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Meyding-Lamadé U, Jacobi C, Martinez-Torres F, Lenhard T, Kress B, Kieser M, Klose C, Einhäupl K, Bösel J, Mackert MB, Homberg V, Koennecke C, Weißheit G, Claus D, Kieseier B, Bardutzky J, Neumann-Haefelin T, Lorenz MW, Steinmetz H, Gerloff C, Schneider D, Grau A, Klein M, Dziewas R, Bogdahn U, Jakob W, Linker R, Fuchs K, Sander A, Luntz S, Hoppe-Tichy T, Hanley DF, von Kummer R, Craemer E. The German trial on Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE): a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Res Pract 2019; 1:26. [PMID: 33324892 PMCID: PMC7650106 DOI: 10.1186/s42466-019-0031-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Comprehensive treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major clinical challenge. The current therapy gold standard is aciclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains around 20% and a majority of survivors suffer from severe disability. Experimental research and recent retrospective clinical observations suggest a favourable therapy response to adjuvant dexamethasone. Currently there is no randomized clinical trial evidence, however, to support the routine use of adjuvant corticosteroid treatment in HSVE. Methods The German trial of Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE) studied the effect of adjuvant dexamethasone versus placebo on top of standard aciclovir treatment in adult patients aged 18 up to 85 years with proven HSVE in German academic centers of Neurology in a randomized and double blind fashion. The trial was open from November 2007 to December 2012. The initially planned sample size was 372 patients with the option to increase to up to 450 patients after the second interim analysis. The primary endpoint was a binary functional outcome after 6 months assessed using the modified Rankin scale (mRS 0-2 vs. 3-6). Secondary endpoints included mortality after 6 and 12 months, functional outcome after 6 months measured with the Glasgow outcome scale (GOS), functional outcome after 12 months measured with mRS and GOS, quality of life as measured with the EuroQol 5D instrument after 6 and 12 months, neuropsychological testing after 6 months, cranial magnetic resonance imaging findings after 6 months, seizures up to day of discharge or at the latest at day 30, and after 6 and 12 months. Results The trial was stopped prematurely for slow recruitment after 41 patients had been randomized, 21 of them treated with dexamethasone and 20 with placebo. No difference was observed in the primary endpoint. In the full analysis set (n = 19 in each group), 12 patients in each treatment arm achieved a mRS of 0-2. Similarly, we did not observe significant differences in the secondary endpoints (GOS, mRS, quality of life, neuropsychological testing). Conclusion GACHE being prematurely terminated demonstrated challenges encountered performing randomized, placebo-controlled trials in rare life threatening neurological diseases. Based upon our trial results the use of adjuvant steroids in addition to antiviral treatment remains experimental and is at the decision of the individual treating physician. Unfortunately, the small number of study participants does not allow firm conclusions. Trial registration EudraCT-Nr. 2005-003201-81.
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Affiliation(s)
- U Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - C Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany
| | - F Martinez-Torres
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Lenhard
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - B Kress
- Department of Neuroradiology, Krankenhaus Nordwest, Frankfurt, Germany
| | - M Kieser
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - K Einhäupl
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J Bösel
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - M-B Mackert
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - V Homberg
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - C Koennecke
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - G Weißheit
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - D Claus
- Department of Neurology, Klinikum Darmstadt, Darmstadt, Germany.,Praxis Dr. Meyer & Prof. Claus, Bensheim, Germany
| | - B Kieseier
- Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - J Bardutzky
- Department of Neurology, University of Freiburg, Freiburg, Germany
| | | | - M W Lorenz
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - H Steinmetz
- Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - C Gerloff
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - D Schneider
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - A Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen am Rhein, Lugwigshafen, Germany
| | - M Klein
- Department of Neurology, Klinikum der Ludwig-Maximilians- Universität München, Großhadern, Germany
| | - R Dziewas
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - U Bogdahn
- Department of Pharmacy Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - W Jakob
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - R Linker
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - K Fuchs
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - A Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - S Luntz
- Koordinierungszentrum für Klinische Studien (KKS), University of Heidelberg, Heidelberg, Germany
| | - T Hoppe-Tichy
- Department of Pharmacy Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - D F Hanley
- Division of Brain Injury Outcomes, John Hopkins University, Baltimore, MD USA
| | - R von Kummer
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - E Craemer
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany
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Knebel P, Fröhlich B, Knaebel HP, Kienle P, Luntz S, Buchler MW, Seiler CM. Comparison of Venae Sectio vs. modified Seldinger Technique for totally implantable access ports; Portas-trial [ISRCTN:52368201]. Trials 2006; 7:20. [PMID: 16762049 PMCID: PMC1550252 DOI: 10.1186/1745-6215-7-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 06/08/2006] [Indexed: 11/15/2022] Open
Abstract
Background The insertion of a Totally Implantable Access Port (TIAP) is a routinely employed technique in patients who need a safe and permanent venous access. The number of TIAP implantations is increasing constantly mainly due to advanced treatment options for malignant diseases. Therefore it is important to identify the implantation technique which has the optimal benefit/risk ratio for the patient. Study design A single-centre, randomized, controlled superiority trial to compare two different TIAP implantation techniques. Sample size: 160 patients will be included and randomized intra-operatively. Eligibility criteria: Age equal or older than 18 years, patients scheduled for primary elective implantation of a TIAP in local anaesthesia and a signed informed consent. Primary endpoint: Primary success rate of the randomized technique. Intervention: Venae Sectio in combination with the Seldinger Technique (guide wire and a peel away sheath) will be used to place a TIAP. Reference treatment: Conventional Venae Sectio will be used with a direct insertion of the TIAP without guide wire or peel away sheath. Duration of study: Approximately 20 months. Organisation/Responsibility The trial will be conducted in compliance with the protocol and in accordance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The trial will also be carried out in keeping with local and regulatory requirements. The Klinisches Studienzentrum Chirurgie (KSC) – Centre of Clinical Trials in Surgery at the Department of Surgery, University Hospital Heidelberg is responsible for planning and conduction of the trial. Documentation of patient's data will be accomplished via electronical Case Report Files (eCRF) with MACRO®-Software by the KSC. Randomization, data management, monitoring and biometry are provided by the independent Koordinierungszentrum für Klinische Studien (KKS) – Coordination Centre for Clinical Trails at the University of Heidelberg.
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Affiliation(s)
- P Knebel
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - B Fröhlich
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - H-P Knaebel
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Kienle
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - S Luntz
- Coordination Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - MW Buchler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - CM Seiler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
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Kunst G, Pfeilschifter J, Kummermehr G, Luntz S, Bauer H, Martin E, Motsch J. Assessment of sex hormone-binding globulin and osteocalcin in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2000; 14:546-52. [PMID: 11052436 DOI: 10.1053/jcan.2000.9450] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine sex hormone-binding globulin (SHBG) and osteocalcin (OC) levels in patients undergoing coronary artery bypass graft surgery to clarify the status of peripheral thyroid metabolism and to correlate SHBG and OC with thyroid hormones and adverse postoperative events. DESIGN Prospective study. SETTING University medical center. PARTICIPANTS Fifty randomly selected patients undergoing coronary artery bypass graft surgery. INTERVENTIONS On the morning of surgery before induction of anesthesia; 30 minutes after cross-clamping of the aorta; 2 hours and 6 hours after aortic cross-clamp removal; and on the first, second, third, and seventh postoperative mornings, blood samples were drawn and analyzed for OC, SHBG, triiodothyronine (tT3), free T3 (fT3), thyroxine (tT4), free T4 (fT4), thyroid-stimulating hormone, and thyroid-binding globulin. Adverse postoperative events were recorded. MEASUREMENTS AND MAIN RESULTS Mean tT3 and fT3 decreased on average by 35% and 18% but remained within the normal range perioperatively. Similarly, mean SHBG and OC remained within the normal range. More than half of the patients investigated (60%) had OC concentrations below the normal range. Patients with pathologically decreased tT3 (n = 6) and tT4 (n = 16) intraoperatively and postoperatively had SHBG and OC concentrations similar to those in patients with normal tT3 and tT4 levels. Patients with postoperative complications had significantly lower OC levels preoperatively and on the first postoperative morning than those with an uneventful postoperative recovery. CONCLUSION Despite significant intraoperative and postoperative decreases in levels of thyroid hormones, low T3 syndrome was rare in this patient population. Unchanged concentrations of SHBG and OC in patients with pathologically decreased tT3 or tT4 suggest normal local thyroid exposure at the tissue sites in these patients. OC may act as a predictor for postoperative outcome.
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Affiliation(s)
- G Kunst
- Department of Anesthesiology, University of Heidelberg, Germany
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