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Erikstein BS, Ahmed AB, Forthun RB, Leh F, Gjertsen BT, Reikvam H. Treatment and Response Evaluation Challenges in a Pregnant Woman With B-Cell Lymphoblastic Leukemia and Li-Fraumeni Syndrome. J Hematol 2023; 12:92-99. [PMID: 37187497 PMCID: PMC10181328 DOI: 10.14740/jh1107] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Li-Fraumeni syndrome (LFS) is a cancer predisposing syndrome caused by pathogenic germline TP53 gene mutations with important therapeutic and prognostic implications for many types of cancer. A small proportion of LFS patients develop B-cell lymphoblastic leukemia (B-ALL) in adult years. Standard treatment often proves inadequate, but immunotherapy has provided new treatment options. The current case report presents a pregnant woman with LFS and newly diagnosed B-ALL with hypodiploidy developed after treatment for early-onset breast cancer. We describe the treatment course, treatment-related complications and provide laboratory data crucial for evaluating and modifying treatment for this difficult clinical case. Our findings support the need for close collaboration between clinicians and experts on immunophenotyping. Through our report, we show that immunotherapy is feasible in patients with LFS and B-ALL, despite a poor initial response to induction therapy.
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Affiliation(s)
- Bjarte Skoe Erikstein
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Corresponding Author: Bjarte Skoe Erikstein, Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
| | - Aymen Bushra Ahmed
- Department of Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
| | | | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Tore Gjertsen
- Department of Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, Precision Oncology Research Group, University of Bergen, Bergen, Norway
| | - Håkon Reikvam
- Department of Medicine, Hematology Section, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Leh F, Stalund IV, Bjånes TK, Ohldieck C, Svarstad E, Leh S. Polyvinylpyrrolidone deposition disease in patients with intravenous opioid use: a case series. Hum Pathol 2021; 116:102-111. [PMID: 34329652 DOI: 10.1016/j.humpath.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/27/2022]
Abstract
The polymer polyvinylpyrrolidone (PVP) is an excipient widely used in prescription drugs. Depending on the molecular weight (MW), parenterally administered PVP may accumulate in various tissues. Consequently, moderate and high MW PVP have only been used in oral preparations since the late 1970s. Surprisingly, starting in 2009, pathology departments in Norway received biopsies revealing PVP deposition, all from patients with a history of intravenous drug use. We identified 13 patients with PVP deposition and re-evaluated 31 biopsies and two autopsies. Common indications for biopsy were renal insufficiency, anemia, pathological fractures, and abdominal complaints. We observed PVP deposits in all biopsies (kidney, hematopoietic bone marrow, bone, gastrointestinal tract, lymph node, and skin) and all sampled tissue from the autopsies. Overall, the clinical findings could be related to PVP deposits in the biopsies. In the most seriously affected patients, PVP deposition caused severe organ dysfunction and contributed to the fatal outcomes of two patients. All patients except for one were prescribed opioid substitution drugs (OSDs), and most of the patients admitted to having injected such medications. Several OSDs contain PVP. One methadone formulation that was marketed in Norway from 2007 to 2014 contained large amounts of very high MW PVP, making it the most likely source of PVP deposition. Although the presumed source of PVP in these patients has now been withdrawn from the market, pathologists should be aware of PVP deposits when evaluating biopsies from this patient group.
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Affiliation(s)
- Friedemann Leh
- Department of Pathology, Haukeland University Hospital, Jonas Lies Vei 65, Bergen, 5021, Norway.
| | - Ida Viken Stalund
- Department of Pathology, Haukeland University Hospital, Jonas Lies Vei 65, Bergen, 5021, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies Vei 87, Bergen, 5021, Norway.
| | - Tormod Karlsen Bjånes
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Jonas Lies Vei 65, Bergen, 5021, Norway.
| | - Christian Ohldieck
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, Bergen, 5021, Norway.
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Jonas Lies Vei 87, Bergen, 5021, Norway.
| | - Sabine Leh
- Department of Pathology, Haukeland University Hospital, Jonas Lies Vei 65, Bergen, 5021, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies Vei 87, Bergen, 5021, Norway.
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Wiese-Hansen H, Leh F, Lodvir Hemsing A, Reikvam H. Immunoglobulin-Storing Histiocytosis: A Case Based Systemic Review. J Clin Med 2021; 10:jcm10091834. [PMID: 33922555 PMCID: PMC8122927 DOI: 10.3390/jcm10091834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare event in disorders associated with monoclonal gammopathy and is mostly associated with the accumulation of immunoglobulins (Igs) in the cytoplasm of histiocytes. In this article, we present a case of a 75-year-old female with IgG kappa monoclonal gammopathy of undetermined significance (MGUS) and signs of a non-crystallized version of immunoglobulin-storing histiocytosis (IgSH) in a vertebra corpus. Furthermore, we performed a literature review based on all cases of storing histiocytosis identified by literature search between 1987 and 2020 and identified 140 cases in total. The median age at diagnosis was 60 years (range 18–91), with an equal sex distribution (51% men). The majority of the patients had an underlying neoplastic B-cell disorder, most often multiple myeloma (MM), MGUS, or lymphoplasmacytic lymphoma (LPL). The main affected organ systems or tissue sites were bone (n = 52), followed by head and neck (n = 31), kidney (n = 23), lung (n = 20), and gastrointestinal (GI)-tract (n = 18). IgG was the main immunoglobulin class involved, and most cases were associated with kappa light chain expression. We conclude that IgSH is a rare disease entity but should be considered with unusual findings in several organ systems associated with monoclonal gammopathy, especially with kappa light chain expression.
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Affiliation(s)
- Hanne Wiese-Hansen
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
| | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Anette Lodvir Hemsing
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Håkon Reikvam
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
- Correspondence:
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Stalund IV, Riise GN, Leh F, Bjånes TK, Riise L, Svarstad E, Leh S. Case Report: Polyvinylpyrrolidone deposition disease from repeated injection of opioid substitution drugs: report of a case with a fatal outcome. F1000Res 2021; 10:300. [PMID: 34316359 PMCID: PMC8276182 DOI: 10.12688/f1000research.51927.1] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Intravenous injection of oral opioid substitution drugs (OSD) is widespread among injecting drug users. Several OSDs contain the polymer polyvinylpyrrolidone (PVP) as an excipient. Parenterally administered PVP of high molecular weight may accumulate in tissues and organs. This phenomenon was first described in the 1950s, when PVP was utilised in medication for parenteral use. We report a case of an opioid-addicted patient with extensive PVP-deposition caused by repeated injections of OSDs. Case presentation: A 30-year-old male drug addicted patient in opioid substitution therapy (OST) was repeatedly referred to his local hospital in a poor general condition. Work-up revealed severe normocytic anaemia, renal insufficiency, pancreas insufficiency and pathological fractures. Biopsies from fractured bones, bone marrow and gastric mucosa showed extensive infiltrates of histiocytes with intracytoplasmic vacuoles. Vacuole content stained slightly bluish in hematoxylin and eosin stain, red in Congo red stain and black in periodic acid methenamine silver stain. The morphological appearance and staining properties were in accordance with the diagnosis of PVP deposition. The patient had been injecting both buprenorphine tablets and a specific methadone syrup for several years. The methadone syrup contained large amounts of high molecular weight PVP, making it the most likely cause of the deposition. His health quickly deteriorated and he died, impaired by multi-organ failure and cachexia, five years after the first diagnosis of PVP-deposition. The autopsy revealed extensive PVP-deposition in all sampled organs and tissues. Conclusions: Histological investigation and the correct identification of PVP in the biopsies led to the discovery of a severe adverse effect from long-standing misuse of a drug. The disseminated PVP deposition likely contributed to multi-organ dysfunction and cachexia with a fatal outcome. The deposited PVP likely originated from repeated injections of a certain methadone syrup.
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Affiliation(s)
- Ida Viken Stalund
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
| | - Gro Nygard Riise
- Department of Medicine, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Tormod Karlsen Bjånes
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Lars Riise
- Kvam Municipality, Grovagjelet 16, 5600 Norheimsund, Norway
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
| | - Sabine Leh
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
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5
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Stalund IV, Riise GN, Leh F, Bjånes TK, Riise L, Svarstad E, Leh S. Case Report: Polyvinylpyrrolidone deposition disease from repeated injection of opioid substitution drugs: report of a case with a fatal outcome. F1000Res 2021; 10:300. [PMID: 34316359 PMCID: PMC8276182 DOI: 10.12688/f1000research.51927.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Intravenous injection of oral opioid substitution drugs (OSD) is widespread among injecting drug users. Several OSDs contain the polymer polyvinylpyrrolidone (PVP) as an excipient. Parenterally administered PVP of high molecular weight may accumulate in tissues and organs. This phenomenon was first described in the 1950s, when PVP was utilised in medication for parenteral use. We report a case of an opioid-addicted patient with extensive PVP-deposition caused by repeated injections of OSDs. Case presentation: A 30-year-old male drug addicted patient in opioid substitution therapy (OST) was repeatedly referred to his local hospital in a poor general condition. Work-up revealed severe normocytic anaemia, renal insufficiency, pancreas insufficiency and pathological fractures. Biopsies from fractured bones, bone marrow and gastric mucosa showed extensive infiltrates of histiocytes with intracytoplasmic vacuoles. Vacuole content stained slightly bluish in hematoxylin and eosin stain, red in Congo red stain and black in periodic acid methenamine silver stain. The morphological appearance and staining properties were in accordance with the diagnosis of PVP deposition. The patient had been injecting both buprenorphine tablets and a specific methadone syrup for several years. The methadone syrup contained large amounts of high molecular weight PVP, making it the most likely cause of the deposition. His health quickly deteriorated and he died, impaired by multi-organ failure and cachexia, five years after the first diagnosis of PVP-deposition. The autopsy revealed extensive PVP-deposition in all sampled organs and tissues. Conclusions: Histological investigation and the correct identification of PVP in the biopsies led to the discovery of a severe adverse effect from long-standing misuse of a drug. The disseminated PVP deposition likely contributed to multi-organ dysfunction and cachexia with a fatal outcome. The deposited PVP likely originated from repeated injections of a certain methadone syrup.
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Affiliation(s)
- Ida Viken Stalund
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
| | - Gro Nygard Riise
- Department of Medicine, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Tormod Karlsen Bjånes
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
| | - Lars Riise
- Kvam Municipality, Grovagjelet 16, 5600 Norheimsund, Norway
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
| | - Sabine Leh
- Department of Pathology, Haukeland University Hospital, Post box 1, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, 5021 Bergen, Norway
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Vikse J, Bryne K, Haukås E, Leh F, Sæverås MZ, Omdal R. Lymphomatoid granulomatosis: a mimicker of systemic inflammatory rheumatological disease. Scand J Rheumatol 2020; 50:165-166. [PMID: 32669017 DOI: 10.1080/03009742.2020.1769180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J Vikse
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway
| | - K Bryne
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway
| | - E Haukås
- Department of Hematology, Stavanger University Hospital, Stavanger, Norway
| | - F Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - M Z Sæverås
- Diagnostic Center, Stavanger University Hospital, Stavanger, Norway
| | - R Omdal
- Clinical Immunology Unit, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Knoop T, Larsen KK, Leh F, Hemsing AL, Teigen IA, Reikvam H. Severe nephritis as initial sign of Waldenström's macroglobulinemia. Clin Pract 2019; 9:1184. [PMID: 31929868 PMCID: PMC6945070 DOI: 10.4081/cp.2019.1184] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Waldenström's macroglobulinemia (WM), characterized with monoclonal immunoglobulins of type M and lymphoplasmacytic lymphoma, is a rare clonal Bcell disorder. WM usually present as an indolent lymphoma, and renal involvement is, in contrast to multiple myeloma, very rarely seen. We present a patient presenting with severe nephritis and nephrotic range proteinuria of more than 9 g/day as initial manifestations of WM. Furthermore, we discuss diagnostic and therapeutic approaches for this rare manifestation of the disease, in the light of recent research and treatment recommendations.
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Affiliation(s)
- Thomas Knoop
- Department of Medicine, Haukeland University Hospital.,Institute of Medical Science, University of Bergen
| | | | | | | | | | - Håkon Reikvam
- Department of Medicine, Haukeland University Hospital.,Institute of Clinical Science, University of Bergen, Bergen, Norway
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Aarset H, Brevig T, Casati B, Collett K, Ellingsen CL, Leh F, Sviland L. Silje Fismen. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.19.0567] [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: 11/02/2022] Open
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9
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Brattås MK, Lilleeng K, Hovland R, Lægreid IJ, Vorland M, Leh F, Bruserud Ø, Gjertsen BT, Reikvam H. Philadelphia chromosome positive AML arising from JAK2-positive myelofibrosis. Biomark Res 2018; 6:33. [PMID: 30479769 PMCID: PMC6249888 DOI: 10.1186/s40364-018-0147-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/31/2018] [Indexed: 02/06/2023] Open
Abstract
Background A feature of myeloproliferative neoplasia is transforming to more aggressive and malignant myeloid neoplasia, including acute myeloid leukemia. Different pathogenesis mechanisms participate in transformation, including transformation of existing potential preleukemic clones, since JAK2-mutant myeloproliferative neoplasms often transform to JAK2 wild-type acute myeloid leukemia. Case presentation Here, we present an 80 year old man with a JAK2-V617F mutant primary myelofibrosis. After 10 months the disease transform into a Philadelphia chromosome positive acute myeloid leukemia, detecting the cytogenetic aberration; t(9;22)(q34;q22) encoding the rare BCR-ABL1 fusion gene; e6a2. The patient had treatment response to tyrosine kinases, illustrating the potential benefits of such approach in treating these patients subset. Conclusion The case illustrates the potential of leukemic transformation to Philadelphia chromosome positive myeloid malignancies from potential existing preleukemic clones, and the awareness of such an evolution among patients with myeloproliferative neoplasms. Tyrosine kinases have potential effect also in patients presenting without chronic myeloid leukemia and with rare BCR-ABL1 fusion transcripts, and should probably be a part of the treatment approach.
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Affiliation(s)
| | - Kyrre Lilleeng
- 1Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Randi Hovland
- 2Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | | | - Marta Vorland
- 4Department of Medical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Friedemann Leh
- 5Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Øystein Bruserud
- 6Department of Clinical Science, University of Bergen, Bergen, Norway.,7Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Tore Gjertsen
- 6Department of Clinical Science, University of Bergen, Bergen, Norway.,7Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Håkon Reikvam
- 6Department of Clinical Science, University of Bergen, Bergen, Norway.,7Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Trost W, Leh F, Houvenaghel JF, Choppin S, Drapier S, Sauleau P, Haegelen C, Robert G, Grandjean D, Vérin M. Subthalamic deep brain stimulation influences complex emotional musical experience in Parkinson's disease. Neuropsychologia 2018; 117:278-286. [PMID: 29936120 DOI: 10.1016/j.neuropsychologia.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 11/27/2022]
Abstract
Subthalamic deep brain stimulation (STN DBS) is an effective treatment for reducing the motor symptoms of patients with Parkinson's disease (PD), but several side effects have been reported, concerning the processing of emotions. Music has been shown to evoke powerful emotional experiences - not only basic emotions, but also complex, so-called aesthetic experiences. The goal of the present study was therefore to investigate how STN DBS influences the experience of both basic and more complex musical emotions in patients with PD. In a three-group between-participants design, we compared healthy controls (HC), patients receiving STN DBS (PD-DBS), and patients who were candidates for STN DBS and receiving medication only (PD-MO) on their assessments of subjectively experienced musical emotions. Results showed that in general, the experience of musical emotions differed only marginally between the PD-MO, PD-DBS, and HC groups. Nonetheless, we were able to discern subtle but distinct effects of PD and STN DBS in the emotional responses. Happy music, for instance, seemed to induce a heightened experience of negative emotions (tension) in PD-MO patients. STN DBS appeared to normalize this particular effect, but increased nostalgic feelings - a rather complex affective experience - in response to the same emotional stimuli. This should not be taken as indicating a bias for nostalgia in the PD-DBS subgroup, as these patients found music inducing melancholy to be less nostalgic and more joyful than HC did. In conclusion, our study showed that music elicits slightly altered emotional experiences in patients with and without STN DBS. In particular, STN DBS seems to induce less distinct emotional responses, blurring the boundaries between complex musical emotions.
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Affiliation(s)
- W Trost
- Neurosciences of Emotions and Affective Dynamics Laboratory, Department of Psychology, University of Geneva, Switzerland; Swiss Centre for Affective Sciences, University of Geneva, Switzerland.
| | - F Leh
- Neurology Department, Rennes University Hospital, Rennes, France.
| | - J-F Houvenaghel
- Neurology Department, Rennes University Hospital, Rennes, France
| | - S Choppin
- University Centre of Excellence in Psychiatry, Albert Chenevier Hospital, Créteil, France
| | - S Drapier
- Neurology Department, Rennes University Hospital, Rennes, France
| | - P Sauleau
- Neurology Department, Rennes University Hospital, Rennes, France
| | - C Haegelen
- Neurology Department, Rennes University Hospital, Rennes, France
| | - G Robert
- Neurology Department, Rennes University Hospital, Rennes, France
| | - D Grandjean
- Neurosciences of Emotions and Affective Dynamics Laboratory, Department of Psychology, University of Geneva, Switzerland; Swiss Centre for Affective Sciences, University of Geneva, Switzerland
| | - M Vérin
- Neurology Department, Rennes University Hospital, Rennes, France
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Kristoffersen AH, Bjånes TK, Jordal S, Leh S, Leh F, Svarstad E. Polyvinylpyrrolidone induced artefactual prolongation of activated partial thromboplastin times in intravenous drug users with renal failure. J Thromb Haemost 2016; 14:936-939. [PMID: 26921123 DOI: 10.1111/jth.13299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/13/2016] [Indexed: 12/01/2022]
Abstract
Essentials Prolonged activated partial thromboplastin times (APTT) were found in drug users with renal failure. An oral methadone solution containing polyvinylpyrrolidone (PVP) had been injected intravenously. Spiking normal plasma with increasing concentrations of PVP resulted in artifically prolonged APTT. APTT prolongation may indicate PVP deposits as underlying cause in patients with renal failure. SUMMARY Unexpectedly prolonged activated partial thromboplastin times (APTTs) were noted in several patients with chronic renal insufficiency and a history of intravenous drug abuse. Deposits of polyvinylpyrrolidone (PVP), an excipient in one oral methadone solution used in opioid maintenance programs, were found in renal biopsies. One case is described in detail, and this is followed by a summary of findings in 11 other patients and the results of an in vitro experiment in which plasma was spiked with PVP at increasing concentrations. APTTs measured with STA PTT automate (Stago) were prolonged in all patients and in spiked samples, whereas supplemental coagulation parameters and APTTs measured with HemosIL SynthAsil or Actin FSL (Siemens) were within reference intervals. These results indicate that interference with APTTs by PVP is reagent-dependent. We suggest that a prolonged APTT should raise the suspicion of PVP deposit-associated kidney disease in patients with chronic renal failure and a history of intravenous drug abuse.
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Affiliation(s)
- A H Kristoffersen
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
- Norwegian Quality Improvement of Primary Health Care Laboratories (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - T K Bjånes
- Laboratory of Clinical Biochemistry, Section of Clinical Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - S Jordal
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - F Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - E Svarstad
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Volgina G, Gadzhikulieva M, Uyshuk N, Kawamura E, Hisano S, Nakashima H, Saito T, Boor P, Babi kova J, Martin IV, Bucher EB, Eriksson U, Van Roeyen CRC, Eitner F, Floege J, Peutz-Kootstra CJ, Ostendorf T, Leh S, Leh F, Bjanes TK, Ohldieck C, Svarstad E, Han BG, Kim JS, Yang JW, Choi SO, Lollinga W, Rahbar A, De Wit RH, Riezebos-Brilman A, Soderberg-Naucler C, Van Son WJ, Sanders JS, Smit MJ, Van Den Born J, Koike K, Tsuboi N, Ikezumi Y, Go K, Ogura M, Saitoh A, Yokoo T, Yamaguchi T, Nokiba H, Hara M, Morito T, Kakihana K, Ohashi K, Ando M, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Alfieri CM, Regalia A, Simonini P, Ikehata M, Chatziantoniou C, Moroni G, Rastaldi MP, Messa P, Bockmeyer C, Sauberlich K, Zell S, Zeuschner P, Agustian PA, Wittig J, Becker JU, Peters B, Andersson Y, Hadimeri H, Stegmayr B, Molne J, Li T, He Y, Chen H, Chen J, Kobayashi A, Mitome J, Yamamoto I, Mafune A, Yamakawa T, Nakada Y, Tanno Y, Ohkido I, Tsuboi N, Yamamoto H, Yokoyama K, Yokoo T, Dervishi E, Buti E, Nozzoli C, Caldini LA, Giannakakis C, Minetti EE, Cirami L, Bergesio F, Ryuge A, Nomura A, Shimizu H, Fujita Y, Nishi S, Goto S, Nakai K, Ito J, Fujii H, Hara S, Mori G, Ligabue G, Cappelli G, Pinho A, Moreno F, Dias R, Vizcaino R, Ossareh S, Asgari M, Abdi E, Ataipour Y, Malakoutian T, Saddadi F, Rayatnia M. RENAL HISTOPATHOLOGY. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu172] [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: 11/14/2022] Open
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Roth K, Eagan TM, Andreassen AH, Leh F, Hardie JA. A randomised trial of endobronchial ultrasound guided sampling in peripheral lung lesions. Lung Cancer 2011; 74:219-25. [PMID: 21481486 DOI: 10.1016/j.lungcan.2011.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 01/18/2011] [Accepted: 02/27/2011] [Indexed: 10/18/2022]
Abstract
AIM The aim of the study was to evaluate endobronchial ultrasound (EBUS) for peripheral lung lesions and to find the most cost effective combination of sampling techniques. MATERIALS 264 patients with lesions suspicious of malignancy were recruited in Bergen and Aalesund, Norway from 2005 to 2008. METHODS The study was a prospective randomised cohort study. EBUS was performed with a 1.7 mm rotating probe. X-ray fluoroscopy was used in both arms. The different sampling techniques were evaluated in a cost-effectiveness analysis. RESULTS The detection rate for cancer was 36% in the EBUS group, 44% in the non-EBUS group (ns). Lesions below 3 cm and lesions assumed difficult to reach had significant lower detection rates in the EBUS group. Lesions visualised by EBUS had a higher detection rate for cancer than lesions not visualised by EBUS (62% vs. 19%, p<0.01). The cost of one additional positive sample was 1211 euro when brushing was added to biopsy. It was not cost effective to add washing or TBNA. CONCLUSION EBUS did not increase the detection rate for cancer in peripheral lung lesions when bronchoscopy was performed by bronchoscopists at all levels of expertise. Biopsy and brushing was the most cost effective combination of sampling techniques.
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Affiliation(s)
- Kjetil Roth
- Department of internal medicine, Helse Sunnmøre, Aalesund, Norway.
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Roth K, Hardie JA, Andreassen AH, Leh F, Eagan TML. Predictors of diagnostic yield in bronchoscopy: a retrospective cohort study comparing different combinations of sampling techniques. BMC Pulm Med 2008; 8:2. [PMID: 18221551 PMCID: PMC2267157 DOI: 10.1186/1471-2466-8-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 01/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported diagnostic yield from bronchoscopies in patients with lung cancer varies greatly. The optimal combination of sampling techniques has not been finally established. The objectives of this study were to find the predictors of diagnostic yield in bronchoscopy and to evaluate different combinations of sampling techniques. METHODS All bronchoscopies performed on suspicion of lung malignancy in 2003 and 2004 were reviewed, and 363 patients with proven malignant lung disease were included in the study. Sampling techniques performed were biopsy, transbronchial needle aspiration (TBNA), brushing, small volume lavage (SVL), and aspiration of fluid from the entire procedure. Logistic regression analyses were adjusted for sex, age, endobronchial visibility, localization (lobe), distance from carina, and tumor size. RESULTS The adjusted odds ratios (OR) with 95% confidence intervals (CI) for a positive diagnostic yield through all procedures were 17.0 (8.5-34.0) for endobronchial lesions, and 2.6 (1.3-5.2) for constriction/compression, compared to non-visible lesions; 3.8 (1.3-10.7) for lesions > 4 cm, 6.7 (2.1-21.8) for lesions 3-4 cm, and 2.5 (0.8-7.9) for lesions 2-3 cm compared with lesions <= 2 cm. The combined diagnostic yield of biopsy and TBNA was 83.7% for endobronchial lesions and 54.2% for the combined group without visible lesions. This was superior to either technique alone, whereas additional brushing, SVL, and aspiration did not significantly increase the diagnostic yield. CONCLUSION In patients with malignant lung disease, visible lesions and larger tumor size were significant predictors of higher diagnostic yield, after adjustment for sex, age, distance from carina, side and lobe. The combined diagnostic yield of biopsy and TBNA was significant higher than with either technique alone.
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Affiliation(s)
- Kjetil Roth
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Dept. of Internal Medicine, Aalesund Hospital, Aalesund, Norway
| | - Jon A Hardie
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Alf H Andreassen
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Friedemann Leh
- Dept. of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Tomas ML Eagan
- Dept. of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Leh F, Chan KM. Electron Spin Resonance Study of Adduct Formation by Bis(trifluoroacetylacetonato) copper(II) with Phosphorus Donor Ligands. BCSJ 1972. [DOI: 10.1246/bcsj.45.2709] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Reactions of Cu(I)Cl, Cu(II)Cl2, Cu(II) acetylacetonates, and Cu(II) N-methylsalicylalidiiminate with the stable free radical 2,2-diphenyl-1-picrylhydrazyl have been investigated. In all cases Cu(II) was reduced and the organic radical behaved as an electron donor-ligand to form complexes containing Cu(I). These novel free radical Cu(I) complexes were characterized by various spectroscopic methods, including e.s.r.
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Leh F, Wong SK, Wan JKS. Photochemistry of Metal Olefin Complexes. Isomerization and Stereospecific Cyclodimerization of Silver Cycloalkene Complexes. CAN J CHEM 1971. [DOI: 10.1139/v71-460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Photolysis of AgClO4 – 1-methylene cyclohexane complex in pure polycrystalline state or in methanol solution leads to isomerization of the complex to AgClO4 – 1-methylcyclohexene. The isomerized complex undergoes further photochemical cyclodimerization giving the stereospecific exo-trans-exo dimer of the 1-methylcyclohexene and colloidal silver. Similar photoisomerization and a less stereospecific photodimerization were observed in the photolysis of the polycyclic AgClO4 – β-pinene complex.
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Abstract
Sodium N,N-diethyldithiocarbamate reacts smoothly with methylene chloride (even in the presence of various transition metal ions) to give the dithiocarbamate ester Et2NC(S)SCH2S(S)CNEt2 in very high yield. With chloroform and acetonitrile, proton abstraction occurs followed by partial decomposition of the N,N-diethyldithiocarbamic acid so formed to give diethylammonium N,N-diethyldithiocarbamate.
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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part XIII. cis-Chloro-2-methoxyethylamine- and cis-chloro-3-methoxy-propylamine-bis(ethylenediamine)cobalt(III) complexes. ACTA ACUST UNITED AC 1968. [DOI: 10.1039/j19680001079] [Citation(s) in RCA: 5] [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: 11/21/2022]
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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part VII. The role of haloalkylamines as influencing ligands in hydrolytic reactions of the bis(ethylenediamine)cobalt(III) system. ACTA ACUST UNITED AC 1967. [DOI: 10.1039/j19670000288] [Citation(s) in RCA: 3] [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: 11/21/2022]
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Chan SC, Cheng CY, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part X. Effect of replacing chlorine by bromine on the reactivity of some cis-chloroaminebis(ethylenediamine)cobalt(III) cations. ACTA ACUST UNITED AC 1967. [DOI: 10.1039/j19670001586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [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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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropenta-ammine type. Part XI. The preparation, properties, and reactions of some chloroaminebis(ethylenediamine)cobalt(III) salts containing unidentate aminoalkanols as influencing ligands. ACTA ACUST UNITED AC 1967. [DOI: 10.1039/j19670001730] [Citation(s) in RCA: 8] [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: 11/21/2022]
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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part IX. The acid hydrolysis of cis-chlorohydroxylaminebis(ethylenediamine)cobalt(III) nitrate. ACTA ACUST UNITED AC 1967. [DOI: 10.1039/j19670000573] [Citation(s) in RCA: 5] [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: 11/21/2022]
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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part IV. The hydrolyses of cis-chloroallylamine- and cis-chloropropargylamine-bis(ethylenediamine)cobalt(III) cations. ACTA ACUST UNITED AC 1966. [DOI: 10.1039/j19660000138] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [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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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part I. The release of chloride ions from the cis-chlorohydroxylaminebis-(ethylenediamine)cobalt(III) cation in neutral and in basic solutions. ACTA ACUST UNITED AC 1966. [DOI: 10.1039/j19660000126] [Citation(s) in RCA: 6] [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: 11/21/2022]
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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part II. The solvolytic aquation and hydrolysis by base of cis-chloromethylamine- and cis-chloroethylamine-bis(ethylenediamine)cobalt(III) cations. ACTA ACUST UNITED AC 1966. [DOI: 10.1039/j19660000129] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [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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Chan SC, Leh F. Octahedral cobalt(III) complexes of the chloropentammine type. Part III. The solvolytic aquation and basic hydrolysis of cis-chloro-n-propylamine- and cis-chloroisopropylamine-bis(ethylenediamine)-cobalt(III) cations. ACTA ACUST UNITED AC 1966. [DOI: 10.1039/j19660000134] [Citation(s) in RCA: 6] [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: 11/21/2022]
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Abstract
The kinetics for the
release of halide ions from some haloalkylamines and
the corresponding haloalkylammonium ions have been
investigated in aqueous solutions under different conditions. In basic
solutions, the free amines react according to a two-term rate law
����������������������� kobs = k1+k2[OH-]
and their reactivities are
in the order: 2-chloroethylamine ≈ 2-chloro- n-propylamine �
3-chloro-n-propylamine. The products formed are the corresponding iminoalkanes
and the possible mechanisms are briefly discussed. In neutral solutions, the haloalkylammonium ions release halide ions by a
considerably slower first-order reaction, which is retarded by acid. Since here
there is not much difference in reactivity between 2-chloro-n-propylamine and
3-chloro-n-propylamine, the reaction probably involves a single-stage
bimolecular attack by the solvent, leading to the formation of aminoalkanols.
In both cases, the reactivities of 2-bromoethylamine me greater than those of
the corresponding chloro compound.
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