1
|
Katz D, Farber M, Getrajdman C, Hamburger J, Reale S, Butwick A. The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care. Am J Obstet Gynecol 2024; 230:S1089-S1106. [PMID: 38462250 DOI: 10.1016/j.ajog.2022.09.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 03/12/2024]
Abstract
Viscoelastic hemostatic assays are point-of-care devices that assess coagulation and fibrinolysis in whole blood samples. These technologies provide numeric and visual information of clot initiation, clot strength, and clot lysis under low-shear conditions, and have been used in a variety of clinical settings and subpopulations, including trauma, cardiac surgery, and obstetrics. Emerging data indicate that these devices are useful for detecting important coagulation defects during major postpartum hemorrhage (especially low plasma fibrinogen concentration [hypofibrinogenemia]) and informing clinical decision-making for blood product use. Data from observational studies suggest that, compared with traditional formulaic approaches to transfusion management, targeted or goal-directed transfusion approaches using data from viscoelastic hemostatic assays are associated with reduced hemorrhage-related morbidity and lower blood product requirement. Viscoelastic hemostatic assays can also be used to identify and treat coagulation defects in patients with inherited or acquired coagulation disorders, such as factor XI deficiency or immune-mediated thrombocytopenia, and to assess hemostatic profiles of patients prescribed anticoagulant medications to mitigate the risk of epidural hematoma after neuraxial anesthesia and postpartum hemorrhage after delivery.
Collapse
Affiliation(s)
- Daniel Katz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Michaela Farber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Chloe Getrajdman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Hamburger
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sharon Reale
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexander Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
2
|
Sherwin M, Hamburger J, Katz D, DeMaria S. Influence of semaglutide use on the presence of residual gastric solids on gastric ultrasound: a prospective observational study in volunteers without obesity recently started on semaglutide. Can J Anaesth 2023; 70:1300-1306. [PMID: 37466909 DOI: 10.1007/s12630-023-02549-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
PURPOSE Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) have become increasingly popular as both diabetic and weight loss therapies. One effect of this class of medication is delayed gastric emptying, which may impact the risk of aspiration during anesthesia delivery. METHODS In this prospective study, we used gastric ultrasound to evaluate the presence of solid gastric contents in both supine and lateral positions after an eight-hour fast in those taking GLP-1RA compared with controls. Participants underwent a second ultrasound evaluation two hours later after drinking 12 fluid ounces of water (approximately 350 mL). RESULTS Twenty adults voluntarily enrolled, giving a total of ten participants in each group. In the supine position, 70% of semaglutide participants and 10% of control participants had solids present on gastric ultrasound (risk ratio [RR], 3.50; 95% confidence interval [CI], 1.26 to 9.65; P = 0.02.) In the lateral position, 90% of semaglutide participants and 20% of control participants had solids identified on gastric ultrasound (RR, 7.36; 95% CI, 1.13 to 47.7; P = 0.005). Two hours after drinking clear liquids, the two groups did not differ in the lateral position, but in the supine position, 90% of control group participants were rated as empty compared with only 30% of semaglutide group participants (P = 0.02). CONCLUSIONS This study provides preliminary evidence that GLP-1RAs may affect gastric emptying and residual gastric contents following an overnight fast and two hours after clear liquids, which may have implications for aspiration risk during anesthetic care.
Collapse
Affiliation(s)
- Marc Sherwin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, Box 1010, New York, NY, 10029, USA
| | - Joshua Hamburger
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, Box 1010, New York, NY, 10029, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, Box 1010, New York, NY, 10029, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L., Levy Place, Box 1010, New York, NY, 10029, USA.
| |
Collapse
|
3
|
Wang J, Leibner E, Hyman JB, Ahmed S, Hamburger J, Hsieh J, Dangayach N, Tandon P, Gidwani U, Leibowitz A, Kohli-Seth R. The Mount Sinai Hospital Institute for critical care medicine response to the COVID-19 pandemic. Acute Crit Care 2021; 36:201-207. [PMID: 34372628 PMCID: PMC8435441 DOI: 10.4266/acc.2021.00402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of critically ill patients. This was especially true in New York City. We present a roadmap for hospitals and healthcare systems to prepare for a Pandemic. METHODS This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the pandemic. MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds, expanded the workforce, and created guidelines. RESULTS MSH a 1,139-bed quaternary care academic referral hospital with 104 ICU beds expanded to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 42.8% (n=263) died, and 47.8% (n=294) were discharged alive. CONCLUSIONS Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines were critical accommodating the surge of critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.
Collapse
Affiliation(s)
- Jennifer Wang
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Leibner
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaime B. Hyman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanam Ahmed
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Hamburger
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean Hsieh
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neha Dangayach
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pranai Tandon
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Umesh Gidwani
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Leibowitz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - On behalf of Mount Sinai Anesthesiology and Critical Care COVID19 Writing Group
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
4
|
Katz D, Maher P, Getrajdman C, Hamburger J, Zhao S, Madek J, Bhatt H, Levin M, Görlinger K. Monitoring of COVID-19-Associated Coagulopathy and Anticoagulation with Thromboelastometry. Transfus Med Hemother 2021; 48:168-172. [PMID: 34177421 PMCID: PMC8018202 DOI: 10.1159/000514486] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/12/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Thrombosis occurs frequently in COVID-19. While the exact mechanism is unclear, 3 processes seem to play important roles in sepsis-related thrombosis and mortality: tissue factor expression on circulating monocytes and microparticles, hypercoagulability (increased clot firmness), and hypofibrinolysis. Rotational thromboelastometry is a point-of-care viscoelastic technique that uses the viscoelastic properties of blood to monitor coagulation. Using various assays, viscoelastometry could monitor this triad of changes in severely ill, COVID-19-positive patients. Similarly, with the increased incidence of coagulopathy, many patients are placed on anticoagulants, making management more difficult depending on the agents utilized. Viscoelastometry might also be used in these settings to monitor anticoagulation status and guide therapy, as it has in other areas. Case Presentation We present a case series of 6 patients with different stages of disease and different management plans. These cases occurred at the height of the pandemic in New York City, which limited testing abilities. We first discuss the idea of using the NaHEPTEM test as a marker of tissue factor expression in COVID-19. We then present cases where patients are on different anticoagulants and review how viscoelastometry might be used in a patient on anticoagulation with COVID-19. Conclusion In a disease such as COVID-19, which has profound effects on hemostasis and coagulation, viscoelastometry may aid in patient triage, disease course monitoring, and anticoagulation management.
Collapse
Affiliation(s)
- Daniel Katz
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Patrick Maher
- Icahn School of Medicine at Mount Sinai, Department of Critical Care Medicine, New York, New York, USA
| | - Chloe Getrajdman
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Joshua Hamburger
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Shan Zhao
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Jonathan Madek
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Himani Bhatt
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Matthew Levin
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, New York, USA
| | - Klaus Görlinger
- University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Tem Innovations, Medical Department, Munich, Germany
| |
Collapse
|
5
|
Abstract
Agreement between estimated fibrinogen concentration via thromboelastography and traditional assays is not established in the parturient. We therefore recruited 56 parturients and performed Clauss and functional fibrinogen level (FLEV) tests. Mean difference of measurements was 36.8 mg/dL (95% CI, 21.8-51.9) with a standard deviation of 52.8 mg/dL. Calculated limits of agreement were 140.2 mg/dL (95% CI, 166.3-114.6) and -66.6 mg/dL (95% CI, -40.8 to -92.5), within the maximum allowable difference of 165 mg/dL. We therefore conclude that while most measurements fell within the limits of agreement, more work is needed to clearly define the role of this test in the obstetric population.
Collapse
Affiliation(s)
- Daniel Katz
- From the Department of Anesthesiology, Pain, and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | |
Collapse
|
6
|
Abstract
It is critical to adequately treat postoperative cesarean delivery pain. The use of parenteral or neuraxial opioids has been a mainstay, but opioids have side effects that can be troubling and the opioid crisis in the United States has highlighted the necessity to utilize analgesics other than opioids. Other analgesic options include neuraxial analgesics, nerve blocks such as the transversus abdominis plane block, and non-opioid parenteral and oral medications. The goal of this article is to review non-opioid systemic analgesic adjuncts following cesarean delivery, focusing on their efficacy and side effects as well as their impact on reduction of opioid requirements after surgery.
Collapse
Affiliation(s)
- J Hamburger
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, USA.
| | - Y Beilin
- Department of Anesthesiology, Pain and Perioperative Medicine, Department of Obstetrics, Genecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, USA
| |
Collapse
|
7
|
Katz D, Hamburger J, Gutman D, Wang R, Lin HM, Marotta M, Zahn J, Beilin Y. The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery. Anesth Analg 2018; 127:171-178. [DOI: 10.1213/ane.0000000000002542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
8
|
Hamburger J, Weiner MM. There is No "I" in Team. J Cardiothorac Vasc Anesth 2018; 32:2560-2561. [PMID: 29730240 DOI: 10.1053/j.jvca.2018.04.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua Hamburger
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
9
|
Patel PA, Fernando RJ, Augoustides JG, Yoon J, Gutsche JT, Feinman JW, Zhou E, Weiss SJ, Hamburger J, Evans AS, Aljure O, Fabbro M. Acute Type-B Aortic Dissection in Pregnancy: Therapeutic Challenges in a Multidisciplinary Setting. J Cardiothorac Vasc Anesth 2017; 31:2268-2276. [DOI: 10.1053/j.jvca.2017.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Indexed: 01/16/2023]
|
10
|
Franco C, Taylor C, Sevalkumar K, Cowan S, Heilbron B, Tsang M, Hamburger J, Gosal-Sadhra T, Kaila K, Leipsic J, Ramanathan K. WILL INFLAMMATORY MONOCYTE HETEROGENEITY BE THE KEY TO UNLOCKING THE SECRET OF PREMATURE CORONARY ATHEROSCLEROSIS IN SOUTH ASIANS? A PROSPECTIVE EVALUATION OF CANADIAN SOUTH ASIAN AND CAUCASIANS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
11
|
Salant H, Hamburger J, Spira D, David AB, Schwan EV. Seroprevalence of Toxoplasma gondii infection in poultry kept under different housing conditions in Israel. Vet Parasitol Reg Stud Reports 2016; 5:34-36. [PMID: 31014535 DOI: 10.1016/j.vprsr.2016.09.003] [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] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
A Toxoplasma gondii seroprevalence survey was conducted in poultry flocks kept under different housing systems in Israel. The seroprevalence rates were 35.4% (46/130) in battery-raised chicken egg-layers from Jerusalem which were first raised on the ground, 12.5% (19/152) in free-range chickens from various locations of the country and 9% (4/45) in turkeys from the north. However, all broilers (50) and chicken breeding stock (58) kept under high biosecurity conditions in Jerusalem were found to be T. gondii seronegative. It is concluded that high biosecurity conditions prevent contamination with oocysts by rendering premises inaccessible to cats.
Collapse
Affiliation(s)
- H Salant
- Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, Hadassah Medical School, Hebrew University, Jerusalem, Israel.
| | - J Hamburger
- Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - D Spira
- Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | | | - E V Schwan
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| |
Collapse
|
12
|
Aslam A, Hamburger J. Photography – a powerful tool for prioritising oral cancer referrals. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.035] [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: 11/28/2022]
|
13
|
Mitton D, Blake T, Carruthers D, Damato E, Denniston A, Poveda-Gallego A, Hamburger J, Murray P, Powell S, Richards A, Sewell V, Situnayake D. THU0544 Auditing the Impact of the Application of the Proposed New 2014 International Criteria for Behçet's Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4475] [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: 11/04/2022]
|
14
|
Hamburger J, Crosnier J, Dormont J. La transplantation r�nale. Clin Nephrol 2015. [DOI: 10.1159/000391487] [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: 11/19/2022] Open
|
15
|
Hamburger J, Hofer IS, Khelemsky Y. A patient who received clopidogrel with an indwelling epidural catheter. J Clin Anesth 2014; 26:577-80. [PMID: 25439423 DOI: 10.1016/j.jclinane.2014.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/20/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 10/24/2022]
Abstract
A patient with a drug-eluting stent placed 18 months earlier received a thoracic epidural for perioperative analgesic control as part of her thoracotomy. Postoperatively, the patient was started on clopidogrel for secondary prevention. After consultation with the Hematology service and a platelet function assay, the patient was transfused two pools of platelets and the epidural catheter was removed on postoperative day 4. The patient then underwent hourly neurologic checks for 24 hours and was discharged several days later without any negative sequelae. If neuraxial techniques and the need for clopidogrel prophylaxis come into direct conflict, vigilance is necessary for warning signs of epidural hematoma and platelet transfusion should be considered to reverse the effects of the drug.
Collapse
Affiliation(s)
- Joshua Hamburger
- Department of Anesthesiology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10128, USA
| | - Ira S Hofer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
| | - Yury Khelemsky
- Department of Anesthesiology/Division of Pain Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10128, USA
| |
Collapse
|
16
|
Abstract
Transcatheter aortic valve replacement (TAVR) is considered an option for patients with severe aortic stenosis who are not surgical candidates. We describe the case of a patient who presented with cardiac tamponade shortly after uneventful TAVR by a direct aortic approach. The patient was brought to the operating room for exploration and repair. Although TAVR is less invasive than traditional open aortic valve replacement, TAVR nonetheless poses serious risk. This case highlights a potential complication of the less commonly used transaortic approach for TAVR and the importance of taking a multidisciplinary approach when identifying and managing all TAVR-associated complications.
Collapse
Affiliation(s)
- Cindy Wang
- From the Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | |
Collapse
|
17
|
Poulter R, Lim I, Hoole S, Wood D, Saw J, Fung A, Hamburger J. Predicting Fractional Flow Reserve Using Optical Coherence Tomography Parameters In Patients With Stable Chest Pain Versus Acute Coronary Syndromes. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.420] [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: 11/16/2022]
|
18
|
Astorri E, Bombardieri M, Corsiero E, Gabba S, Barone F, Proctor G, Pitzalis C, Bowman SJ, St Pierre Y, Sutcliffe N, Isenberg DA, Goldblatt F, Price E, Hamburger J, Richards A, Rauz S, Regan M, Jones A, Rigby S, Mulherin D, Clarke A, Ong V, Nihtyanova S, Black C, Denton C, Barnes T, Spiller D, Anderson M, Edwards S, Moots R, Gamal M, Zaki E, Khaled HF, Abdul-Aziz OA, Shaaban AA, Abu Senna H, Bishop VL, Herrick A, Wragg E, Ioannou Y, Zhang JY, Passam FH, Rahgozar S, Qi JC, Giannakopoulos B, Qi M, Yu P, Yu DM, Hogg PJ, Krilis SA, Hopkins CW, Spiers LR, Bhagat SS, Ostor AJ, Hall FC. Concurrent Oral 10 - Connective Tissue Disease [OP65-OP72]: OP65. Molecular and Cellular Evolution of Functional Tertiary Lymphoid Structures in Salivary Glands of NOD Mice. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq710] [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
|
19
|
Kagai JM, Mpoke S, Muli F, Hamburger J, Kenya EU. Molecular Technique Utilising Sputum For Detecting Wuchereria bancrofti Infections In Malindi, Kenya. ACTA ACUST UNITED AC 2009; 85:118-22. [DOI: 10.4314/eamj.v85i3.9630] [Citation(s) in RCA: 3] [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: 11/17/2022]
|
20
|
Bowman SJ, Ibrahim GH, Holmes G, Hamburger J, Ainsworth JR. Estimating the prevalence among Caucasian women of primary Sjögren's syndrome in two general practices in Birmingham, UK. Scand J Rheumatol 2009; 33:39-43. [PMID: 15124941 DOI: 10.1080/03009740310004676] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To establish the prevalence among women of primary Sjögren's syndrome (PSS) in Birmingham, UK. METHODS Eight hundred and forty-six female Caucasians from two general practitioner lists were invited to complete a questionnaire that included a screening question on dry eyes and mouth. Individuals who responded positively were evaluated further. RESULTS Overall, 65/% of individuals who were sent a questionnaire responded. Two had possible PSS, but were negative for anti-Ro/La antibodies. Our estimates of the prevalence of PSS ranged from < 0.1% up to 0.4%, depending on the assumptions used. CONCLUSION Our data support previous studies suggesting a prevalence of PSS in the community of 0.1-0.6% rather than those suggesting a higher figure.
Collapse
Affiliation(s)
- S J Bowman
- Department of Rheumatology, University of Birmingham, Medical School, Edgbaston, UK.
| | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Erosive oral lichen planus (LP) is a painful chronic inflammatory condition that is frequently resistant to immunosuppressive agents. Topical tacrolimus has been reported as a safe and effective treatment. OBJECTIVE To evaluate the efficacy and safety of topical tacrolimus in the treatment of symptomatic erosive oral LP. METHODS A retrospective review of consecutive patients with oral LP treated with topical tacrolimus between June 1999 and November 2003 was performed. Clinical improvement and adverse events were recorded by the physician. Patients were asked retrospectively to rate their symptoms immediately prior to and after tacrolimus therapy using a visual analogue scale. RESULTS Physician-observed clinical improvement was found in 21 of 23 patients (91.3%) within 6 weeks. Six patients (26.1%) remained asymptomatic after stopping treatment and 15 patients (65.2%) required maintenance therapy to prevent subsequent flares. Patients' self-reported symptom scores were significantly better (p<0.001) with tacrolimus treatment, which supported physician-observed clinical improvement. There was no evidence of systemic absorption and only minor local side effects were noted. CONCLUSIONS Topical tacrolimus is an effective treatment for erosive oral LP. The majority of patients require long-term therapy to maintain remission.
Collapse
Affiliation(s)
- M A Thomson
- Department of Dermatology, Selly Oak Hospital, Birmingham, UK
| | | | | | | |
Collapse
|
22
|
Kamoun P, Hamburger J. Effect of antiplatelet antibodies on the 5-hydroxytryptamine uptake by blood platelets. Acta Med Scand Suppl 2009; 525:153-6. [PMID: 5317104 DOI: 10.1111/j.0954-6820.1972.tb05813.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
23
|
Bowman SJ, Hamburger J, Richards A, Barry RJ, Rauz S. Patient-reported outcomes in primary Sjogren's syndrome: comparison of the long and short versions of the Profile of Fatigue and Discomfort--Sicca Symptoms Inventory. Rheumatology (Oxford) 2008; 48:140-3. [PMID: 19074185 DOI: 10.1093/rheumatology/ken426] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The long-form 64-item Profile of Fatigue and Discomfort--Sicca Symptoms Inventory (PROFAD-SSI) questionnaire was developed as a patient-reported assessment tool for use in primary SS (PSS) and other rheumatic disorders. In this study, we assess whether the (shorter and more practical) 19-item PROFAD-SSI-SF (short form) gives similar results and whether a still briefer version using visual analogue scales (VASs) is feasible. METHODS Questionnaire surveys comprising the long and short versions of the PROFAD-SSI were mailed to 43 patients with PSS and 50 patients with RA, who were asked to complete these contemporaneously as well as repeating the process 1 month later. PSS patients also completed a series of VASs comprising fatigue and sicca domains of the SSI. RESULTS Surveys were returned from 35 PSS patients and 35 RA patients. All domains of the long- and short-form PROFAD-SSI showed strong correlations (Spearman rho between 0.779 and 0.996, P < 0.01). Factor analysis generally confirmed the previously validated domain structure with Cronbach's alpha = 0.99. The PROFAD-SF somatic fatigue domain correlated more strongly with a fatigue VAS than did the mental fatigue domain. The SSI-SF domain scores correlated with equivalent VAS scores. CONCLUSION The long- and short-form PROFAD-SSI questionnaires correlate closely suggesting that the PROFAD-SF is valid as an outcome tool. Preliminary data also suggest that an even briefer form with compression of the domains into single VAS is also feasible.
Collapse
Affiliation(s)
- S J Bowman
- Department of Rheumatology, University Hospital Birmingham NHS Foundation Trust (Selly Oak), Raddlebarn Road, Birmingham B296JD, UK.
| | | | | | | | | |
Collapse
|
24
|
Barry RJ, Sutcliffe N, Isenberg DA, Price E, Goldblatt F, Adler M, Canavan A, Hamburger J, Richards A, Regan M, Gadsby K, Rigby S, Jones A, Mathew R, Mulherin D, Stevenson A, Nightingale P, Rauz S, Bowman SJ. The Sjögren's Syndrome Damage Index--a damage index for use in clinical trials and observational studies in primary Sjögren's syndrome. Rheumatology (Oxford) 2008; 47:1193-8. [PMID: 18524804 DOI: 10.1093/rheumatology/ken164] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To validate a tool for assessment of accumulated damage in patients with Primary SS (PSS). METHODS Of the total 114 patients fulfilling American-European Consensus Group (AECG) criteria for PSS 104 were included in the study and assessed by rheumatologists at T (time) = 0 months and T = 12 months. On each occasion, damage and activity data, and autoantibody status were collected. SF-36 and Profile of Fatigue and Discomfort-Sicca Symptoms Inventory (PROFAD-SSI) questionnaires were completed. Cross-sectional analysis of this data was subject to a process of expert validation by 11 ophthalmologists, 14 oral medicine specialists and 8 rheumatologists. Items were removed from the index if >or= 50% of respondents recommended exclusion. Statistical validation was performed on remaining items. Spearman's rank analysis was used to investigate associations between damage scores and other disease status measures and Wilcoxon matched-pair analysis to assess sensitivity to change in the damage score. RESULTS Based on the expert validation, a 29-item damage score was agreed incorporating ocular, oral and systemic domains. Total damage score correlated with disease duration at study entry (r = 0.436; P < 0.001), physical function as measured by SF-36 (r = 0.250, T = 0 months; r = 0.261 T = 12 months) and activity as measured by the Sjögren's Systemic Clinical Activity Index (r = 0.213, T = 0 months; r = 0.215, T =12 months). Ocular damage score correlated with the 'eye dry' domain of PROFAD-SSI (r = 0.228, T = 0 months; r = 0.365, T = 12 months). Other associations not present on both assessments were considered clinically insignificant. On Wilcoxon analysis, the index was sensitive to change over 12 months (z = -3.262; P < 0.01). CONCLUSION This study begins validation of a tool for collection of longitudinal damage data in PSS. We recommend further trial in both the experimental and clinical environment.
Collapse
Affiliation(s)
- R J Barry
- Academic Unit of Ophthalmology, University of Birmingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Dass S, Bowman SJ, Vital EM, Ikeda K, Pease CT, Hamburger J, Richards A, Rauz S, Emery P. Reduction of fatigue in Sjögren syndrome with rituximab: results of a randomised, double-blind, placebo-controlled pilot study. Ann Rheum Dis 2008; 67:1541-4. [PMID: 18276741 DOI: 10.1136/ard.2007.083865] [Citation(s) in RCA: 251] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Primary Sjögren syndrome (pSS) causes significant systemic symptoms including fatigue as well as glandular dysfunction. There are currently no effective systemic therapies; however, open label series have suggested that rituximab may be beneficial for systemic and glandular manifestations. Therefore, we performed a double blind, placebo-controlled, randomised pilot study of the efficacy of rituximab in reducing fatigue in pSS. METHODS A total of 17 patients with pSS and a score on fatigue visual analogue scale (VAS) >50 were randomised to receive either 2 infusions of rituximab 1 g or placebo; patients also received oral and intravenous steroids. Outcome measures included: the proportion of patients with >20% reduction in fatigue VAS, changes in pSS related symptoms, health related quality of life and immunological parameters of pSS. These were measured 6 months after therapy. RESULTS There was significant improvement from baseline in fatigue VAS in the rituximab group (p<0.001) in contrast to the placebo group (p = 0.147). There was a significant difference between the groups at 6 months in the social functioning score of SF-36 (p = 0.01) and a trend to significant difference in the mental health domain score of SF-36 (p = 0.06). There was one episode of serum sickness in the rituximab treated group. CONCLUSIONS This is the first double blind study of rituximab in pSS to show benefit; further studies are justified.
Collapse
Affiliation(s)
- S Dass
- Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bowman SJ, Sutcliffe N, Isenberg DA, Goldblatt F, Adler M, Price E, Canavan A, Hamburger J, Richards A, Rauz S, Regan M, Gadsby K, Rigby S, Jones A, Mathew R, Mulherin D, Stevenson A, Nightingale P. Sjogren's Systemic Clinical Activity Index (SCAI) a systemic disease activity measure for use in clinical trials in primary Sjogren's syndrome. Rheumatology (Oxford) 2007; 46:1845-51. [DOI: 10.1093/rheumatology/kem280] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Hamburger J, Crosnier J, Dormont J. observations in patients with a well-tolerated homotransplanted kidney: possibility of a new secondary disease. Ann N Y Acad Sci 2006. [DOI: 10.1111/j.1749-6632.1965.tb30685.x] [Citation(s) in RCA: 36] [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: 10/23/2022]
|
28
|
Hamburger J. Human disease for dentistry. Br Dent J 2005. [DOI: 10.1038/sj.bdj.4812096] [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: 11/09/2022]
|
29
|
|
30
|
White DA, Morris AJ, Burgess L, Hamburger J, Hamburger R. Facilitators and barriers to improving the quality of referrals for potential oral cancer. Br Dent J 2004; 197:537-40. [PMID: 15543109 DOI: 10.1038/sj.bdj.4811800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 10/13/2003] [Indexed: 11/08/2022]
Abstract
The quality and content of referral letters are important for prioritisation of patients who may have oral cancer. Referrals letters to the Oral Medicine Clinic at Birmingham Dental Hospital were analysed and practitioners interviewed. Whilst acceptable for general purposes, most letters did not contain sufficient information to allow effective prioritisation. Interviews disclosed a misunderstanding amongst practitioners about the way in which referrals were handled. A number of barriers to increasing the information included in letters were identified. Referral guidelines and a standardised proforma might help improve the ability of the service to operate a fast-track system.
Collapse
Affiliation(s)
- D A White
- Dental Public Health, School of Dentistry, University of Birmingham.
| | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- J Hamburger
- The University of Birmingham, School of Dentistry, Birmingham, UK.
| |
Collapse
|
32
|
Hamburger J. Oral and Maxillofacial Medicine. Br Dent J 2004. [DOI: 10.1038/sj.bdj.4811395] [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: 11/09/2022]
|
33
|
Dubey JP, Salant H, Sreekumar C, Dahl E, Vianna MCB, Shen SK, Kwok OCH, Spira D, Hamburger J, Lehmann TV. High prevalence of Toxoplasma gondii in a commercial flock of chickens in Israel, and public health implications of free-range farming. Vet Parasitol 2004; 121:317-22. [PMID: 15135872 DOI: 10.1016/j.vetpar.2004.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 03/01/2004] [Accepted: 03/04/2004] [Indexed: 10/26/2022]
Abstract
Little is known of the prevalence of Toxoplasma gondii in commercially raised chickens. In the present study, the prevalence of T. gondii in 96 free-range chickens (Gallus domesticus) from a commercial farm in Israel was assessed. Blood, heart, and brain from each chicken were examined for T. gondii infection. Antibodies to T. gondii, assayed with the modified agglutination test (MAT > or = 1:5), were found in 45 of the 96 chickens. Hearts and brains of seropositive (MAT > or = 1:5) chickens were bioassayed in mice. Additionally, hearts and brains of 51 seronegative (MAT < 1:5) chickens were bioassayed in two T. gondii-free cats. T. gondii was isolated from 19 of the 45 (42.2%) seropositive chickens by bioassay in mice. Both the cats fed tissues pooled from seronegative chickens shed T. gondii oocysts. Tachyzoites and tissue cysts of all 21 isolates of T. gondii from chickens were avirulent for mice. Seventeen of the 19 isolates genotyped were found to be type II, and 2 were type III. Understanding of the sources of infection on such farms could be the key to the development of better prevention strategies.
Collapse
Affiliation(s)
- J P Dubey
- Animal Parasitic Diseases Laboratory, United States Department of Agriculture, Agricultural Research Service, Animal and Natural Resources Institute, BARC-East, Beltsville, MD 20705-2350, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hertel J, Haberl B, Hamburger J, Haas W. Description of a tandem repeated DNA sequence of Echinostoma caproni and methods for its detection in snail and plankton samples. Parasitology 2003; 126:443-9. [PMID: 12793648 DOI: 10.1017/s0031182003003093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Echinostome larval stages in the snail have a great potential as effective competitors for the control of schistosomes and adult worms can cause painful intestinal diseases in humans. Ecology and transmission of the larval stages of trematodes are poorly understood, especially because their identification in field-collected samples by microscopy is difficult. We cloned, sequenced and analysed a 192 bp tandem repreated DNA sequence of Echinostoma caproni (EcSau3A), an often discussed antagonist of Schistosoma mansoni in Biomphalaria snails. PCR primers against this sequence can detect less than 10 fg of E. caproni DNA, 2 miracidia in snails 1 day p.i., 1 metacercaria in 50 mg snail tissue and 1 cercaria in 50 mg plankton with high specificity. Methods described in this study can support the discovery of fundamental ecological principles on distribution, host specificity and epidemiology of E. caproni larvae under field conditions.
Collapse
Affiliation(s)
- J Hertel
- Institute for Zoology I, University Erlangen-Nürnberg, Staudtstrasse 5, D-91058 Erlangen, Germany.
| | | | | | | |
Collapse
|
35
|
Mason GI, Hamburger J, Bowman S, Matthews JB. Salivary gland expression of transforming growth factor beta isoforms in Sjogren's syndrome and benign lymphoepithelial lesions. Mol Pathol 2003; 56:52-9. [PMID: 12560464 PMCID: PMC1187290 DOI: 10.1136/mp.56.1.52] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2002] [Indexed: 01/05/2023]
Abstract
AIM Transforming growth factor beta (TGF-beta) is involved in the control of autoimmune reactions, cell proliferation, and the accumulation of lymphocytes within organs. The aim of this study was to determine the expression of TGF-beta in salivary glands from patients with primary Sjogren's syndrome (SS) and benign lymphoepithelial lesions (BLEL) with emphasis on ductal epithelium. METHODS Immunoperoxidase staining for TGF-beta isoforms and Ki67 antigen was performed on formalin fixed sections of labial glands from patients with primary SS (n = 15) and controls (n = 5) and parotid glands reported as BLEL (n = 5) or normal (n = 5). Ductal expression of TGF-beta was quantified by absorbance measurements using image analysis. The specificity of staining was confirmed by peptide blocking studies. RESULTS All TGF-beta isoforms were detected within the cytoplasm of most lymphocytes, endothelial cells, and ducts in all specimens. Acinar expression was variable and weaker than that seen in ducts. Absorbance measurements revealed that the expression of all isoforms was greater in ducts within primary SS glands than in control glands. Ductal expression in control parotid glands was greater than that seen in BLEL glands, irrespective of the presence of adjacent lymphoid infiltrates. Comparisons between control specimens showed that ductal expression of all isoforms was highest in parotid glands, whereas no differences were detected between primary SS and BLEL glands. Ki67 positive lymphocytes and duct cells were mainly restricted to pathological specimens, with BLEL glands containing larger populations of positive cells than primary SS glands. CONCLUSION These results demonstrate complex and variable changes in ductal expression of TGF-beta in primary SS and BLEL, which may be important in the control of lymphoid infiltration and the proliferation of lymphocytes and ductal epithelium.
Collapse
Affiliation(s)
- G I Mason
- Unit of Oral Pathology and Biology, School of Dentistry, The University of Birmingham, St Chad's Queensway, Birmingham B4 6NN, UK
| | | | | | | |
Collapse
|
36
|
Hamburger J, Abbasi I, Ramzy RM, Jourdane J, Ruppel A. Polymerase chain reaction assay based on a highly repeated sequence of Schistosoma haematobium: a potential tool for monitoring schistosome-infested water. Am J Trop Med Hyg 2001; 65:907-11. [PMID: 11791997 DOI: 10.4269/ajtmh.2001.65.907] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have cloned from Schistosoma haematobium genome a repeated sequence, the DraI repeated sequence, which consists of tandemly arranged 121-bp-long units and which is highly abundant (approximately 15% of the S. haematobium genome). By these features, the DraI repeat is similar to the Sm1-7 sequence of Schistosoma mansoni previously described by us. However, their nucleotide sequences are profoundly different. Polymerase chain reaction (PCR) primers were designed on the basis of the DraI sequence information and were used in a PCR assay by which as little as 10 fg of schistosomal DNA as well as individual cercariae were detected. The DraI repeat cross-hybridized with DNA from Schistosoma bovis, Schistosoma magrebowiei, Schistosoma mattheei, Schistosoma curassoni, and Schistosoma intercalatum, but not with DNA from S. mansoni nor from Trichobilharzia ocellata and Echinostoma sp. A potential value of this PCR assay is suggested for monitoring free-living cercariae and infected snails only in bodies free of cross-hybridizing species.
Collapse
Affiliation(s)
- J Hamburger
- Kuvin Centre, Hebrew University, Hadassah Medical School, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
37
|
Mulherin D, Ainsworth JR, Hamburger J, Situnayake D, Speculand B, Bowman SJ. Survey of artificial tear and saliva usage among patients with Sjögren's syndrome. Ann Rheum Dis 2001; 60:1077. [PMID: 11688489 PMCID: PMC1753406 DOI: 10.1136/ard.60.11.1077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
38
|
Amft N, Curnow SJ, Scheel-Toellner D, Devadas A, Oates J, Crocker J, Hamburger J, Ainsworth J, Mathews J, Salmon M, Bowman SJ, Buckley CD. Ectopic expression of the B cell-attracting chemokine BCA-1 (CXCL13) on endothelial cells and within lymphoid follicles contributes to the establishment of germinal center-like structures in Sjögren's syndrome. Arthritis Rheum 2001; 44:2633-41. [PMID: 11710719 DOI: 10.1002/1529-0131(200111)44:11<2633::aid-art443>3.0.co;2-9] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To test the hypothesis that the formation of ectopic germinal center (GC)-like structures in Sjögren's syndrome (SS) is associated with the ectopic expression of the constitutive lymphoid tissue-homing chemokines B cell-attracting chemokine 1 (BCA-1; or, CXCL13) and stromal cell-derived factor 1 (SDF-1; or, CXCL12). METHODS Immunohistochemical and immunofluorescence analysis was used to determine the expression of the constitutive chemokines BCA-1 (CXCL13) and SDF-1 (CXCL12) in salivary glands from 5 SS patients and 3 non-SS patients. In addition, the expression of their respective receptors (CXCR5 and CXCR4) was examined on infiltrating lymphocytes. Human tonsil was used as a positive control for secondary lymphoid tissue. RESULTS BCA-1 (CXCL13) was expressed within lymphoid aggregates in SS, which shared many structural features with GCs in tonsil. BCA-1 (CXCL13) was completely absent in control biopsy samples from patients who did not have SS. High levels of BCA-1 (CXCL13) were also found on endothelial cells in salivary glands from SS patients. Diseased SS tissue was infiltrated by CXCR5-expressing B cells which organized into GC-like clusters. In complete contrast, SDF-1 (CXCL12), a constitutive chemokine involved in leukocyte retention within lymphoid tissue, was expressed by epithelial cells in both diseased and control samples. The chemokine receptor for SDF-1, CXCR4, was expressed on T cells that accumulated in a periductal distribution in diseased tissue. CONCLUSION The ectopic expression of BCA-1 (CXCL13) on endothelial cells and within GC-like structures, together with the strong expression of SDF-1 (CXCL12) on ductal epithelial cells, is a unique feature of inflamed glands in SS. By creating a local microenvironment supportive of focal B cell aggregation and differentiation, with structural features that are remarkably similar to GCs, BCA-1 (CXCL13) and SDF-1 (CXCL12) may contribute to the excessive production of high-affinity, class-switched autoantibodies and to the high incidence of B cell lymphomas classically associated with SS.
Collapse
MESH Headings
- B-Lymphocytes/metabolism
- Chemokine CXCL12
- Chemokine CXCL13
- Chemokines, CXC/analysis
- Chemokines, CXC/biosynthesis
- Endothelium, Lymphatic/metabolism
- Endothelium, Lymphatic/pathology
- Fluorescent Antibody Technique, Indirect
- Germinal Center/metabolism
- Germinal Center/pathology
- Humans
- Immunohistochemistry
- Palatine Tonsil/metabolism
- Palatine Tonsil/pathology
- Parotid Gland/metabolism
- Parotid Gland/pathology
- Receptors, CXCR4/biosynthesis
- Receptors, CXCR5
- Receptors, Chemokine
- Receptors, Cytokine/biosynthesis
- Salivary Glands, Minor/metabolism
- Salivary Glands, Minor/pathology
- Sjogren's Syndrome/metabolism
- Sjogren's Syndrome/pathology
- Tonsillitis/metabolism
- Tonsillitis/pathology
Collapse
Affiliation(s)
- N Amft
- Medical Research Council Centre for Immune Regulation, University of Birmingham, Edgbaston, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
This article provides a brief overview of the various orofacial presentations of Sjögren's syndrome. The paper summarises the clinical features of patients with xerostomia, and alludes to differential diagnosis, investigative procedures and therapeutic modalities for the oral component of Sjögren's syndrome.
Collapse
Affiliation(s)
- J Hamburger
- Unit of Oral Medicine, The University of Birmingham School of Dentistry, UK.
| |
Collapse
|
40
|
Abstract
Although lichen planus is a relatively common mucocutaneous disorder in adults, it has only rarely been described in children. Moreover, even less data has been published regarding mucosal lesions in children. Six case reports of childhood oral lichen planus are presented and the available literature reviewed. It is believed that this paper documents the largest series of cases of childhood oral mucosal lichen planus to be reported in the literature to date. Lichen planus should be considered in the differential diagnosis of oral mucosal white patches in children, particularly those of Asian origin.
Collapse
Affiliation(s)
- F Alam
- Unit of Oral Medicine, University of Birmingham School of Dentistry, St. Chad's Queensway, Birmingham B4 6NN, UK
| | | |
Collapse
|
41
|
Affiliation(s)
- I L Chapple
- Unit of Periodontology, School of Dentistry, University of Birmingham
| | | |
Collapse
|
42
|
Mason GI, Hamburger J, Matthews JB. Mast cells, extracellular matrix components, TGFbeta isoforms and TGFbeta receptor expression in labial salivary glands in systemic sclerosis. Ann Rheum Dis 2000; 59:183-9. [PMID: 10700426 PMCID: PMC1753093 DOI: 10.1136/ard.59.3.183] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether there was altered elaboration of non-collagenous extracellular matrix proteins or expression of TGFbeta isoforms and their receptors in salivary glands of patients with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Because of the possible role of mast cells in the early stages of SSc their presence was also investigated. METHODS Sections of normal labial salivary glands (n=10) and glands from patients with SSc (n = 13) and RP (n = 5) were stained immunohistochemically and using acid toluidine blue. RESULTS SSc glands contained more mast cells than control tissues (p<0.005) and similar numbers to those found in RP specimens. There were no differences in the pattern or amount of non-collagenous matrix proteins detected. Tenascin and elastin were predominantly found surrounding ducts whereas fibronectin had a more general distribution. TGFbeta isoforms and receptors were expressed by glandular epithelium, fibroblasts, vascular endothelium and inflammatory cells. Cell counts showed no differences in expression of TGFbeta1 or TGFbeta receptors between groups. However, the percentage of TGFbeta2 positive fibroblasts was significantly higher in SSc glands compared with controls (p<0.004). RP glands showed an intermediate level of expression. By contrast, a lower percentage of RP fibrolasts expressed TGFbeta3 compared with controls with SSc glands showing an intermediate level of expression. CONCLUSIONS These results show that (a) there are no changes in glandular expression of tenascin, elastin and fibronectin in SSc and RP and (b) both conditions are associated with an increased salivary gland mast cell population and changes in expression of TGFbeta2 and beta3 isoforms by glandular fibroblasts.
Collapse
Affiliation(s)
- G I Mason
- Unit of Oral Pathology, University of Birmingham, School of Dentistry, St Chad's Queensway, Birmingham B4 6NN
| | | | | |
Collapse
|
43
|
Abstract
Behçet's syndrome is a multisystem disorder characterized by recurrent orogenital ulceration and an occlusive vasculitis. Histologically, there is a combination of a perivascular lymphocytic infiltration with endothelial cell damage coupled with a pro-thrombotic tendency. We present a multidisciplinary approach to the management of Behçet's syndrome, and compare our findings with other published studies. Over a nine-year period, 50 patients with Behçet's syndrome were followed in a multidisciplinary combined clinic. Patients were assessed by an ophthalmologist, a rheumatologist and a specialist in oral medicine. Data on disease activity and damage were collected using a standardized proforma for each specialty. Mean age of onset was 30 years; 56% were male. Recurrent oral ulceration was the commonest manifestation and the presenting feature in 76%. The commonest second systems involved were genital mucosae and eyes. We found a larger proportion of patients with ophthalmic (80%) and central nervous system (14%) manifestations compared with many other studies. There was an association between central nervous system and thrombotic events (p<0.001). Our multidisciplinary approach allowed us to keep each system involved in Behçet's syndrome under careful review. The development of recurrent sight-threatening eye disease was unpredictable and occurred despite aggressive immunosuppression.
Collapse
Affiliation(s)
- A J Whallett
- Heartlands and Solihull NHS Trust, Birmingham and Midland Eye Centre, and Birmingham Dental Hospital, Birmingham, UK
| | | | | | | | | |
Collapse
|
44
|
Abstract
BACKGROUND White sponge naevus (WSN) is a rare autosomal dominant condition which is characterised by benign, white spongy plaques (oral leukokeratoses) affecting non-cornifying, wet mucosa. WSN shares several ultrastructural characteristics (eg, epithelial thickening, acanthosis, keratin filament aggregation) with a number of epithelial disorders caused by mutations in keratin genes and to-date two mutations, one in each of the mucosal specific keratins, K4 and K13, have been identified as the molecular basis of the disorder. OBJECTIVES To identify the molecular basis of WSN in two families with a history of the disease. RESULTS Two novel mutations were identified in helix initiation motif of K13. A T-to-C transition was found in the affected members of one family which is predicted to change leucine115 to proline. In the second family, a similar T-to-C transition was found in codon 108 which is predicted to change methionine to threonine in the protein sequence. These changes were not found in 50 unrelated, unaffected individuals. CONCLUSIONS The mutations in the helix initiation motif of K13 are the cause of WSN in these families. These cases confirm mutations in the mucosal specific keratins as a significant cause of the disorder.
Collapse
Affiliation(s)
- E Rugg
- Cancer Research Campaign Cell Structure Research Group, Department of Anatomy & Physiology, University of Dundee, Dundee DD1 5EH, UK
| | | | | | | | | | | |
Collapse
|
45
|
Abbasi I, Githure J, Ochola JJ, Agure R, Koech DK, Ramzy RM, Williams SA, Hamburger J. Diagnosis of Wuchereria bancrofti infection by the polymerase chain reaction employing patients' sputum. Parasitol Res 1999; 85:844-9. [PMID: 10494812 DOI: 10.1007/s004360050643] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A preliminary evaluation of the diagnostic potential of a polymerase chain reaction (PCR) assay using diurnally collected sputum from bancroftian filariasis patients is described. A new set of PCR primers amplifying a 254-bp-long sequence termed AccI, derived from a long dispersed repeated sequence and SspI primers previously employed for PCR-based diagnosis were employed in this study with similar results. Of the 34 sputum samples from patients, 32 (94%) were PCR positive. Of the 18 patients with low to high microfilaremia (21-1560 microfilariae/ml), 16 (88.8%) were PCR positive. Of the remaining 16 patients, 6 with very low microfilaremia (2-6 microfilariae/ml) and 10 without microfilaremia, all (100%) were PCR positive. Two PCR-positive cases among the 13 endemic normal individuals tested (15.4%) may represent cases of occult filariasis. PCR amplification was also demonstrated with one PCR-positive sputum aliquot when mixed with 14 sputum aliquots from uninfected (PCR-negative) individuals. The potential diagnostic merits of the sputum-PCR assay are discussed.
Collapse
Affiliation(s)
- I Abbasi
- The Kuvin Centre for the Study of Infectious and Tropical Diseases, Hebrew University of Jerusalem, Israel
| | | | | | | | | | | | | | | |
Collapse
|
46
|
van Domburg RT, Foley DP, de Jaegere PP, de Feyter P, van den Brand M, van der Giessen W, Hamburger J, Serruys PW. Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients. Heart 1999; 82 Suppl 2:II27-34. [PMID: 10490586 PMCID: PMC1766511 DOI: 10.1136/hrt.82.2008.ii27] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe the long term clinical outcome (up to 11 years) after coronary stenting. DESIGN A single centre observational study encompassing 1000 consecutive patients with a first stent implantation (1560 stents) between 1986 and 1996, who were followed for at least one year with a median follow up of 29 months (range 12-132 months). RESULTS Up to July 1997 the cumulative incidence of the major adverse cardiac events (MACE) of death, non-fatal acute myocardial infarction, coronary artery bypass grafting, and repeat percutaneous transluminal coronary angioplasty was 8.2%, 12.8%, 13.1%, and 22.4%, respectively. Survival at one, three, and five years was 95%, 91%, and 86%, respectively. Comparison of MACE incidence during the "anticoagulant era" and the "ticlopidine era" revealed significantly improved event free survival with ticlopidine (27% v 13%; p < 0.005). Multivariable analyses showed that ejection fraction < 50% (relative risk (RR) 4. 1), multivessel disease (RR 3.0), diabetes (RR 2.9), implantation in saphenous vein graft (RR 2.1), indication for unstable angina (RR 1. 9), and female sex (RR 1.7) were independent predictors of increased mortality after stenting. Independent predictors of any MACE were multivessel stenting (RR 2.0), implantation in saphenous bypass graft (RR 1.6), diabetes (RR 1.5), anticoagulant treatment (versus ticlopidine and aspirin) (RR 1.5), bailout stenting (RR 1.5), multivessel disease (RR 1.4), and multiple stent implantation (RR 1. 5). CONCLUSIONS Long term survival and infarct free survival was good, particularly in non-diabetic men with single vessel disease and good ventricular function, who had a single stent implanted in a native coronary artery. A dramatic improvement was observed in event free survival, both early and late, with the replacement of anticoagulation by ticlopidine. This, of course, cannot be separated from improved stent implantation techniques between 1986 and 1995. Ultimately, almost 40% of the patients experienced an adverse cardiac event (mainly repeat intervention) in the long term. New advances in restenosis treatments and in secondary prevention must be directed at this aspect of patient management after stenting.
Collapse
Affiliation(s)
- R T van Domburg
- Department of Cardiac Catheterization and Interventional Cardiology, Erasmus University and University Hospital Rotterdam, Thoraxcenter, Bd 308, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Hamburger J, Xin XY, Ramzy RM, Jourdane J, Ruppel A. A polymerase chain reaction assay for detecting snails infected with bilharzia parasites (Schistosoma mansoni) from very early prepatency. Am J Trop Med Hyg 1998; 59:872-6. [PMID: 9886192 DOI: 10.4269/ajtmh.1998.59.872] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the present study, we adapted a polymerase chain reaction (PCR) assay, previously shown by us to be very sensitive for detecting cercariae in water, for the sensitive detection of Schistosoma mansoni DNA in infected snails from early prepatency. Polymerase chain reaction primers were designed based on the 121-basepair highly repeated sequence we previously identified in the genome of S. mansoni. The DNA was prepared from the snails by a simple alkaline extraction procedure, and the PCR assay enabled a clear differentiation between infected and normal snails. Infected snails were detected as early as one day after penetration of a single miracidium. The high sensitivity of the test enabled identification of a single infected snail even when its DNA was pooled with material from up to 99 uninfected snails, thus demonstrating the possibility of mass diagnosis in pools of snails. The assay has the potential for large-scale determination of prepatent infection prevalence in snails, thus offering new possibilities for the evaluation of schistosomiasis transmission and for schistosomiasis control, as discussed.
Collapse
Affiliation(s)
- J Hamburger
- Kuvin Centre, Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
48
|
Abstract
Carbamazepine is a drug commonly prescribed by medical and dental practitioners for the treatment of trigeminal neuralgia. Although included in the Dental Practitioners' Formulary, general dental practitioners (GDPs) rarely prescribe this medication. Those GDPs who do prescribe carbamazepine may need to liaise with the patient's medical practitioner for haematological monitoring. However, a significant number of patients attending their GDP are taking carbamazepine prescribed by hospital colleagues or general medical practitioners. Thus a knowledge of potential side-effects and adverse reactions is useful for all practitioners.
Collapse
Affiliation(s)
- S J Neale
- Birmingham Dental Hospital and School of Dentistry, Birmingham
| | | | | |
Collapse
|
49
|
Hamburger J, Xu YX, Ramzy RM, Jourdane J, Ruppel A. Development and laboratory evaluation of a polymerase chain reaction for monitoring Schistosoma mansoni infestation of water. Am J Trop Med Hyg 1998; 59:468-73. [PMID: 9749646 DOI: 10.4269/ajtmh.1998.59.468] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A sensitive and specific detection of cercariae of human schistosomes is required for better definition of risk of infection. In the present study, we have developed a polymerase chain reaction (PCR) assay for the detection of cercariae of Schistosoma mansoni in water. A simple DNA preparation was adapted for this purpose, and PCR primers were designed based on the 121-basepair highly repeated sequence we previously identified in the genome of S. mansoni. The PCR assay detected as little as 10(-6) ng of S. mansoni DNA, and the high sensitivity enabled the detection of a single cercaria. For trapping of cercariae we adapted a filtration apparatus previously used for separating schistosome eggs from turbid enzymatic digests of tissues. A single cercaria could be detected in repeated tests of water filtrates. Since the target DNA is tandemly arranged, a ladder pattern of the PCR products was demonstrated. A direct relationship was demonstrated between the number of ladder bands of the amplification products, and DNA concentration or number of cercariae. The feasibility of semiquantitation of schistosome larvae in natural water was thus suggested. The potential of the procedures described here for epidemiologic studies is discussed.
Collapse
Affiliation(s)
- J Hamburger
- Hebrew University, Hadassah Medical School, Jerusalem Israel
| | | | | | | | | |
Collapse
|
50
|
Oesterle SN, Bittl JA, Leon MB, Hamburger J, Tcheng JE, Litvack F, Margolis J, Gilmore P, Madsen R, Holmes D, Moses J, Cohen H, King S, Brinker J, Hale T, Geraci DJ, Kerker WJ, Popma J. Laser wire for crossing chronic total occlusions: "learning phase" results from the U.S. TOTAL trial. Total Occlusion Trial With Angioplasty by Using a Laser Wire. Cathet Cardiovasc Diagn 1998; 44:235-43. [PMID: 9637452 DOI: 10.1002/(sici)1097-0304(199806)44:2<235::aid-ccd23>3.0.co;2-k] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Prima laser guidewire system (Spectranectics Corp., Colorado Springs, CO) consists of an 0.018" hypotube containing a bundle of 45-microm optical fibers coupled to a pulsed excimer laser operating at a tip fluence of 60 ml/mm2 and a repetition rate ranging from 25-40 Hz. This laser guidewire was specifically designed to cross total occlusions refractory to passage with conventional wires. The Prima wire was evaluated in a feasibility study at 15 U.S. centers. Following failure to cross a total occlusion with approved guidewires, the Prima wire was utilized in 179 patients. Average age of subjects was 61 yr. Lesion locations included left anterior descending (36%), right (45%), and circumflex (19%) coronary arteries. Mean angiographic age of total occlusions was 70 wk (range, 2-1,020 wk, median, 14 wk). The use of the Prima wire either solely or in combination with conventional guidewires resulted in successful crossing in 61% of these previously impenetrable occlusions. Failure of the device was commonly related to length of the occlusion and tortuosity along the occluded pathway. Major complications included myocardial infarction in 7 patients (3.9%), tamponade in 3 (1.7%), and death in 2 (1.1%). This "learning phase" pilot study confirmed the feasibility of a laser guidewire in chronic total occlusions that are resistant to passage of conventional guidewires. An extended registry at these investigative sites is planned.
Collapse
Affiliation(s)
- S N Oesterle
- Department of Medicine, Stanford University Medical Center, California 94305, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|