) without prophylaxis suffered from a PEG-related infection. This difference was not significant on chi-squared test (P = 0.5). Sixty patients had a body temperature >38°C within the first 3 days after the PEG procedure. A total of 77% of these patients had no antibiotic prophylaxis. Mean body temperature differed significantly between patients with and without prophylaxis (37.9°C vs. 38.3°C, respectively; P = 0.02). CONCLUSIONS The incidence of PEG-related local or systemic infection after PEG-placement was not significantly different between patients with and without antibiotic prophylaxis, but the latter had a significantly higher mean body temperature after the PEG procedure. Taking elevated mean body temperature as a marker for putative bacteremia it is suggested that antibiotic prophylaxis is indicated in all pediatric patients after PEG placement.
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Abstract
Herstellung und Reaktionen einiger 1.2.3.4-Tetrahalo-cyclopentadiene-(1.3) werden beschrieben.
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Affiliation(s)
- R. Riemschneider
- Aus dem Institut für Organische Chemie der Freien Universität Berlin-Dahlem
| | - G. Engelmann
- Aus dem Institut für Organische Chemie der Freien Universität Berlin-Dahlem
| | - K. Rosswitz
- Aus dem Institut für Organische Chemie der Freien Universität Berlin-Dahlem
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Selmi B, Engelmann G, Flechtenmacher C, Teufel U, Sakka SE, Schenk JP. Real-time tissue Elastografie (RTE) für nicht-invasive Bestimmung der Leberfibrose bei pädiatrischen Lebererkrankungen im Vergleich zur Leberbiopsie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373589] [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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Engelmann G, Hoffmann GF, Grulich-Henn J, Teufel U. Alanine aminotransferase elevation in obese infants and children: a marker of early onset non alcoholic Fatty liver disease. Hepat Mon 2014; 14:e14112. [PMID: 24748893 PMCID: PMC3989734 DOI: 10.5812/hepatmon.14112] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/21/2014] [Accepted: 02/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elevated aminotransferases serve as surrogate markers of non-alcoholic fatty liver disease, a feature commonly associated with the metabolic syndrome. Studies on the prevalence of fatty liver disease in obese children comprise small patient samples or focus on those patients with liver enzyme elevation. OBJECTIVES We have prospectively analyzed liver enzymes in all overweight and obese children coming to our tertiary care centre. PATIENTS AND METHODS In a prospective study 224 healthy, overweight or obese children aged 1 - 12 years were examined. Body Mass Index-Standard Deviation Score, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transpeptidase were measured. RESULTS Elevated alanine aminotransferase was observed in 29% of children. 26 % of obese and 30 % of overweight children had liver enzyme elevations. Obese children had significantly higher alanine aminotransferase levels than overweight children (0.9 vs. 0.7 times the Upper Limit of Normal; P = 0.04). CONCLUSIONS Elevation of liver enzymes appears in 29 % obese children in a tertiary care centre. Absolute alanine aminotransferase levels are significantly higher in obese than in overweight children. Even obese children with normal liver enzymes show signs of fatty liver disease as demonstrated by liver enzymes at the upper limit of normal.
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Affiliation(s)
- Guido Engelmann
- Department of Pediatrics, Lukas Hospital, Neuss, Germany
- Corresponding Author: Guido Engelmann, Department of Pediatrics, Lukas Hospital, Preussen Str 84, D-41464 Neuss, Germany. Tel: +49-21318883500, Fax: +49-21318883599, E-mail:
| | | | | | - Ulrike Teufel
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
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Selmi B, Engelmann G, Teufel U, El Sakka S, Dadrich M, Schenk JP. Normal values of liver elasticity measured by real-time tissue elastography (RTE) in healthy infants and children. J Med Ultrason (2001) 2013; 41:31-8. [PMID: 27277630 DOI: 10.1007/s10396-013-0465-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/07/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To define normal values of liver elasticity measured by real-time tissue elastography (RTE) in healthy infants and children. METHODS RTE was performed on 91 children and adolescents by two experienced observers (female, n = 43; male, n = 48) and in two age groups (0-10 years, n = 45; 11-20 years, n = 46). Hepatopathies were excluded clinically by extensive laboratory testing and by ultrasound. RTE provides a histogram from a region of interest (ROI) in the liver representing the degree of stiffness of the liver. The distribution of the colors in the histogram corresponds to organ elasticity. By calculating the mean of stiffness values, a numerical value is expressed in arbitrary units (a.u.) representing the mean elasticity of the liver (MEAN). Additionally, the percentage values of relatively stiffer areas (color coded in blue) in the ROI can be calculated (%AREA). A Mann-Whitney U test was performed for these two parameters according to gender. The reproducibility of these values was determined with an intraclass correlation coefficient (ICC) test on another group of 18 healthy volunteers. RESULTS The median elasticity was 106 a.u. Gender did not have an influence on the parameters (MEAN: p = 0.052; %AREA: p = 0.051). Age-specific analyses did not yield any significant difference between the two age groups for either of the two analyzed parameters (MEAN: p = 0.059; %AREA: p = 0.058). The ICC test demonstrated a moderate agreement for MEAN (ICC = 0.582) and %AREA (ICC = 0.659). CONCLUSION Real-time elastography is a new sonography-based method and may be used as a supportive analysis to assess liver parenchyma elasticity in children, especially when fibrosis is suspected. We measured RTE normal values in children as reference data.
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Affiliation(s)
- Buket Selmi
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany.
| | - Guido Engelmann
- Department of General Pediatrics, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany
| | - Ulrike Teufel
- Department of General Pediatrics, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany
| | - Saroa El Sakka
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany
| | - Monika Dadrich
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany
| | - Jens-Peter Schenk
- Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 430, 69120, Heidelberg, Germany
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Engelmann G, Bonatz E, Ganster J, Pinnow M, Bohn A. Preparation of PTT/clay nanocomposites with solid-state polymerized polytrimethylene terephthalate. J Appl Polym Sci 2012. [DOI: 10.1002/app.37501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schaefer B, Schaefer F, Wittmer D, Engelmann G, Wenning D, Schmitt CP. Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus. Pediatr Nephrol 2012; 27:829-34. [PMID: 22083365 DOI: 10.1007/s00467-011-2058-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant. METHODS We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus). RESULTS MARS sessions were initially performed three times weekly at a mean duration of 6.3 ± 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 ± 67 μmol/l. They declined to 67 ± 9%, 48 ± 3%, 38 ± 14%, and 37 ± 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 ± 33 μmol/l per day. Mean NRS score decreased from 6.5 ± 2.3 to 3.3 ± 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated. CONCLUSION MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.
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Affiliation(s)
- Betti Schaefer
- Center for Pediatric and Adolescent Medicine Heidelberg, University of Heidelberg, INF 430, 69120 Heidelberg, Germany
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Selmi B, Schenk JP, Engelmann G, Teufel U, Grulich-Henn J, El Sakka S. Real-time tissue Elastographie (RTE): Normkollektiv und klinische Anwendung im Kindesalter - erste Ergebnisse. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311026] [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: 10/28/2022]
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Haas D, Gan-Schreier H, Langhans CD, Rohrer T, Engelmann G, Heverin M, Russell DW, Clayton PT, Hoffmann GF, Okun JG. Differential diagnosis in patients with suspected bile acid synthesis defects. World J Gastroenterol 2012; 18:1067-76. [PMID: 22416181 PMCID: PMC3296980 DOI: 10.3748/wjg.v18.i10.1067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 11/17/2011] [Accepted: 12/10/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical presentations associated with bile acid synthesis defects and to describe identification of individual disorders and diagnostic pitfalls.
METHODS: Authors describe semiquantitative determination of 16 urinary bile acid metabolites by electrospray ionization-tandem mass spectrometry. Sample preparation was performed by solid-phase extraction. The total analysis time was 2 min per sample. Authors determined bile acid metabolites in 363 patients with suspected defects in bile acid metabolism.
RESULTS: Abnormal bile acid metabolites were found in 36 patients. Two patients had bile acid synthesis defects but presented with atypical presentations. In 2 other patients who were later shown to be affected by biliary atresia and cystic fibrosis the profile of bile acid metabolites was initially suggestive of a bile acid synthesis defect. Three adult patients suffered from cerebrotendinous xanthomatosis. Nineteen patients had peroxisomal disorders, and 10 patients had cholestatic hepatopathy of other cause.
CONCLUSION: Screening for urinary cholanoids should be done in every infant with cholestatic hepatopathy as well as in children with progressive neurological disease to provide specific therapy.
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Billing H, Breil T, Schmidt J, Tönshoff B, Schmitt CP, Giese T, Engelmann G. Pharmacodynamic monitoring by residual NFAT-regulated gene expression in stable pediatric liver transplant recipients. Pediatr Transplant 2012; 16:187-94. [PMID: 22360403 DOI: 10.1111/j.1399-3046.2012.01660.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 12/29/2022]
Abstract
Pharmacokinetic monitoring of CNI is unsatisfactory, because at comparable CNI blood concentrations frequency and severity of adverse effects vary considerably among individual patients. Determining the RGE of NFAT-regulated genes in leukocytes is a new pharmacodynamic approach to measure directly the functional consequences of calcineurin inhibition in T-lymphocytes. We compared clinical outcome parameters and RGE of activated T-cells after pLtx. We measured prospectively RGE of NFAT regulated genes in 33 pLTX recipients in the maintenance period after pLTX. CsA-treated patients with recurrent infections had significantly lower RGE rates (27%) than children without recurrent infections (50%; p = 0.04), whereas pharmacokinetic parameters of CsA and the concomitant immunosuppressive therapy were comparable between both groups. In patients on tacrolimus-based IS therapy NFAT RGE was only slightly reduced (90%). Pharmacodynamic monitoring of CsA by measurement of RGE in T-lymphocytes has the potential to identify over-immunosuppressed pediatric liver transplant recipients on a CsA-based IS therapy, while in children on low-dose tacrolimus therapy, RGE measurement does not provide additional clinically useful information.
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Affiliation(s)
- Heiko Billing
- Department of Pediatrics I, University Children's Hospital Surgery, University of Heidelberg, Heidelberg, Germany
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Engelmann G, Gebhardt C, Wenning D, Wühl E, Hoffmann GF, Selmi B, Grulich-Henn J, Schenk JP, Teufel U. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr 2012; 171:353-60. [PMID: 21861093 DOI: 10.1007/s00431-011-1558-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [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: 06/08/2011] [Accepted: 08/10/2011] [Indexed: 12/14/2022]
Abstract
Transient elastography (TE) is a new technique for the non-invasive assessment of liver fibrosis. The degree of fibrosis is equivalent to the liver stiffness measured in kilopascal (kPa). It is frequently used in adult patients with a mean normal stiffness of 4.4-5.5 kPa. Since 2008, liver stiffness can be measured even in small children and infants following the availability of a new probe with a smaller diameter (S-probe 5 mm) than the regular probe (M-probe 7 mm). We report control values for healthy children between 0 and 18 years and investigated the feasibility of this technique in a pediatric population. For control values, TE was performed in infants and children after exclusion of liver disease by medical history, clinical examination, blood investigation, and abdominal ultrasound. For feasibility analyses the results of all TE performed in our clinic were analyzed irrespective of the underlying disease. Liver stiffness was measured with the S-probe (thorax diameter <45 cm (S1) or 45-75 cm (S2)) and the M-probe (thorax diameter >75 cm) according to the manufacturer's recommendations. A total of 240 healthy children were analyzed to establish control values. The median liver stiffness was 4.7 kPa resulting in an upper limit of normal of 6.47 kPa. Median values of stiffness were significantly age dependent with 4.40, 4.73, and 5.1 kPa in children 0-5, 6-11, and 12-18 years (p = 0.001) while the interquartile range decreased with age (0.8, 0.7, and 0.6 kPa). The resulting upper limit of normal (median plus 1.64 times standard deviation) was 5.96, 6.65, and 6.82 kPa. Girls between 11 and 18 years showed a significantly lower median stiffness than boys of the same age (4.7 vs. 5.6 kPa; p < 0.005). Feasibility was tested in 975 consecutive liver stiffness measurements (LSM) in children 0-18 years of age. Patients with invalid LSM were significantly younger than those with valid LSM (5.8 vs. 9.7 years, p < 0.0001), showed a significantly higher stiffness (10.2 vs. 6.17, p < 0.0001), and examinations took significantly longer (202 vs. 160 s, p < 0.0001). TE is technically possible in children of all age groups. The upper limit of normal increases significantly with age. Due to movement artifacts the measurement is reliable from the age of 6 without sedation. In younger children the number of invalid measurements increases significantly. Further studies are needed to asses the value of TE in the diagnosis and follow-up of liver disease in pediatric hepatology.
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Affiliation(s)
- Guido Engelmann
- Department of General Pediatrics, University Hospital, Heidelberg, INF 430, 69120 Heidelberg, Germany.
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Teufel U, Engelmann G, Flechtenmacher C, Peccerella T, Millonig G, Hoffmann G, Mueller S, Seitz HK. Detection of highly carcinogenic, exocyclic etheno-DNA-adducts in the liver of children with non-alcoholic fatty liver disease. Z Gastroenterol 2012. [DOI: 10.1055/s-0031-1295833] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Teufel U, Weitz J, Flechtenmacher C, Prietsch V, Schmidt J, Hoffmann GF, Kölker S, Engelmann G. High urgency liver transplantation in ornithine transcarbamylase deficiency presenting with acute liver failure. Pediatr Transplant 2011; 15:E110-5. [PMID: 21884343 DOI: 10.1111/j.1399-3046.2009.01171.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 01/03/2023]
Abstract
OTCD can present with ALF at any age. Under adequate therapy symptoms resolve quickly. We report a three-yr-old girl with the manifestation of an OTCD as ALF. Despite adequate pharmacotherapy and protein restriction, the patient deteriorated and developed hepatic encephalopathy. A high urgency liver transplantation was performed and the patient recovered completely. We conclude that in patients with ALF urea cycle defects in general and OTCD in particular should be considered as differential diagnosis. Patients should be managed in a center that has the capacity for an emergency liver transplantation.
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Affiliation(s)
- Ulrike Teufel
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany.
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Selmi B, Engelmann G, Teufel U, El Sakka S, Grulich-Henn J, Schenk JP. Real-time tissue Elastografie (RTE): Normkollektiv und klinische Anwendung im Kindesalter – erste Ergebnisse. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286233] [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]
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Schenk JP, Teufel U, Gebhardt C, Selmi B, El Sakka S, Wühl E, Engelmann G. Transiente Elastografie (TE) – eine ergänzende Diagnostik zur Lebersonografie: Normwerte und klinische Anwendung im Kindesalter. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286226] [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]
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Engelmann G, Gebhardt C, Wenning D, Wühl E, Hoffmann GF, Selmi B, Grulich-Henn J, Schenk JP, Teufel U. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr 2011. [PMID: 21861093 DOI: 10.1007/s00431-012-1778-5] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transient elastography (TE) is a new technique for the non-invasive assessment of liver fibrosis. The degree of fibrosis is equivalent to the liver stiffness measured in kilopascal (kPa). It is frequently used in adult patients with a mean normal stiffness of 4.4-5.5 kPa. Since 2008, liver stiffness can be measured even in small children and infants following the availability of a new probe with a smaller diameter (S-probe 5 mm) than the regular probe (M-probe 7 mm). We report control values for healthy children between 0 and 18 years and investigated the feasibility of this technique in a pediatric population. For control values, TE was performed in infants and children after exclusion of liver disease by medical history, clinical examination, blood investigation, and abdominal ultrasound. For feasibility analyses the results of all TE performed in our clinic were analyzed irrespective of the underlying disease. Liver stiffness was measured with the S-probe (thorax diameter <45 cm (S1) or 45-75 cm (S2)) and the M-probe (thorax diameter >75 cm) according to the manufacturer's recommendations. A total of 240 healthy children were analyzed to establish control values. The median liver stiffness was 4.7 kPa resulting in an upper limit of normal of 6.47 kPa. Median values of stiffness were significantly age dependent with 4.40, 4.73, and 5.1 kPa in children 0-5, 6-11, and 12-18 years (p = 0.001) while the interquartile range decreased with age (0.8, 0.7, and 0.6 kPa). The resulting upper limit of normal (median plus 1.64 times standard deviation) was 5.96, 6.65, and 6.82 kPa. Girls between 11 and 18 years showed a significantly lower median stiffness than boys of the same age (4.7 vs. 5.6 kPa; p < 0.005). Feasibility was tested in 975 consecutive liver stiffness measurements (LSM) in children 0-18 years of age. Patients with invalid LSM were significantly younger than those with valid LSM (5.8 vs. 9.7 years, p < 0.0001), showed a significantly higher stiffness (10.2 vs. 6.17, p < 0.0001), and examinations took significantly longer (202 vs. 160 s, p < 0.0001). TE is technically possible in children of all age groups. The upper limit of normal increases significantly with age. Due to movement artifacts the measurement is reliable from the age of 6 without sedation. In younger children the number of invalid measurements increases significantly. Further studies are needed to asses the value of TE in the diagnosis and follow-up of liver disease in pediatric hepatology.
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Affiliation(s)
- Guido Engelmann
- Department of General Pediatrics, University Hospital, Heidelberg, INF 430, 69120 Heidelberg, Germany.
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Lichtenstein S, Teufel U, Weiland C, Engel N, Engelmann G, Hoffmann G, Grulich-Henn J. Adipositasprävention in Grundschulen. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2467-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bartsch O, Schneider E, Damatova N, Weis R, Tufano M, Iorio R, Ahmed A, Engelmann G, Flechtenmacher C, Beyer V, Zechner U, Haaf T. Corrigendum: Fulminant Hepatic Failure Requiring Liver Transplantation in 22q13.3 Deletion Syndrome. Am J Med Genet A 2011. [DOI: 10.1002/ajmg.a.34008] [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: 11/07/2022]
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Schaefer B, Schaefer F, Engelmann G, Meyburg J, Heckert KH, Zorn M, Schmitt CP. Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in children with acute liver failure. Nephrol Dial Transplant 2011; 26:3633-9. [PMID: 21421589 DOI: 10.1093/ndt/gfr115] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Molecular Adsorbents Recirculating System (MARS) is an extracorporeal liver support system eliminating albumin-bound and water-soluble substances. While it is increasingly applied in patients with acute liver failure (ALF), no comparison with standard dialysis methods has yet been performed. METHODS This is an analysis of ten children (0.1-18 years) with ALF, who underwent a total of 22 MARS sessions. Standard adult MARS sets were used in seven (23.5-72 kg) and MARS Mini in three children (2.8-13 kg). In eight children, MARS was alternated with combined plasma exchange (PE) and haemodialysis (HD) treatments. Mean treatment duration was 7.2 (6-10) h for MARS and 5.7 (4.5-6.6) h for PE/HD. RESULTS Standard MARS treatment only slightly decreased serum bilirubin (16.3 ± 6.5-13.8 ± 5.9 mg/dL) and ammonia (113 ± 62-99 ± 68 μmol/L) and international normalized ratio (INR) tended to increase (1.5 ± 0.3 and 2 ± 1.1). Mini-MARS did not reduce serum bilirubin (19.7 ± 3-20.5 ± 3.2 mg/dL), ammonia slightly decreased (70 ± 24-56 ± 9 μmol/L) and INR increased (2.5 ± 0.7-2.9 ± 1.1, all P = n.s.). In contrast, PE/HD reduced serum bilirubin (23 ± 8.4-14.7 ± 7 mg/dL), ammonia (120 ± 60-70 ± 40 μmol/L) and INR (2.4 ± 0.8-1.4 ± 0.1, all P < 0.05). Intraindividual comparison showed a slight increase in bilirubin by 2 ± 22% with MARS and a reduction by 37 ± 11% with PE/HD (P < 0.001 versus MARS) and a decrease in ammonia of 18 ± 27 and 39 ± 23% (P < 0.05). INR increased during MARS by 26 ± 41% and decreased with PE/HD by 37 ± 20% (P < 0.01). All treatment sessions were well tolerated. Five children died, including the three children treated with Mini-MARS. CONCLUSION Our experience suggests superior efficacy of combined PE/HD as compared to intermittent MARS therapy for treating ALF.
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Affiliation(s)
- Betti Schaefer
- Department of General Pediatrics, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
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Houben RMGJ, Crampin AC, Ndhlovu R, Sonnenberg P, Godfrey-Faussett P, Haas WH, Engelmann G, Lombard CJ, Wilkinson D, Bruchfeld J, Lockman S, Tappero J, Glynn JR. Human immunodeficiency virus associated tuberculosis more often due to recent infection than reactivation of latent infection. Int J Tuberc Lung Dis 2011; 15:24-31. [PMID: 21276292] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND It is unclear whether human immunodeficiency virus (HIV) increases the risk of tuberculosis (TB) mainly through reactivation or following recent Mycobacterium tuberculosis (re)infection. Within a DNA fingerprint-defined cluster of TB cases, reactivation cases are assumed to be the source of infection for subsequent secondary cases. As HIV-positive TB cases are less likely to be source cases, equal or higher clustering in HIV-positives would suggest that HIV mainly increases the risk of TB following recent infection. METHODS A systematic review was conducted to identify all studies on TB clustering and HIV infection in HIV-endemic populations. Available individual patient data from eligible studies were pooled to analyse the association between clustering and HIV. RESULTS Of seven eligible studies, six contributed individual patient data on 2116 patients. Clustering was as, or more, likely in the HIV-positive population, both overall (summary OR 1.26, 95%CI 1.0-1.5), and within age groups (OR 1.50, 95%CI 0.9-2.3; OR 1.00, 95%CI 0.8-1.3 and OR 2.57, 95%CI 1.4-5.7) for ages 15-25, 26-50 and >50 years, respectively. CONCLUSIONS Our results suggest that HIV infection mainly increases the risk of TB following recent M. tuberculosis transmission, and that TB control measures in HIV-endemic settings should therefore focus on controlling M. tuberculosis transmission rather than treating individuals with latent M. tuberculosis infection.
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Affiliation(s)
- R M G J Houben
- Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK.
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40
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Esmaeilzadeh M, Dictus C, Kayvanpour E, Sedaghat-Hamedani F, Eichbaum M, Hofer S, Engelmann G, Fonouni H, Golriz M, Schmidt J, Unterberg A, Mehrabi A, Ahmadi R. One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-. BMC Med 2010; 8:74. [PMID: 21087498 PMCID: PMC3002294 DOI: 10.1186/1741-7015-8-74] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/18/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND An accident or a catastrophic disease may occasionally lead to brain death (BD) during pregnancy. Management of brain-dead pregnant patients needs to follow special strategies to support the mother in a way that she can deliver a viable and healthy child and, whenever possible, also be an organ donor. This review discusses the management of brain-dead mothers and gives an overview of recommendations concerning the organ supporting therapy. METHODS To obtain information on brain-dead pregnant women, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included the age of the mother, the cause of brain death, maternal medical complications, gestational age at BD, duration of extended life support, gestational age at delivery, indication of delivery, neonatal outcome, organ donation of the mothers and patient and graft outcome. RESULTS In our search of the literature, we found 30 cases reported between 1982 and 2010. A nontraumatic brain injury was the cause of BD in 26 of 30 mothers. The maternal mean age at the time of BD was 26.5 years. The mean gestational age at the time of BD and the mean gestational age at delivery were 22 and 29.5 weeks, respectively. Twelve viable infants were born and survived the neonatal period. CONCLUSION The management of a brain-dead pregnant woman requires a multidisciplinary team which should follow available standards, guidelines and recommendations both for a nontraumatic therapy of the fetus and for an organ-preserving treatment of the potential donor.
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Affiliation(s)
- Majid Esmaeilzadeh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
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Schupp CJ, Nitsche A, Bock-Hensley O, Böhm S, Flechtenmacher C, Kurth A, Saenger K, Hoferer M, Küsters U, Günther P, Engelmann G, Schnitzler P. A 14-year-old girl with a vesicle on her finger and lymphadenitis. J Clin Virol 2010; 50:1-3. [PMID: 20829104 DOI: 10.1016/j.jcv.2010.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/09/2010] [Indexed: 11/16/2022]
Affiliation(s)
- C J Schupp
- Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany
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Decker E, Engelmann G, Findeisen A, Gerner P, Laass M, Ney D, Posovszky C, Hoy L, Hornef MW. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010; 125:e1433-40. [PMID: 20478942 DOI: 10.1542/peds.2009-2260] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [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: 12/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyze a possible association between cesarean delivery and enteric inflammatory diseases in children. METHODS A retrospective, multicenter, case-control study that included 1950 children was performed in cooperation with 26 university and 16 nonacademic children's hospitals. Information on intestinal disease manifestation, together with mode of delivery and gestational age at birth, postnatal complications, and breastfeeding, was collected by the attending physician from children and their parents who were visiting a gastrointestinal outpatient clinic for Crohn disease (CD; 516 cases), ulcerative colitis (250 cases), celiac disease (157 cases), and other gastrointestinal diseases (165 cases) and control subjects who were visiting ophthalmologic, orthodontic, and dental outpatient clinics (862 cases). RESULTS Whereas the rate of cesarean delivery of children with Crohn disease or ulcerative colitis was similar to that of control subjects, a significantly enhanced likelihood of being born by cesarean delivery was found in children with celiac disease compared with control subjects (odds ratio: 1.8 [95% confidence interval: 1.13-2.88]; P = .014). CONCLUSIONS The mode of delivery and associated alterations in the development of the enteric homeostasis during the neonatal period might influence the incidence of celiac disease.
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Affiliation(s)
- Evalotte Decker
- Department of Pediatrics, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
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43
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Takeichi T, Engelmann G, Mocevicius P, Schmidt J, Ryschich E. 4-dimensional intravital microscopy: a new model for studies of leukocyte recruitment and migration in hepatocellular cancer in mice. J Gastrointest Surg 2010; 14:867-72. [PMID: 20229071 DOI: 10.1007/s11605-010-1179-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 02/09/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although it is accepted that the immune system plays a role in the prognosis of hepatocellular carcinoma (HCC), the exact mechanisms of leukocyte recruitment into HCC are poorly understood. Progress in the study of this aspect has been hindered by technical limitations. MATERIALS AND METHODS In the present study, we describe the use of 4D intravital microscopy which represents an advantageous technology for the investigation of the microvascular system and leukocyte migration in HCC. To establish 4D intravital microscopy, we used a HCC tumor model in transgenic mice expressing enhanced green fluorescent protein in specific leukocyte subpopulations and combined digital time-lapse recording, laser scanning confocal microscopy, and 3D reconstruction. Using this technology, we studied the intra- and extravascular leukocyte adhesion and migration in HCC in vivo at the single-cell level. RESULTS We showed that although vessel density in HCC was lower than in normal liver, tumor tissue was moderately infiltrated with leukocytes of lymphoid and myeloid origin. Most tumor-infiltrating leukocytes migrated in a random manner frequently changing direction of migration in the tumor tissue. The migration velocity of myeloid and lymphoid leukocytes in HCC tissue was not different. DISCUSSION These results demonstrated that 4D intravital microscopy has potential to be a powerful tool in the study of mechanisms of leukocyte recruitment and intratumoral migration in HCC.
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Affiliation(s)
- Takayuki Takeichi
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Engelmann G, Schmidt J, Weitz J, Flechtenmacher C, Schenk JP, Weigand MA, Lenhartz H, Wenning D, Holland-Cunz S, Hoffmann GF, Martin E, Büchler MW, Schmitt CP, Burdelski M, Meyburg J. A new pediatric liver transplantation program in Southern Germany. The Heidelberg experience. Pediatr Transplant 2010; 14:12-8. [PMID: 19793222 DOI: 10.1111/j.1399-3046.2009.01247.x] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
pLTx is a highly complex procedure. It can only be performed safely by experienced teams. Starting a new pLTx program in a country with established centers must therefore avoid a learning curve. We have initiated a liver transplantation program for children in 2003. Medical standards were defined by a team of surgeons, pediatricians, radiologists, anesthesiologists, and pathologists before the first transplantation. An external expert in the field of pLTx supervised the whole process. In a pilot phase, six children weighing more than 20 kg were successfully transplanted. Following this series, the clinical pathways were re-evaluated, and the program was opened for children of all age groups. Between 2003 and 2008, 32 children received 34 organs. Sixty-eight percent of patients received a split-liver, 26% a full size organ, and 6% a reduced size graft. Four LRLTx were performed. Patient survival rate was 91%. We conclude that a new pLTx program can be established without a significant learning curve regarding mortality if a strict strategy of team-building is followed. In the pilot phase, small children and infants have to be referred and transplanted in an established center. An interdisciplinary team of specialists closely working together is the key for sustained success.
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Affiliation(s)
- Guido Engelmann
- Department of Pediatrics, University Hospital, Heidelberg, Germany.
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Engelmann G, Heim A, Greil J, Schmitt CP, Flechtenmacher C, Daum E, Küsters U, Schmidt J, Meyburg J, Schnitzler P. Adenovirus infection and treatment with cidofovir in children after liver transplantation. Pediatr Transplant 2009; 13:421-8. [PMID: 18783361 DOI: 10.1111/j.1399-3046.2008.01014.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In a retrospective study, serum samples from 21 pediatric liver transplant recipients were analysed by quantitative real-time PCR for ADV infection up to 24 wk after Tx. ADV DNA was detected in serum of eight children after Tx, one of whom developed life-threatening fulminant hepatitis and sepsis. None of these children were symptomatic at the time of first detection of ADV DNA in serum after Tx. Seven children with positive ADV PCR had low adenoviral loads, showed no increase in viral load and remained clinically asymptomatic in the follow-up period of 24 wk. After 10 wk under immunosuppression one child presented clinically with adenoviral sepsis and severe necrotizing hepatitis. This patient revealed a dramatic increase of ADV from baseline titers up to 1.3 x 10(9 )copies/mL serum within 10 wk after Tx. ADV was also detected in a liver biopsy of this child at 1.2 x 10(4) copies/cell and typed by sequence analysis as human ADV species C, type 6, a rarely detected ADV type and first described in a liver transplant patient. Immunosuppression was reduced in this patient immediately and the antiviral drug cidofovir administered intravenously followed by viral suppression and clinical improvement of the child.
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Affiliation(s)
- Guido Engelmann
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
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Teufel U, Weitz J, Flechtenmacher C, Prietsch V, Schmidt J, Hoffmann GF, Kölker S, Engelmann G. High urgency liver transplantation in ornithine transcarbamylase deficiency presenting with acute liver failure. Pediatr Transplant 2009. [PMID: 21884343 DOI: 10.1111/j.1399-3064.2009.01171.x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OTCD can present with ALF at any age. Under adequate therapy symptoms resolve quickly. We report a three-yr-old girl with the manifestation of an OTCD as ALF. Despite adequate pharmacotherapy and protein restriction, the patient deteriorated and developed hepatic encephalopathy. A high urgency liver transplantation was performed and the patient recovered completely. We conclude that in patients with ALF urea cycle defects in general and OTCD in particular should be considered as differential diagnosis. Patients should be managed in a center that has the capacity for an emergency liver transplantation.
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Affiliation(s)
- Ulrike Teufel
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany.
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Buschmann KV, Ruef P, Engelmann G, Greil J, Poeschl J. Case report: FG 25+4 SSW mit Mikrozephalie, kompletter B-Zelldefizienz, Pancolitis, Krampfanfällen und rezidivierenden Septitiden – der ungelöste Fall. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lichtenstein S, Teufel U, Weiland C, Engel N, Engelmann G, Hoffmann GF, Grulich-Henn J. Ein 6-monatiges Präventionsprogramm vermindert das Adipositasrisiko von Grundschülern. Klin Padiatr 2009. [DOI: 10.1055/s-0029-1214256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Civit E, de Bazúa C, Engelmann G, González. S, Hartmann L. Anaerobic treatment of maize processing waste water (Nejayote) in a packed bed reactor cascade. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/09593338409384257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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López-Benítez R, Schlieter M, Hallscheidt PJ, Radeleff BA, Kauffmann G, Richter GM, Schmidt J, Engelmann G. Successful arterial thrombolysis and percutaneous transluminal angioplasty for early hepatic artery thrombosis after split liver transplantation in a four-month-old baby. Pediatr Transplant 2008; 12:606-10. [PMID: 18652621 DOI: 10.1111/j.1399-3046.2008.00925.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 10/21/2022]
Abstract
Early HAT is the most frequent and severe vascular complication following liver transplantation. It is one of the major causes of graft failure and mortality. Endovascular thrombolytic treatment in patients with thrombotic complications after liver transplantation is an attractive alternative to open surgery as lower morbidity and mortality rates are reported for it. PTA following transcatheter thrombolysis has been successfully used to treat HAT in adults. To the best of our knowledge, there have not been any reports of a successful transcatheter thrombolysis using interventional radiological techniques in a patient only four months old. The present report describes the successful endovascular emergency treatment of a HAT three days after DD split liver transplantation.
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Affiliation(s)
- R López-Benítez
- Department of Diagnostic Radiology, University of Heidelberg, Heidelberg, Germany.
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