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Gerwing M, Hoffmann E, Geyer C, Helfen A, Maus B, Schinner R, Wachsmuth L, Heindel W, Eisenblaetter M, Faber C, Wildgruber M. Intratumoral heterogeneity after targeted therapy in murine cancer models with differing degrees of malignancy. Transl Oncol 2023; 37:101773. [PMID: 37666208 PMCID: PMC10483060 DOI: 10.1016/j.tranon.2023.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Conventional morphologic and volumetric assessment of treatment response is not suitable for adequately assessing responses to targeted cancer therapy. The aim of this study was to evaluate changes in tumor composition after targeted therapy in murine models of breast cancer with differing degrees of malignancy via non-invasive magnetic resonance imaging (MRI). MATERIALS AND METHODS Mice bearing highly malignant 4T1 tumors or low malignant 67NR tumors were treated with either a combination of two immune checkpoint inhibitors (ICI, anti-PD1 and anti-CTLA-4) or the multi-tyrosine kinase inhibitor sorafenib, following experiments with macrophage-depleting clodronate-loaded liposomes and vessel-stabilizing angiopoietin-1. Mice were imaged on a 9.4 T small animal MRI system with a multiparametric (mp) protocol, comprising T1 and T2 mapping and diffusion-weighted imaging. Tumors were analyzed ex vivo with histology. RESULTS AND DISCUSSIONS All treatments led to an increase in non-viable areas, but therapy-induced intratumoral changes differed between the two tumor models and the different targeted treatments. While ICI treatment led to intratumoral hemorrhage, sorafenib treatment mainly induced intratumoral necrosis. Treated 4T1 tumors showed increasing and extensive areas of necrosis, in comparison to 67NR tumors with only small, but also increasing, necrotic areas. After either of the applied treatments, intratumoral heterogeneity, was increased in both tumor models, and confirmed ex vivo by histology. Apparent diffusion coefficient with subsequent histogram analysis proved to be the most sensitive MRI sequence. In conclusion, mp MRI enables to assess dedicated therapy-related intratumoral changes and may serve as a biomarker for treatment response assessment.
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Affiliation(s)
- M Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany.
| | - E Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - C Geyer
- Clinic of Radiology, University of Münster, Münster, Germany
| | - A Helfen
- Clinic of Radiology, University of Münster, Münster, Germany
| | - B Maus
- Clinic of Radiology, University of Münster, Münster, Germany
| | - R Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - L Wachsmuth
- Clinic of Radiology, University of Münster, Münster, Germany
| | - W Heindel
- Clinic of Radiology, University of Münster, Münster, Germany
| | - M Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - C Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - M Wildgruber
- Clinic of Radiology, University of Münster, Münster, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Luen SJ, Viale G, Nik-Zainal S, Savas P, Kammler R, Dell'Orto P, Biasi O, Degasperi A, Brown LC, Láng I, MacGrogan G, Tondini C, Bellet M, Villa F, Bernardo A, Ciruelos E, Karlsson P, Neven P, Climent M, Müller B, Jochum W, Bonnefoi H, Martino S, Davidson NE, Geyer C, Chia SK, Ingle JN, Coleman R, Solbach C, Thürlimann B, Colleoni M, Coates AS, Goldhirsch A, Fleming GF, Francis PA, Speed TP, Regan MM, Loi S. Genomic characterisation of hormone receptor-positive breast cancer arising in very young women. Ann Oncol 2023; 34:397-409. [PMID: 36709040 PMCID: PMC10619213 DOI: 10.1016/j.annonc.2023.01.009] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/14/2022] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Very young premenopausal women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+HER2-) early breast cancer (EBC) have higher rates of recurrence and death for reasons that remain largely unexplained. PATIENTS AND METHODS Genomic sequencing was applied to HR+HER2- tumours from patients enrolled in the Suppression of Ovarian Function Trial (SOFT) to determine genomic drivers that are enriched in young premenopausal women. Genomic alterations were characterised using next-generation sequencing from a subset of 1276 patients (deep targeted sequencing, n = 1258; whole-exome sequencing in a young-age, case-control subsample, n = 82). We defined copy number (CN) subgroups and assessed for features suggestive of homologous recombination deficiency (HRD). Genomic alteration frequencies were compared between young premenopausal women (<40 years) and older premenopausal women (≥40 years), and assessed for associations with distant recurrence-free interval (DRFI) and overall survival (OS). RESULTS Younger women (<40 years, n = 359) compared with older women (≥40 years, n = 917) had significantly higher frequencies of mutations in GATA3 (19% versus 16%) and CN amplifications (CNAs) (47% versus 26%), but significantly lower frequencies of mutations in PIK3CA (32% versus 47%), CDH1 (3% versus 9%), and MAP3K1 (7% versus 12%). Additionally, they had significantly higher frequencies of features suggestive of HRD (27% versus 21%) and a higher proportion of PIK3CA mutations with concurrent CNAs (23% versus 11%). Genomic features suggestive of HRD, PIK3CA mutations with CNAs, and CNAs were associated with significantly worse DRFI and OS compared with those without these features. These poor prognostic features were enriched in younger patients: present in 72% of patients aged <35 years, 54% aged 35-39 years, and 40% aged ≥40 years. Poor prognostic features [n = 584 (46%)] versus none [n = 692 (54%)] had an 8-year DRFI of 84% versus 94% and OS of 88% versus 96%. Younger women (<40 years) had the poorest outcomes: 8-year DRFI 74% versus 85% and OS 80% versus 93%, respectively. CONCLUSION These results provide insights into genomic alterations that are enriched in young women with HR+HER2- EBC, provide rationale for genomic subgrouping, and highlight priority molecular targets for future clinical trials.
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Affiliation(s)
- S J Luen
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - G Viale
- International Breast Cancer Study Group Central Pathology Office, IEO European Institute of Oncology IRCCS, University of Milan, Milan, Italy
| | - S Nik-Zainal
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - P Savas
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - R Kammler
- International Breast Cancer Study Group, Coordinating Center, Central Pathology Office, Bern, Switzerland
| | - P Dell'Orto
- International Breast Cancer Study Group Central Pathology Office, Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - O Biasi
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - A Degasperi
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - L C Brown
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - I Láng
- Istenhegyi Health Center Oncology Clinic, National Institute of Oncology, Budapest, Hungary
| | - G MacGrogan
- Biopathology Department, Institut Bergonié Comprehensive Cancer Centre, Bordeaux, France
| | - C Tondini
- Osp. Papa Giovanni XXIII, Bergamo, Italy
| | - M Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Villa
- Oncology Unit, Department of Oncology, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - A Bernardo
- ICS Maugeri IRCCS, Medical Oncology Unit of Pavia Institute, Italy
| | - E Ciruelos
- University Hospital 12 de Octubre, Madrid, Spain
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - M Climent
- Instituto Valenciano de Oncologia, Valencia, Spain
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Santiago, Chile
| | - W Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - H Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1218, Bordeaux, France; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - S Martino
- The Angeles Clinic and Research Institute, Santa Monica, USA
| | - N E Davidson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA
| | - C Geyer
- Houston Methodist Cancer Center, NRG Oncology, Houston, USA
| | - S K Chia
- BC Cancer and Canadian Cancer Trials Group, Vancouver, Canada
| | - J N Ingle
- Mayo Clinic, Rochester, Minnesota, USA
| | - R Coleman
- National Institute for Health Research (NIHR) Cancer Research Network, University of Sheffield, Sheffield, UK
| | - C Solbach
- Breast Center, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - B Thürlimann
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland; Breast Center, Kantonsspital, St. Gallen, Switzerland
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A S Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group (IBCSG), Bern Switzerland and IEO European Institute of Oncology IRCCS, Milan, Italy
| | - G F Fleming
- Section of Hematology Oncology, The University of Chicago, Chicago, USA
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - T P Speed
- Bioinformatics Division, Walter and Eliza Hall Institute, Melbourne, Australia
| | - M M Regan
- Division of Biostatistics, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
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Loibl S, Sikov W, Huober J, Rugo H, Wolmark N, O'Shaughnessy J, Maag D, Untch M, Golshan M, Lorenzo JP, Metzger O, Dunbar M, Symmans W, Geyer C. 119O Event-free survival (EFS), overall survival (OS), and safety of adding veliparib (V) plus carboplatin (Cb) or carboplatin alone to neoadjuvant chemotherapy in triple-negative breast cancer (TNBC) after ≥4 years of follow-up: BrighTNess, a randomized phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.400] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Loibl S, Rastogi P, Seiler S, Jackisch C, Lucas P, Denkert C, Poklepovic A, Moreno F, Mamounas E, Nekljudova V, Lin Y, Wolmark N, Geyer C. 248TiP A randomized, double-blind, phase III trial of neoadjuvant chemotherapy (NACT) with atezolizumab/placebo in patients (pts) with triple-negative breast cancer (TNBC) followed by adjuvant continuation of atezolizumab/placebo (GeparDouze). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.369] [Citation(s) in RCA: 1] [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: 10/23/2022] Open
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Sparano J, Gray R, Makower D, Albain K, Saphner T, Badve S, Wagner L, Mihalcioiu C, Desbiens C, Hayes D, Dees E, Geyer C, Olson J, Wood W, Lively T, Paik S, Ellis M, Abrams J, Sledge G. Clinical outcomes by chemotherapy regimen in patients with RS 26-100 in TAILORx. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Loibl S, Jackisch C, Rastogi P, Seiler S, Lucas P, Denkert C, Costantino J, Nekljudova V, Wolmark N, Geyer C. GeparDouze/NSABP B-59: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy with atezolizumab or placebo in patients with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz097.014] [Citation(s) in RCA: 2] [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: 11/12/2022] Open
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Tutt A, Kaufman B, Garber J, Gelber R, McFadden E, Goessl C, Viale G, Geyer C, Zardavas D, Arahmani A, Fumagalli D, De Azambuja E, Ponde N, Herbolsheimer P, Wu W, Constantino J, Rastogi P. OlympiA: A randomized phase III trial of olaparib as adjuvant therapy in patients with high-risk HER2-negative breast cancer (BC) and a germline BRCA1/2 mutation (gBRCAm). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pouillot C, Fournier S, Glasenapp J, Rambaud G, Bougrini K, Vi Fane R, Geyer C, Adjedj J. P1738Pressure wire versus microcatheter for FFR measurement: a head-to-head comparison. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Sparano J, Gray R, Zujewski J, Makower D, Pritchard K, Albain K, Hayes D, Geyer C, Dees C, Perez E, Keane M, Vallejos C, Goggins T, Mayer I, Brufsky A, Toppmeyer D, Kaklamani V, Atkins J, Olson J, Sledge G. 5BA Prospective trial of endocrine therapy alone in patients with estrogen-receptor positive, HER2-negative, node-negative breast cancer: Results of the TAILORx low risk registry. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31935-9] [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: 10/22/2022]
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Ritter L, Götz G, Sorge I, Lehnert T, Hirsch FW, Bühligen U, Vieweger A, Geyer C. Significance of MR angiography in the diagnosis of aberrant renal arteries as the cause of ureteropelvic junction obstruction in children. ROFO-FORTSCHR RONTG 2014; 187:42-8. [PMID: 25226231 DOI: 10.1055/s-0034-1385106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the importance of MRI with contrast-enhanced MRA for the detection or exclusion of aberrant or obstructing renal arteries in ureteropelvic junction obstruction in children. MATERIALS AND METHODS Key word-based search in RIS database (ureteropelvic junction obstruction/ MRI) and retrospective comparison of arterial findings from preoperative contrast -enhanced MRA and intra-operative inspection. From 2007 to 2013, 19 children with ureteropelvic junction obstruction underwent contrast-enhanced MRA. Based on the results of the MRI scan and MAG3 scintigraphy, the children were referred to surgery (Anderson-Hynes-pyeloplasty). RESULTS An aberrant renal artery was diagnosed with MRI in 14 of 19 children, and intra-operative inspection confirmed 13 of those 14. In the remaining 5 children, no aberrant vessel could be observed in MRI and this was confirmed intra-operatively in 3 of the 5 cases, while in the remaining 2, an aberrant vessel was found. Of the 14 children with aberrant vessels, 12 underwent surgery due to assumed ureteral obstruction, which was confirmed by surgery in 11 cases. In one case, an aberrant artery was found intra-operatively, but obstruction could not be confirmed. In one of the 14 children, the vessel was found in MRI, but its obstructing character was negated via MRA, which was confirmed intra-operatively. In the diagnosis of aberrant and obstructing renal arteries, contrast-enhanced MRA presents 85% sensitivity and 80% specificity, with a positive predictive value of 0.8. CONCLUSION MRI with contrast-enhanced MRA is suitable to detect aberrant and obstructing renal arteries. An obstructive effect of the aberrant vessel is to be assumed if the vessel has a close relationship to the ureteropelvic junction and if it is linearly stretched. KEY POINTS • MRI with contrast-enhanced MRA is a sure method for the detection of aberrant renal arteries in children with ureteropelvic junction obstruction. • The obstructive effect of the aberrant vessel can be derived from the close proximity of the vessel to the ureteropelvic junction and from the streched course of the vessel.
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Affiliation(s)
- L Ritter
- Department of Pediatric Radiology, University of Leipzig
| | - G Götz
- Department of Pediatric Surgery, University of Leipzig
| | - I Sorge
- Department of Pediatric Radiology, University of Leipzig
| | - T Lehnert
- Department of Pediatric Surgery, University of Leipzig
| | - F W Hirsch
- Department of Pediatric Radiology, University of Leipzig
| | - U Bühligen
- Department of Pediatric Surgery, University of Leipzig
| | - A Vieweger
- Department of Pediatric Radiology, University of Leipzig
| | - C Geyer
- Department of Pediatric Surgery, University of Leipzig
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Tutt A, Balmana J, Robson M, Garber J, Kaufman B, Geyer C, Saini K, Stuart M, Mann H, Fasching P. Olympia, Neo-Olympia and Olympiad: Randomized Phase III Trials of Olaparib in Patients (Pts) with Breast Cancer (Bc) and a Germline Brca1/2 Mutation (Gbrcam). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.76] [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: 11/12/2022] Open
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Manios Y, Androutsos O, Katsarou C, Iotova V, Socha P, Geyer C, Moreno L, Koletzko B, De Bourdeaudhuij I. Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:5-13. [PMID: 25047374 DOI: 10.1111/obr.12175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 04/08/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children's key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012-2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.
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Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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Androutsos O, Katsarou C, Payr A, Birnbaum J, Geyer C, Wildgruber A, Kreichauf S, Lateva M, De Decker E, De Craemer M, Socha P, Moreno L, Iotova V, Koletzko BV, Manios Y. Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study. Obes Rev 2014; 15 Suppl 3:48-52. [PMID: 25047378 DOI: 10.1111/obr.12182] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
Since school-based interventions are mainly delivered by the school staff, they need to be well-trained and familiarized with the programme's aims, procedures and tools. Therefore, the institute, research group, governmental or non-governmental body in charge of the coordination and implementation of the programme needs to devote time and resources to train the school staff before programme's implementation. This is particularly crucial in multi-centre studies where more than one research teams are involved. Both research teams and school staff need to be trained, using standard protocols and procedures, to ensure that the intervention will be delivered in a standardized manner throughout the intervention centres. The ToyBox-intervention, a multi-component, kindergarten-based, family-involved intervention, focusing on water consumption, snacking, physical activity and sedentary behaviours in preschool children, was implemented over the academic year 2012-2013 in six European countries. As part of this intervention, three teachers' training sessions were delivered to motivate and train teachers in implementing the intervention. The local researchers were trained centrally before delivering the training sessions for the teachers and followed a common protocol using standardized presentations and procedures. The aim of the current paper is to describe the protocol and methodological issues related to the teachers' training sessions conducted within the ToyBox-intervention.
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Affiliation(s)
- O Androutsos
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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Pil L, Putman K, Cardon G, De Bourdeaudhuij I, Manios Y, Androutsos O, Lateva M, Iotova V, Zych K, Góźdź M, González-Gil EM, De Miguel-Etayo P, Geyer C, Birnbaum J, Annemans L. Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study. Obes Rev 2014; 15 Suppl 3:81-9. [PMID: 25047383 DOI: 10.1111/obr.12179] [Citation(s) in RCA: 17] [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] [Received: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.
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Affiliation(s)
- L Pil
- Department of Public Health, Ghent University, Ghent, Belgium
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Große HN, Barczyk-Kahlert K, Becker A, Vogl T, Heindel W, Bremer C, Geyer C, Eisenblätter M. Abschätzung des metastatischen Potenzials beim murinen Mammakarzinom mittels optischer in vivo Bildgebung zur Darstellung Tumor-assoziierter Makrophagen. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373255] [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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Lee CK, Davies L, Gebski V, Lord S, Di Leo A, Johnston S, Geyer C, Cameron D, Press M, Ellis C, Simes J, deSouza P. Abstract P1-08-14: HER2 extracellular domain (ECD): A predictive marker of lapatinib treatment benefit in advanced breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-08-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Pretreatment serum HER2 ECD may be associated with clinical outcome to lapatinib therapy and may also have treatment-independent prognostic value. We performed a meta-analysis to examine the prognostic and predictive role of baseline ECD (bECD) levels for lapatinib therapy. We also compared and contrasted its role with tumor HER2 status.
We analyzed bECD and tumor HER2 data in 1902 of 2264 patients (84%) with advanced breast cancer who were randomly assigned to receive lapatinib-containing therapy or control treatment in three clinical trials: EGF30001 (lapatinib and paclitaxel vs paclitaxel), EGF30008 (lapatinib and letrozole vs letrozole), and EGF100151 (lapatinib and capecitabine vs capecitabine). bECD was centrally measured by enzyme linked immunoassay and tumor HER2 was centrally determined by immunohistochemistry and fluorescence in situ hybridization. bECD and tumor HER2 status were examined for associations with objective tumor response (ORR), progression-free survival (PFS) and overall survival (OS) in the treatment groups.
Of the patients with both bECD and tumor HER2 data, 31% had HER2 bECD≥15 ng/mL and 28% had HER2+ cancer. The effectiveness of lapatinib-containing therapy was significantly associated with bECD level (treatment-bECD interaction P<0.001 [ORR], P<0.001 [PFS]). In patients with bECD≥15 ng/mL, lapatinib-containing therapy, compared to control, significantly improved ORR (odds ratio [OR] for complete and partial response, 1.88; P = 0.001) and PFS (hazards ratio [HR] for progression or death, 0.69; P<0.001). Among patients with bECD<15 ng/mL, there was no significant difference between treatment groups for ORR (OR, 1.17; P = 0.19) or PFS (HR, 0.93; P = 0.30). The effectiveness of lapatinib-containing therapy was also significantly associated with HER2 tumor status for ORR (OR [HER2+] 2.39, P<0.001; OR [HER2-] 1.10, P = 0.43; treatment-HER2 interaction P = 0.001) and PFS (HR [HER2+] 0.63, P<0.001; HR [HER2-] 0.95, P = 0.46; treatment-HER2 interaction P<0.001). When bECD and HER2 tumor status were examined together, the effectiveness of lapatinib-containing therapy was significantly associated with both bECD and HER2 tumor status for PFS (treatment-biomarker interaction P = 0.02[HER2], P = 0.001[bECD]) but only for bECD for ORR (treatment-biomarker interaction P = 0.07 [HER2], P = 0.003 [bECD]). The effectiveness of lapatinib-containing therapy was not significantly associated with OS for both biomarkers (treatment-biomarker interaction P = 0.30 [bECD] and P = 0.80 [HER2]). In the control groups, bECD≥15 ng/mL (HR 1.35, P = 0.003) and HER2+ (HR 1.67, P<0.001) were associated with shorter PFS after adjusting for other baseline characteristics. bECD≥15 ng/mL (HR 1.89, P<0.001) but not HER2+ (HR 0.97, P = 0.81) was associated with shorter OS after adjusting for other baseline characteristics.
Lapatinib therapy was associated with higher ORR and longer PFS in patients with elevated ECD levels. Elevated ECD was also associated with shorter PFS and OS in patients treated with non-lapatinib therapy. ECD provided additional predictive and prognostic information, in addition to tumor HER2 status, that if validated, could aid in treatment decisions. The predictive role of ECD in other anti-HER2 therapies requires further research.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-14.
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Affiliation(s)
- CK Lee
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - L Davies
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - V Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - S Lord
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - A Di Leo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - S Johnston
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - C Geyer
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - D Cameron
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - M Press
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - C Ellis
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - J Simes
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
| | - P deSouza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Hospital of Prato, Prato, Italy; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Virginia Commonwealth University Massey Cancer Center, Richmond, VA; The University of Edinburgh, United Kingdom; The University of Southern California, Norris Comprehensive Cancer Center; GlaxoSmithKline; University of Western Sydney, Australia
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Pedrosa DJ, Geyer C, Klosterkötter J, Fink GR, Burghaus L. [Anti-NMDA receptor encephalitis: a neurological and psychiatric emergency]. Fortschr Neurol Psychiatr 2012; 80:29-35. [PMID: 22173967 DOI: 10.1055/s-0031-1281961] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Anti-NMDA receptor encephalitis is a severe autoimmune disease, first described in 2007. Since then a number of cases have been published, suggesting that to date the disease is a considerably underdiagnosed entity. The clinical picture develops over a relatively long period of time and is initially characterised by psychiatric symptoms such as decreased levels of consciousness and hallucinations as well as paranoid behaviour. In the course of the disease neurological symptoms occur, in particular, seizures, autonomic dysfunction and dyskinesias. Due to the young age of many patients, the symptoms are often mistaken as to result from drug-induced psychosis. Anti-NMDA receptor Encephalitis was first described in young women with teratomas. In the past few years the disorder has also been reported in men and children and without any detectable neoplasia. The diagnosis is based on the characteristic clinical picture and supportive findings in MRI, EEG and the cerebrospinal fluid. Hereby, highly specific autoantibodies directed against the NR1 subunit of the NMDA-type glutamate receptors in the CSF (or serum) play an important role and should be sought specifically in any case of an "encephalitis of unknown cause". The prognosis of the disease is favourable, even when autonomic disorders entail ventilation and/or prolonged intensive care treatment is necessary. Nonetheless, the clinical outcome is highly dependent on an early diagnosis and immunotherapy without delay. In the case of a malignancy, tumour removal is also crucial. Taken together, an interdisciplinary approach including neurologists, psychiatrists, oncologists and gynaecologists is essential in order to detect and effectively treat this disorder.
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Affiliation(s)
- D J Pedrosa
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln.
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Lehnert T, Ahmed H, Metzger R, Geyer C, Hirsch W, Till H. [Cystic abdominal mass as a complication due to posterior urethral valves]. Urologe A 2010; 50:74-6. [PMID: 21153395 DOI: 10.1007/s00120-010-2452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A case of urinoma with posterior urethral valves and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.
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Affiliation(s)
- T Lehnert
- Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20a, 04103 Leipzig, Deutschland.
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Meichsner A, Wygoda S, Richter T, Geyer C, Robel-Tillig E. Polyzystische Nierenerkrankungen bei zwei Frühgeborenen und einem Neugeborenen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261522] [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: 10/19/2022]
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Geyer C, Schmuntzsch L, Kaiser WA, Hilger I. Grundlegende Untersuchungen zur Anwendung von Ultrabreitband (UWB)-Radar-Technologie für die nicht-invasive Temperaturüberwachung. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253007] [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: 10/19/2022]
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Landgraf M, Zahner L, Nickel P, Till H, Keller A, Geyer C, Schwanitz N, Gausche R, Schmutzer G, Brähler E, Kiess W. Kindesmisshandlung. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-2129-0] [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: 11/28/2022]
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22
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Rastogi P, Buyse M, Swain S, Jacobs S, Robidoux A, Liepman M, Dy P, Geyer C, Wolmark N. Bevacizumab beginning concurrently with a sequential regimen of doxorubicin and cyclophosphamide followed by docetaxel and capecitabine as neoadjuvant therapy followed by postoperative bevacizumab alone for women with HER2-negative locally advanced breast cancer (LABC): A phase II trial of the NSABP Foundation Research Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
584 Background: Bevacizumab with chemotherapy improves outcomes in patients with metastatic breast cancer. The purpose of this trial was to determine the activity and safety profile of bevacizumab with chemotherapy in women with LABC. Methods: Between November 2006 and August 2007, 45 women with HER-2 negative LABC initiated preoperative standard AC x 4 followed by docetaxel 75 mg/m2 IV and capecitabine 825 mg/m2 BID days 1–14 (TX) every 21 days for 4 cycles. Bevacizumab 15 mg/kg IV was given concurrently with chemotherapy every 21 days for a total of 6 preoperative doses. Postoperatively, bevacizumab was resumed for a total of 10 doses. Primary endpoint was pathologic complete response rate (pCR) in the breast. The secondary endpoints include clinical response rates and toxicity. Results: The median age was 50 yrs (range 30–78). 30 patients had stage IIIA (67%), 12 stage IIIB (27%), and 3 stage IIIC (7%) disease. Of these, 10 (22%) had inflammatory breast cancer. 27 patients (60%) had ER-positive disease. A pCR in the breast was documented in 4/44 (9%) patients, which included negative axillary nodes. A complete clinical response was noted in 14/45 (31%). One patient did not have surgery due to progression. Toxicities included hand-foot (grade 2/3–33%/22%), mucositis (grade 2/3–49%/27%), and febrile neutropenia (grade 3–24%). Conclusions: This regimen demonstrated only modest activity with substantial toxicity, and does not appear to warrant further evaluation. This clinical trial is being conducted through the support of Genentech and Roche. [Table: see text]
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Affiliation(s)
- P. Rastogi
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - M. Buyse
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - S. Swain
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - S. Jacobs
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - A. Robidoux
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - M. Liepman
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - P. Dy
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - C. Geyer
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
| | - N. Wolmark
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; Washington Hospital Center, Washington, DC; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier de l'Universite Montreal, Montreal, QC, Canada; West Michigan Cancer Center, Kalamazoo, MI; Cancer Care Specialists of Central Illinois, Effingham, IL; Allegheny General Hospital, Pittsburgh, PA
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Smith JW, Buyse M, Rastogi P, Geyer C, Jacobs S, Patocskai E, Wolmark N. Epirubicin plus cyclophosphamide followed by docetaxel plus trastuzumab and bevacizumab as neoadjuvant therapy for HER2-positive locally advanced breast cancer (LABC) or as adjuvant therapy for HER2-positive pathologic stage III breast cancer (PS3BC): A phase II trial of the NSABP Foundation Research Group. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.580] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
580 Background: A previous phase II study evaluating the combination of trastuzumab (tras) and bevacizumab (bev) as first-line therapy in HER2 + MBC showed a response rate of 54%. The purpose of this trial is to determine the cardiac safety profile of these agents with docetaxel (T) following epirubicin plus cyclophosphamide (EC) in women with LABC and PS3BC and the activity in those with LABC. Methods: Since June 2007, 75 women with HER-2 + LABC or PS3BC have begun epirubicin 90 mg/m2 IV plus cyclophosphamide 600 mg/m2 IV q3wks x 4 followed by docetaxel 100 mg/m2 IV q3wks x 4. Targeted therapy: Cohort A (neoadjuvant), bev 15 mg/kg IV with Cycle 4 of EC, continued with the first 3 cycles of T. Standard weekly tras with 4 cycles of T. Postop, bev 15 mg/kg IV and tras 6 mg/kg IV q3wks to complete 1 yr of targeted therapy. Cohort B (adjuvant), bev 15 mg/kg q3wks for 4 cycles and weekly tras with T. After chemotherapy, bev and tras q3wks to complete 1 yr of therapy. Primary endpoints were the rate of cardiac events in both cohorts and pCR rate in breast/axillary lymph nodes in Cohort A. Results: Median age was 50 yrs. In Cohort A, 28 (53%) patients (pts) were stage IIIA, 20 (38%) stage IIIB, and 5 (9%) stage IIIC. 13 (25%) had inflammatory BC. A pCR occurred in 19 of the first 36 pts (53%). Toxicity information on the first 73 pts in both cohorts showed that grade 2 LVEF dysfunction has developed in 5 pts and grade 3 LVEF dysfunction in 2, 1 with NYHA Class II and 1 with Class III symptoms. The latter met criteria for a cardiac event. Conclusions: The regimen is active with an acceptable preliminary rate of cardiac toxicity. Updated results will be presented. This trial is conducted with the support of Genentech. [Table: see text]
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Affiliation(s)
- J. W. Smith
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - M. Buyse
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - P. Rastogi
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - C. Geyer
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - S. Jacobs
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - E. Patocskai
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
| | - N. Wolmark
- Columbia River Oncology Program, Portland, OR; International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; UPCI Magee-Womens Hospital Womens Cancer Clinic, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Centre Hospitalier Universite de Montreal, Montreal, QC, Canada
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Geyer C, Helbig M, Schwarz U, Sachs J, Hein MA, Kaiser WA, Hilger I. Can ultra-wideband (UWB) radar be used for imaging purposes? Preliminary in vitro investigations. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-0028-1085912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sherrill B, Amonkar MM, Stein S, Walker M, Geyer C, Cameron D. Q-TWiST analysis of lapatinib combined with capecitabine for the treatment of metastatic breast cancer. Br J Cancer 2008; 99:711-5. [PMID: 18728660 PMCID: PMC2528149 DOI: 10.1038/sj.bjc.6604501] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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] [Indexed: 11/15/2022] Open
Abstract
The addition of lapatinib (Tykerb/Tyverb) to capecitabine (Xeloda) delays disease progression more effectively than capecitabine monotherapy in women with previously treated HER2+ metastatic breast cancer (MBC). The quality-adjusted time without symptoms of disease or toxicity of treatment (Q-TWiST) method was used to compare treatments. The area under survival curves was partitioned into health states: toxicity (TOX), time without symptoms of disease progression or toxicity (TWiST), and relapse period until death or end of follow-up (REL). Average times spent in each state, weighted by utility, were derived and comparisons of Q-TWiST between groups performed with varying combinations of the utility weights. Utility weights of 0.5 for both TOX and REL, that is, counting 2 days of TOX or REL as 1 day of TWiST, resulted in a 7-week difference in quality-adjusted survival favouring combination therapy (P=0.0013). The Q-TWiST difference is clinically meaningful and was statistically significant across an entire matrix of possible utility weights. Results were robust in sensitivity analyses. An analysis with utilities based on EQ-5D scores was consistent with the above findings. Combination therapy of lapatinib with capecitabine resulted in greater quality-adjusted survival than capecitabine monotherapy in trastuzumab-refractory MBC patients.
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Affiliation(s)
- B Sherrill
- RTI Health Solutions, Research Triangle Park, NC 27709, USA.
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Geyer C, Helbig M, Schwarz U, Sachs J, Hein MA, Kaiser WA, Hilger I. Ultrabreitband (UWB)-Radar-Technologie in der Bildgebenden Tumordiagnostik – erste Untersuchungen. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tröbs RB, Krauss M, Geyer C, Tannapfel A, Körholz D, Hirsch W. Surgery in infants and children with testicular and paratesticular tumours: a single centre experience over a 25-year-period. Klin Padiatr 2007; 219:146-51. [PMID: 17525908 DOI: 10.1055/s-2007-973847] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Testicular and even more paratesticular tumours in children are rare. The aim of the study is to characterise the spectrum of these lesions with focus on the feasibility and effectiveness of testis sparing surgery. Twenty-four boys treated between 1980 and 2004 at the University Leipzig Medical Centre were evaluated. At presentation patients were between 5 months and 18 years old (median 23 months). Generally a high rate of malignant or potentially malignant tumours was observed. The majority of these tumours occurred in the first three years of age. The spectrum of testicular tumours comprised 13 germ cell tumours (6 yolk sac tumours, 6 teratomas, 1 embryonal carcinoma) and 4 sex cord stromal tumours (2 Leydig's cell, Sertoli's cell, granulosa cell). Both Leydig's cell tumours were endocrine active. Further on, we observed 3 boys with paratesticular rhabdomyosarcoma (RMS), and three with testicular and paratesticular metastases (Wilms' tumour, neuroblastoma, leukaemia). Serum alpha1-fetoprotein (AFP) was clearly elevated in 5 of 6 yolk sac tumours but remained within normal limits concerning the other entities. Human chorionic gonadotrophin was normal in all cases tested. During the observation period high inguinal orchidectomy was the surgical standard method. Dependent on tumour histology, stage and the recommended treatment schedule postoperative chemotherapy was added. Testis sparing surgery was performed in 3 boys with primary testicular tumours (2 Leydig's cell, mature cystic teratoma). Local relapses were not observed. Systemic relapses occurred in 3 cases (2 RMS, leukaemia). During a median follow up of 5 years all patients with primary testicular tumours survived event free. Meta-analysis of the recent literature revealed that testis sparing surgery is feasible and save in prepubertal boys after exclusion of a malignant tumour. If a testis sparing approach is planned, the following criteria are essential: 1. The presence of a well defined circumscribed nodule confirmed by imaging. 2. Normal levels of serum AFP and hCG. 3. The presence of sufficient healthy testicular parenchyma. However, the high rate of malignant or potentially malignant tumours suggests that high inguinal orchidectomy should remain the surgical standard of therapy.
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Affiliation(s)
- R-B Tröbs
- Kinderchirurgische Klinik, Marienhospital Herne, Ruhr-Universität Bochum, Widumer Strasse 8, 44627 Herne.
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Geyer C, Cernaianu G, Graefe G. Hydrostatic valves in treatment of paediatric hydrocephalus. Cerebrospinal Fluid Res 2005. [DOI: 10.1186/1743-8454-2-s1-s36] [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: 11/10/2022] Open
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Wapnir I, Anderson S, Mamounas E, Geyer C, Hyeon-Jeong J, Costantino J, Fisher B, Wolmark N. Survival after IBTR in NSABP Node Negative Protocols B-13, B-14, B-19, B-20 and B-23. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.517] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I. Wapnir
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - S. Anderson
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - E. Mamounas
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - C. Geyer
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - J. Hyeon-Jeong
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - J. Costantino
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - B. Fisher
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
| | - N. Wolmark
- Stanford Univ Sch of Medcn, Stanford, CA; Univ of Pittsburgh GSPH and NSABP Biostatist, Pittsburgh, PA; Aultman Health Fdn and NSABP Operations Ctr, Canton, OH; NSABP Operations Ctr, Pittsburgh, PA; Allegheny General Hospital, Pittsburgh, PA
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Bechdolf A, Pohlmann B, Geyer C, Ferber C, Klosterkötter J, Gouzoulis-Mayfrank E. Motivationsbehandlung bei Patienten mit der Doppeldiagnose Psychose und Sucht. Fortschr Neurol Psychiatr 2005; 73:728-35. [PMID: 16355315 DOI: 10.1055/s-2004-830258] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with schizophrenia and substance abuse disorders [dually diagnosed patients (DD)] show an unfavourable course of the illness and little interest in participating on specific integrated treatment programmes. Motivational interviewing (MI) has been shown to be effective among other substance abuse disorders and it aims to enhance intrinsic motivation to change problem behaviour. MI has been adapted for DD. The present paper reviews the empirical evidence for the efficacy of MI in DD. A search in the databases MEDLINE, EMBASE, PsycINFO was conducted and the methodological quality of the identified trials was assessed according to the Cochrane Collaboration and to the JADAD Scale. We identified 4 randomised studies with a total of 346 participants, in which MI interventions of 1 to 3 sessions were compared with various control conditions over a follow-up period of up to 6 months. With regard to the main outcome measures "subsequent participation at integrated treatment programme" (1 x positive, 2 x negative) and "substance use" (1 x positive, 1 x negative,) the studies gained contradictory results. In all 4 studies, there were relevant general methodological limitations (randomisation, blindness of raters, description of the reasons for drop-outs) and specific methodological shortcomings (sample size and sample homogenity, numbers of MI sessions, assessment of motivational status). Hence, at present the evidence for supporting MI in DD is not clear. This may be due to the methodological problems mentioned above or it may be that there is, in fact, no effect. Therefore, there is an urgent need for further research of MI in DD.
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Affiliation(s)
- A Bechdolf
- Klinik für Psychiatrie und Psychotherapie der Universität zu Köln.
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31
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Tolcher AW, Gerson SL, Denis L, Geyer C, Hammond LA, Patnaik A, Goetz AD, Schwartz G, Edwards T, Reyderman L, Statkevich P, Cutler DL, Rowinsky EK. Marked inactivation of O6-alkylguanine-DNA alkyltransferase activity with protracted temozolomide schedules. Br J Cancer 2003; 88:1004-11. [PMID: 12671695 PMCID: PMC2376384 DOI: 10.1038/sj.bjc.6600827] [Citation(s) in RCA: 302] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Temozolomide, an oral DNA methylator that inactivates the DNA repair enzyme O(6)-alkylguanine-DNA alkyltransferase (AGAT), has demonstrated anticancer activity on protracted schedules. Protracted schedules may lead to an 'autoenhancement' of temozolomide's inherent cytotoxic potential by cumulative reduction of the cell's capacity for AGAT-mediated DNA repair and resistance. This study was undertaken to characterise AGAT inactivation and regeneration in the peripheral blood mononuclear cells (PBMCs) of patients treated on two protracted temozolomide schedules. O(6)-alkyl guanine-DNA alkyltransferase activity was measured in the PBMCs of patients treated on two phase I protracted temozolomide studies. Patients were treated daily for either 7 days every 2 weeks (Schedule A) or 21 days every 4 weeks (Schedule B). The effects of various temozolomide doses (75-175 mg m(-2)), treatment duration (7-21 days), and temozolomide plasma levels on AGAT inactivation and regeneration, as well as the relation between AGAT inactivation and toxicity, were studied. O(6)-alkyl guanine-DNA alkyltransferase activity in PBMCs was measured serially in 52 patients. Marked inactivation of AGAT occurred following 7 days of temozolomide treatment, with mean AGAT activity decreasing by 72% (P<0.0001). Similarly, mean AGAT activity decreased by 63 and 73% after 14 and 21 days of treatment, respectively (P<0.001 for both comparisons). O(6)-alkyl guanine-DNA alkyltransferase inactivation was greater after 7 days of treatment with higher doses of temozolomide than lower doses and remained markedly reduced 7 days post-treatment. However, AGAT inactivation following temozolomide treatment for 14 and 21 days was similar at all doses. On the continuous 21-day schedule, AGAT inactivation was significantly greater in patients who experienced severe thrombocytopenia than those who did not (90.3+/-5.5 vs 72.5+/-16.1%, P<0.045). In conclusion, protracted administration of temozolomide, even at relatively low daily doses, leads to significant and prolonged depletion of AGAT activity, which may enhance the antitumour activity of the agent.
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Affiliation(s)
- A W Tolcher
- Institute of Drug Development, Cancer Therapy and Research Center, San Antonio, TX 78229, USA.
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Gräfe G, Handrik W, Geyer C. Hydrocephalus internus--first manifestation of chronic meningitis due to Listeria monocytogenes. Eur J Pediatr Surg 2001; 11 Suppl 1:S46-7. [PMID: 11848049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- G Gräfe
- Klinik und Poliklinik für Kinderchirurgie, Universität Leipzig, Germany.
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33
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Geyer C. Mathematical Statistics. J Am Stat Assoc 2001. [DOI: 10.1198/jasa.2001.s397] [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: 11/21/2022]
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Abstract
Congenital tegmental defects that present as unsuspected cerebrospinal fluid (CSF) otorrhea are diagnostic and therapeutic challenges. We reviewed 5 such patients to determine an optimal strategy for evaluation. Five patients presented with watery otorrhea, 4 of them after ventilation tube placement, and only 1 with rhinorrhea. The preoperative analysis of middle ear effusion for beta(2)-transferrin was positive in 2/4, equivocal in 1/4 and false negative in 1/4. Computerized tomography (CT) revealed nonspecific tegmental defects in all 5 patients. Magnetic resonance imaging (MRI) demonstrated meningoencephalocele in 3/5 and dural irregularity in 1/5. Tegmental defects were confirmed at surgery in all cases, demonstrating meningocele or arachnoid granulations in 2/5 and encephalocele in 2/5 patients. We recommend a combination of beta(2)-transferrin analysis to verify CSF, high resolution CT (axial and coronal planes) to diagnose tegmental defects, and MRI (multiplanar) to evaluate the type of herniation. A combination mastoid and middle fossa approach for definitive repair is suggested.
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Affiliation(s)
- H Valtonen
- Central Hospital of Central Finland, Jyväskylä, and Kuopio University Hospital, Kuopio, Finland.
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35
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Gräfe G, Geyer C, Rolle U. Infections after cerebrospinal fluid shunting. Eur J Pediatr Surg 2000; 10 Suppl 1:43-4. [PMID: 11214836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- G Gräfe
- Department of Paediatric Surgery, University of Leipzig, Germany
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36
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Tabet JY, Logeart D, Geyer C, Guiti C, Ennezat PV, Dahan M, Cohen-Solal A. Comparison of the prognostic value of left ventricular filling and peak oxygen uptake in patients with systolic heart failure. Eur Heart J 2000; 21:1864-71. [PMID: 11052859 DOI: 10.1053/euhj.2000.2174] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this prospective study was to compare the prognostic value of the mitral inflow pattern and peak oxygen uptake in patients with systolic heart failure. BACKGROUND Peak oxygen uptake is a major prognostic parameter in heart failure. It is not known whether a restrictive mitral inflow pattern has similar prognostic value. METHODS One hundred heart failure patients (ejection fraction <45%) underwent exercise testing after Doppler evaluation; prognosis was assessed after a mean follow-up of 17 months. RESULTS The ejection fraction was larger in group 1 (non-restrictive pattern: E/A mitral wave ratio <1 or between 1 and 2 with E wave deceleration time >/=140 ms, n=45) than in group 2 (restrictive pattern: E/A ratio >2 or between 1 and 2 with E deceleration time <140 ms, n=40) (29+/-9 vs 22+/-10%, P<0.05). Peak oxygen uptake was lower in group 2 (17+/-4 vs 22+/-5 ml. min(-1). kg(-1)57+/-11 vs 75+/-15% of predicted values;P<0.05 for both comparisons). Univariate analysis showed that the deceleration time (r=0.65), E/A ratio (r=-0.50) and heart rate increment (r=0.47) correlated best with peak oxygen uptake. A third group of patients with persistent fusion of the E and A waves (n=15) had exercise responses similar to those of group 2 patients. A short deceleration time (P=0.006), a restrictive or a fusion pattern (P=0.04) were associated with a poor outcome; the prognostic value of these Doppler variables was greater than that of ejection fraction, but remained less than peak oxygen uptake indexed by predicted values (P=0.0004). CONCLUSION The left ventricular filling pattern is a strong predictor of exercise capacity, and outcome, in patients with systolic heart failure and is independent of the left ventricular ejection fraction. Peak oxygen uptake remains a more powerful prognostic variable.
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Affiliation(s)
- J Y Tabet
- Service de Cardiologie, Hôpital Beaujon, Clìchy, France
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37
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Lee JJ, Hong WK, Hittelman WN, Mao L, Lotan R, Shin DM, Benner SE, Xu XC, Lee JS, Papadimitrakopoulou VM, Geyer C, Perez C, Martin JW, El-Naggar AK, Lippman SM. Predicting cancer development in oral leukoplakia: ten years of translational research. Clin Cancer Res 2000; 6:1702-10. [PMID: 10815888] [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: 02/16/2023]
Abstract
Our 10-year translational study of the oral premalignant lesion (OPL) model has advanced the basic understanding of carcinogenesis. Although retinoids have established activity in this model, a substantial percentage of our OPL patients progress to cancer, especially after treatment is stopped. On the basis of our 10-year OPL study, we have developed the first comprehensive tool for assessing cancer risk of OPL patients. This cancer risk assessment tool incorporates medical/demographic variables, epidemiological factors, and cellular and molecular biomarkers. Between 1988 and 1991, 70 advanced OPL patients were enrolled in a chemoprevention trial of induction with high dose isotretinoin (1.5 mg/kg/day for 3 months) followed by 9 months of maintenance treatment with either low dose isotretinoin (0.5 mg/kg/day) or beta-carotene (30 mg/d; total treatment duration, 1 year). We assessed the relationship between cancer risk factors and time to cancer development by means of exploratory data analysis, logrank test, Cox proportional hazard model, and recursive partitioning. With a median follow-up of 7 years, 22 of our 70 patients (31.4%) developed cancers in the upper aerodigestive tract following treatment. The overall cancer incidence was 5.7% per year. The most predictive factors of cancer risk are OPL histology, cancer history, and three of the five biomarkers we assessed (chromosomal polysomy, p53 protein expression, and loss of heterozygosity at chromosome 3p or 9p). In the multivariable Cox model, histology (P = 0.0003) and the combined biomarker score of chromosomal polysomy, p53, and loss of heterozygosity (P = 0.0008) are the strongest predictors for cancer development. Retinoic acid receptor beta and micronuclei were not associated with increased cancer risk. We have demonstrated a successful strategy of comprehensive cancer risk assessment in OPL patients. Combining conventional medical/demographic variables and a panel of three biomarkers can identify high risk patients in our sample. This result will need to be validated by future studies. With the identification of high risk individuals, more efficient chemoprevention trials and molecular targeting studies can be designed.
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Affiliation(s)
- J J Lee
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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38
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Logeart D, Gambert A, Beyne P, Guiti C, Geyer C, Bourgoin P, Alonso C, Ennezat PV, Gourgon R, Cohen-Solal A. [Brain natriuretic peptide (BNP) in coronary insufficiency: relationship with left ventricular filling and exercise tolerance]. Ann Cardiol Angeiol (Paris) 1999; 48:523-8. [PMID: 12555377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Brain natriuretic peptide (BNP) is a recently discovered peptide, secreted by the atria and ventricles in response to parietal distension. It was recently proposed as a screening test for left ventricular failure. The authors assayed this peptide at rest in 37 patients with chronic heart failure due to left ventricular systolic dysfunction and another 20 patients with various diseases (respiratory failure, cirrhosis, heart transplantation, "diastolic" heart failure) but normal left ventricular systolic function. A significant increase compared to normal values was observed not only in the group of heart failure patients, but also in patients with all other diseases. BNP was significantly higher in NYHA class IV patients. The relationship between plasma BNP levels and ejection fraction was not significant. On the other hand, a good correlation was observed between BNP and left ventricular filling parameters evaluated by cardiac Doppler: E wave deceleration time (r = -0.53, p = 0.001), E/A ratio: r = 0.57 p = 0.005) or VO2 max (r = -0.55, p < 0.005).
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Affiliation(s)
- D Logeart
- Service de Cardiologie et de Biochimie, Hôpital Beaujon, 100, boulevard du Général Leclerc, 92110 Clichy
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39
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Affiliation(s)
- C Geyer
- McKinsey New Venture, Munich, Germany
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40
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Heinz A, Ragan P, Jones DW, Hommer D, Williams W, Knable MB, Gorey JG, Doty L, Geyer C, Lee KS, Coppola R, Weinberger DR, Linnoila M. Reduced central serotonin transporters in alcoholism. Am J Psychiatry 1998; 155:1544-9. [PMID: 9812115 DOI: 10.1176/ajp.155.11.1544] [Citation(s) in RCA: 198] [Impact Index Per Article: 7.6] [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: 11/30/2022]
Abstract
OBJECTIVE Dysfunction of monoamine uptake mechanisms has been implicated in the pathogenesis of alcohol dependence. The authors explored whether serotonergic dysfunction is associated with anxiety and depression, which increase the risk of relapse in alcoholics. METHOD The availability of serotonin and dopamine transporters in 22 male alcoholics and 13 healthy male volunteers was measured with the use of [123I] beta-CIT and single photon emission computed tomography, and psychopathological correlates were assessed. RESULTS A significant reduction (a mean of about 30%) in the availability of brainstem serotonin transporters was found in the alcoholics, which was significantly correlated with lifetime alcohol consumption and with ratings of depression and anxiety during withdrawal. CONCLUSIONS The findings support the hypothesis of serotonergic dysfunction in alcoholism and in withdrawal-emergent depressive symptoms.
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Affiliation(s)
- A Heinz
- Clinical Brain Disorders Branch, NIMH, Washington, D.C., USA.
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41
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Abstract
The concept of field cancerization and the multistep carcinogenesis theory are the premises on which the development of chemoprevention efforts has been based. The first concept underlies the fact that patients who have been cured of a cancer in the aerodigestive tract are still at risk of developing additional primary tumors in the same field, and the multistep carcinogenesis theory implies that the conceivable arrest of one of the steps by chemoprevention might be enough to impede the development of cancer. There is ongoing research for development of new candidate-chemopreventive substances in most areas of oncology. Most of the clinical experience in chemoprevention of head and neck cancer is based on the use of retinoids. Retinoids in high doses have demonstrated activity in treating oral premalignant lesions (OPLs) but with frequent side effects and early relapse after cessation of therapy. Subsequent trials showed better tolerability of retinoids in lower doses. Ongoing trials are currently evaluating whether chemoprevention over 3 years might have longer-lasting effect both on OPLs and in the prevention of second primary tumors.
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Affiliation(s)
- C Geyer
- Thoracic and Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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42
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Cohen-Solal A, Geyer C. [Cardiac insufficiency in the aged]. Soins Gerontol 1998:5-10. [PMID: 9555492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- A Cohen-Solal
- Service de Cardiologie du Pr Gourgon, Hôpital Beaujon, Clichy
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Cohen-Solal A, Laperche T, Czitrom D, Geyer C, Boudvillain O. [Indications for heart transplantation (excluding emergencies)]. Arch Mal Coeur Vaiss 1996; 89 Spec No 6:15-22. [PMID: 9092421] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The improved diagnosis in chronic cardiac failure and the lack of donor hearts have lead to a reexamination of the indications of cardiac transplantation. In the absence of a contraindication, the indication is straightforward in class IV of the NYHA to improve quality of life. In less sympatomatic patients, the primary objectives are to improve the prognosis and prevent sudden death: the indication should be considered with respect to a range of criteria (the VO2 max and arrhythmogenic potential are important features) and the rate of progression of the disease (resistance to treatment, repeated episodes of decompensation). This indication may and should be reevaluated to optimise the distribution of the race donor hearts for the benefit of patient with the most to gain.
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Abstract
BACKGROUND This investigation examined factors affecting patient involvement in consultations to decide local treatment for early breast cancer and the effectiveness of two methods of preconsultation education aimed at increasing patient participation in these discussions. METHODS Sixty patients with Stage I or II breast cancer (1) were pretested on their knowledge about breast cancer treatment and optimism for the future, (2) were randomly assigned to one of two methods for preconsultation education: interactive multimedia program or brochure, (3) completed knowledge and optimism measures, (4) consulted with a medical oncologist, radiation oncologist, and general surgeon, and (5) completed self-report measures assessing their involvement in the consultations and control over decision-making. The consultations were audiorecorded and analyzed to identify behavioral indicators of patient involvement (question-asking, opinion-giving, and expressing concern) and physician utterances encouraging patient participation. RESULTS College-educated patients younger than 65 years of age were more active participants in these consultations than were older, less educated patients. In addition, patients showed more involvement when they interacted with physicians who encouraged and facilitated patient participation. The method of education did not affect patient involvement although patients tended to learn more about breast cancer treatment after using the multimedia program than after reading the brochure. CONCLUSIONS Although patients vary in their expressiveness, physicians may be able to increase patient participation in deciding treatment by using patient-centered behavior. Also, preconsultation education appears to be an effective clinical strategy for helping patients gain an accurate understanding of their treatment options before meeting with physicians.
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Affiliation(s)
- R L Street
- Institute for Health Care Evaluation, Texas A & M University Health Science Center, College Station, TX 77843-4234, USA
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45
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Valberg SJ, Geyer C, Sorum SA, Cardinet GH. Familial basis of exertional rhabdomyolysis in quarter horse-related breeds. Am J Vet Res 1996; 57:286-90. [PMID: 8669756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To trace pedigrees from affected horses, identify likely contributing founder horses, and determine the conditional probability of founder genotypes. DESIGN Muscle biopsy records from the Neuromuscular Disease Laboratory at the University of California-Davis and the University of Minnesota were searched to identify horses with a polysaccharide storage myopathy and exercise intolerance/rhabdomyolysis. Pedigrees containing 5 to 6 generations were obtained where possible. ANIMALS 13 Quarter Horses, 4 American Paint Horses, 3 Appaloosas, and 3 Quarter Horse crossbreds (16 mares, 4 geldings, and 3 stallions) were identified with polysaccharide storage myopathy. Pedigrees were available for 18 horses. PROCEDURE Inbreeding coefficients, founder contributions, and conditional probability of founder genotypes were calculated. RESULTS Three stallions (A, B, and C) were featured prominently in the pedigrees. Stallions A and B descended from a common sire. On average, A contributed 8.8% (range, 0 to 23%) of the genes in affected horses, B contributed 4.2% (range, 0 to 14%), and C contributed 3.0% (range, 0 to 14%). The sire and dam of 4 horses were descendants of stallion A, the sire and dam of 1 horse were descendants of stallion B, and the sire and dam of 11 horses were descendants of a combination of stallions A and B. The pattern of inheritance resembled an autosomal recessive disorder. Assuming this pattern of inheritance, the conditional probability that these founders were carriers or recessive for the trait was > 99.29% for stallions A and B and 92% for stallion C. CONCLUSIONS Results support a familial basis for polysaccharide storage myopathy and associated exertional rhabdomyolysis in Quarter Horse-related breeds. The strong contribution of particular founder stallions to the gene pool in some lines of Quarter Horses may explain the high incidence of exertional rhabdomyolysis in these horses.
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Affiliation(s)
- S J Valberg
- Department of Clinical and Population Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA
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46
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Abstract
BACKGROUND This investigation examined factors affecting patient involvement in consultations to decide local treatment for early breast cancer and the effectiveness of two methods of preconsultation education aimed at increasing patient participation in these discussions. METHODS Sixty patients with Stage I or II breast cancer (1) were pretested on their knowledge about breast cancer treatment and optimism for the future, (2) were randomly assigned to one of two methods for preconsultation education: interactive multimedia program or brochure, (3) completed knowledge and optimism measures, (4) consulted with a medical oncologist, radiation oncologist, and general surgeon, and (5) completed self-report measures assessing their involvement in the consultations and control over decision-making. The consultations were audiorecorded and analyzed to identify behavioral indicators of patient involvement (question-asking, opinion-giving, and expressing concern) and physician utterances encouraging patient participation. RESULTS College-educated patients younger than 65 years of age were more active participants in these consultations than were older, less educated patients. In addition, patients showed more involvement when they interacted with physicians who encouraged and facilitated patient participation. The method of education did not affect patient involvement although patients tended to learn more about breast cancer treatment after using the multimedia program than after reading the brochure. CONCLUSIONS Although patients vary in their expressiveness, physicians may be able to increase patient participation in deciding treatment by using patient-centered behavior. Also, preconsultation education appears to be an effective clinical strategy for helping patients gain an accurate understanding of their treatment options before meeting with physicians.
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Affiliation(s)
- R L Street
- Institute for Health Care Evaluation, Texas A & M University Health Science Center, College Station, TX 77843-4234, USA
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47
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Abstract
Thirty-nine patients who suffered a segmental ischemic necrosis of the hip, fifteen of which affected on both sides, were treated with osteotomy of the femur. The re-examinations were carried out after an average period of 6.6 (2.5-12) years. While in twenty one cases, the hip necrosis was treated exclusively by varisation, in thirty three cases a combination of varisation and flexion was effected. 12 patients (equivalent to 22.2%), all of them with a necrotic angle of more than 115 degrees, were provided with a total hip arthroplasty in the interval. The patients with a necrotic angle smaller than 115 degrees showed a definite alleviation of the pain symptoms, an increased hip flexibility and an improved locomotory pattern.
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Affiliation(s)
- U Helwig
- Orthopädische Universitätsklinik Wien
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48
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Affiliation(s)
- C Geyer
- Institute of Veterinary Pathology, University of Munich, Germany
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49
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Geyer C, Hafner A, Pfleghaar S, Hermanns W. Immunohistochemical and ultrastructural investigation of granular cell tumours in dog, cat, and horse. Zentralbl Veterinarmed B 1992; 39:485-94. [PMID: 1455940 DOI: 10.1111/j.1439-0450.1992.tb01197.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Six canine, one feline and one equine granular cell tumours (GCTs) were investigated electron microscopically and immunohistochemically. The tumours were tested for reactivity with monoclonal antibodies against vimentin and desmin and with polyclonal antibodies against cytokeratin, S-100 protein, glial fibrillary acidic protein (GFAP) and neuron specific enolase (NSE). All GCTs were characterized by their PAS positive cytoplasmic granules in light microscopy, which in electron microscopy appeared as lysosome-like granules. In each case two canine GCTs were stained by the antibody against cytokeratin, vimentin and S-100 protein. Cells of the equine GCT showed reactivity with the antiserum against S-100 protein. In the feline GCT no reactivity with any of the antibodies tested was observed. These differences of the immunohistochemical reactions of GCTs suggest a nonuniform histogenesis of GCTs in domestic animals. The reactivity of the tumour cells with the antiserum against NSE is discussed.
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Affiliation(s)
- C Geyer
- Institut für Tierpathologie, Ludwig-Maximilians-Universität München
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Albrecht H, Ehrlichmann H, Hamacher T, Krüger A, Nau A, Nippe A, Reidenbach M, Schäfer M, Schröder H, Schulz HD, Sefkow F, Wurth R, Appuhn RD, Hast C, Herrera G, Kolanoski H, Lange A, Lindner A, Mankel R, Schieber M, Siegmund T, Spaan B, Thurn H, Töpfer D, Walther A, Wegener D, Paulini MG, Reim K, Volland U, Wegener H, Mundt R, Oest T, Schmidt-Parzefall W, Funk W, Stiewe J, Werner S, Ball S, Gabriel JC, Geyer C, Hölscher A, Hofmann W, Holzer B, Khan S, Knöpfle KT, Spengler J, Britton DI, Charlesworth CEK, Edwards KW, Kapitza H, Krieger P, Kutschke R, MacFarlane DB, Orr RS, Patel PM, Prentice JD, Seidel SC, Tspolitis G, Tzamariudaki K, Water RG, Yoon TS, Reßing D, Schael S, Schubert KR, Strahl K, Waldi R, Weseler S, Bostjančič B, Kernel G, Križan P, Križnič E, Podobnik T, Živko T, Cronström HI, Jönsson L, Balagura V, Danilov M, Droutskoy A, Fominykh B, Golutvin A, Gorelov I, Ratnikov F, Lubimov V, Pakhlov P, Rostovtsev A, Semenov A, Semenov S, Shevchenko V, Soloshenko V, Tichomirov I, Zaitsev Y, Childers R, Darden CW. Production ofD S + mesons inB decays and determination of $$f_{D_S } $$. ACTA ACUST UNITED AC 1992. [DOI: 10.1007/bf01881703] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [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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