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Hsi RA, Gutschenritter T, Pham A, Parsai H, Bradlo JR, Bell J, Mangibin R, Montague M, Reith S. Initial Clinical Outcomes of a Phase II Trial of Focal Salvage LDR Brachytherapy for Local Recurrence of Prostate Cancer after External Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e394. [PMID: 37785321 DOI: 10.1016/j.ijrobp.2023.06.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the clinical outcomes of focal salvage low dose rate brachytherapy (FSB) for biopsy proven local recurrence of prostate cancer after definitive external beam radiation therapy (EBRT). MATERIALS/METHODS Patients with a Phoenix definition PSA recurrence (nadir + 2.0ng/dL) after definitive EBRT for localized prostate cancer and a negative metastatic work up were enrolled in a Phase II clinical trial. Patients first underwent MR-guided transperineal mapping biopsy of the prostate using a template grid. Patients with a pathologically confirmed recurrence underwent FSB using iodine-125 seeds to a prescription dose of 145 Gy. The brachytherapy planning target volume (PTV) was defined by the positions of the pathologically negative core biopsies adjacent to the positive core biopsies as recorded on the template grid during the biopsy procedure. An intraoperative treatment plan was then developed to cover the PTV with the 145 Gy isodose line. Follow up included assessment of genitourinary (GU) and gastrointestinal (GI) toxicities using Common Terminology Criteria for Adverse Events version 4.03 (CTCAEv4.03), patient reported outcomes using the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index-26 (EPIC-26) forms, and serial PSA blood draws. RESULTS Ten patients underwent FSB. The median prior EBRT dose was 7805 cGy (interquartile range IQR 7560-7920) and the median time from completion of EBRT to FSB was 81 months (IQR 68-134). The median PSA prior to FSB was 3.2 ng/dL (IQR 2.3 - 4.5). The median follow up after FSB was 32 months (IQR 18-57). Eight patients were free of Phoenix definition PSA failure at last follow up. Of the two patients who experienced a PSA failure, one developed distant metastases 5 months after FSB and the other a biopsy proven seminal vesicle recurrence 3 years after FSB. The median change in post FSB IPSS score compared to the pre-FSB IPSS score was an increase of 1.5 (IQR -1.5 to 8) at 3 month follow up and an increase of 3.5 (IQR 0.5 to 5.5) at last follow up (≥1 year). The median change in post FSB EPIC-26 urinary domain score compared to the pre-FSB score was -1 (IQR -26 to +14.5) at 3 month follow up and +2 (IQR -12.5 to +14.5) at last follow up (≥1 year). The median change in post FSB EPIC-26 bowel domain score compared to the pre-FSB score was -2 (IQR -9.5 to 0.0) at 3 month follow up and 0 (IQR -6.0 to +3.0) at last follow up (≥1 year). No patients experienced post FSB Grade 3 or higher GU or GI toxicities. CONCLUSION High dose FSB for a local recurrence of prostate cancer after EBRT can be delivered with good biochemical control and a favorable toxicity profile. Further clinical trial enrollment and longer follow up will be needed to better assess long term outcomes.
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Affiliation(s)
- R A Hsi
- University of Washington, Department of Radiation Oncology, Seattle, WA; EvergreenHealth Department of Radiation Oncology, Kirkland, WA
| | - T Gutschenritter
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - A Pham
- University of Washington, Department of Radiation Oncology, Seattle, WA
| | - H Parsai
- University of Washington, Department of Radiation Oncology, Seattle, WA
| | - J R Bradlo
- EvergreenHealth Department of Radiation Oncology, Kirkland, WA
| | - J Bell
- EvergreenHealth Department of Radiation Oncology, Kirkland, WA
| | - R Mangibin
- EvergreenHealth Department of Radiation Oncology, Kirkland, WA
| | - M Montague
- Fred Hutchinson Cancer Center Peninsula, Poulsbo, WA
| | - S Reith
- Fred Hutchinson Cancer Center Peninsula, Poulsbo, WA
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Almalla M, Schroeder J, Marx N, Reith S. P2583Iatrogenic arteriovenous fistula after percutaneous mitral valve repair (PMVR) using the MitraClip system. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2583] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Almalla
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - J Schroeder
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - N Marx
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - S Reith
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
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Altiok E, Becker M, Moersen W, Mischke K, Schroeder J, Marx N, Reith S. P6480Effect of left atrial appendage morphology assessed by 3D transesophageal echocardiography on postprocedural results after percutaneous occlusion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6480] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Altiok
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - M Becker
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - W Moersen
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - K Mischke
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - J Schroeder
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - N Marx
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
| | - S Reith
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology, Pulmonology & Vascular Medicine, Aachen, Germany
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Reith S, Burgmaier M, Altiok E, Marx N, Kaestner W. P4887Acute hemodynamic and echocardiographic effects of percutaneous ventricular restoration therapy using the Parachute device in patients with severe ischemic cardiomyopathy: a single center experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kedhi E, Berta B, Roleder T, Kennedy M, Fabris E, Ijsselmuiden A, Nef H, Reith S, Escaned J, Alfonso F, Van Royen N, Wojakowski W, Ottervanger J, Suryapranata H. P5867COMBINE OCT and FFR assessment of non culprit lesions to better predict adverse event outcomes in diabetes mellitus patients. Rationale, design and initial OCT results. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Almalla M, Kersten A, Vogt F, Mischke K, Becker M, Reith S, Schroeder J, Marx N. P2756Outcome predictors of patients with out of hospital cardiac arrest and immediate coronary angiography. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Burgmaier M, Milzi A, Marx N, Reith S. P689Co-localization of plaque macrophages with calcification is associated with a more vulnerable plaque phenotype and a greater calcification burden in coronary target lesions as determined by OCT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Almalla M, Schroeder J, Altiok E, Marx N, Reith S. P479Persistent iatrogenic atrial septal defect after percutaneous mitral valve repair using the MitraClip system: one step forward or two steps back. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kersten A, Reith S. [Delirium and delirium management in critically ill patients]. Med Klin Intensivmed Notfmed 2016; 111:14-21. [PMID: 26795215 DOI: 10.1007/s00063-015-0130-z] [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: 10/19/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU.
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Affiliation(s)
- A Kersten
- Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - S Reith
- Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Reith S, Brandt H, Hoy S. Simultaneous analysis of activity and rumination time, based on collar-mounted sensor technology, of dairy cows over the peri-estrus period. Livest Sci 2014. [DOI: 10.1016/j.livsci.2014.10.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Almalla M, Altiok E, Reith S, Brehmer K, Marx N, Hoffmann R. Hemodynamic effect of iatrogenic atrial septal defect after percutaneous mitral valve repair using the MitraClip device. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Reith S, Battermann S, Hoffmann R, Marx N, Burgmaier M. Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Reinartz SD, Reith S, Kuhl CK, Mahnken AH. Koronare DSCT-Angiografie zur Vorhersage des perkutanen Rekanalisationserfolgs in chronischen Totalokklusionen (CTO). ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Janssens U, Reith S. [The chronic critically ill patient from the cardiologist's perspective]. Med Klin Intensivmed Notfmed 2013; 108:267-78. [PMID: 23612917 DOI: 10.1007/s00063-012-0193-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
In recent years the prognosis and survival of chronic and acute heart failure (HF) patients has been steadily improving; however, many patients develop advanced chronic HF which is characterized by worsening of symptoms, unplanned hospital admission due to acute decompensation, development of complications, such as life-threatening arrhythmia and shorter life span. Optimal medical therapy is supplemented by interventional cardiology, cardiovascular implantable electronic devices (CIEDs), minimally invasive valve replacement or repair, circulatory mechanical support and heart transplantation. Medical indications and informed consent are essential prerequisites for successfully implementing treatment goals. For patients who are incapable of decisions a legally defined surrogate decision-maker has the same right to refuse or request the withdrawal of treatment as the patient would have if the patient had decision-making capability. As the use of circulatory mechanical support becomes increasingly more prevalent, ethical issues are likely to arise at an increasing rate, as will social and legal ramifications. The concept of turning off an implanted device as death nears is challenging because of ethical and technical concerns. The same holds true for CIEDs. A palliative care approach is applicable to heart failure patients and is particularly relevant to those with advanced disease. Palliative care should be integrated as part of a team approach to comprehensive HF care and should not be reserved for those who are expected to die within days or weeks.
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Affiliation(s)
- U Janssens
- Klinik für Innere Medizin, St. Antonius Hospital, Eschweiler.
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15
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Reith S, Marx N. Erratum zu: Kardiale Biomarker bei kritisch Kranken. Med Klin Intensivmed Notfmed 2012. [DOI: 10.1007/s00063-012-0181-3] [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: 11/24/2022]
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16
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Reith S, Hoy S. Relationship between daily rumination time and estrus of dairy cows. J Dairy Sci 2012; 95:6416-20. [DOI: 10.3168/jds.2012-5316] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 07/10/2012] [Indexed: 11/19/2022]
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17
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Abstract
Cardiac biomarkers in intensive care medicine are an excellent complement to existing clinical and diagnostic information in specific diseases. Due to their lack of specificity, the diagnostic properties of common cardiac biomarkers, such as natriuretic peptides and cardiac troponins, remain ambiguous, while their prognostic value has already been proven. In addition, there are several promising new biomarkers that might contribute to a "multimarker strategy" in the critically ill patient in the future, but further evaluation is still required.
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Affiliation(s)
- S Reith
- Medizinische Klinik I, Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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18
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Reith S, Marx N. Therapeutische Hypothermie nach Reanimation. Dtsch Med Wochenschr 2010; 135:2355-60. [DOI: 10.1055/s-0030-1267523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stuart AE, Jolobe OMP, Dwarakanath A, Booth C, Reith S, Syed GMS. Letters to the editor. J R Coll Physicians Edinb 2009. [DOI: 10.4997/jrcpe.2009.421] [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
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Müller-Werdan U, Buerke M, Christoph A, Flieger R, Loppnow H, Prondzinsky R, Reith S, Schmidt H, Werdan K. Schock. Klinische Kardiologie 2006. [PMCID: PMC7143837 DOI: 10.1007/3-540-29425-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Reith S, Werdan K. Therapie des Organversagens bei prim�r extrakardialen Erkrankungen. Internist (Berl) 2005; 46:256-64. [PMID: 15750842 DOI: 10.1007/s00108-005-1352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are a number of primary extracardiac circulatory disorders leading to organ dysfunction, multi-organ dysfunction syndrome and finally to multi-organ-failure. The origin of this hemodynamic disturbances are potentially different forms of circulatory shock (septic, hypovolemic, anaphylactic or neurogenic shock) and the systemic inflammatory reaction syndrome (SIRS). The primary aim of therapy is the removal of the underlying causes and the restoration of adequate tissue perfusion by using fluids, vasopressors and inotropics. The supportive treatment of the individual organ dysfunction is - at present - unequally efficient.
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Affiliation(s)
- S Reith
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum Kröllwitz der Martin-Luther-Universität Halle-Wittenberg.
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Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common disease of the cardiac sarcomere with broad heterogeneity in terms of the disease-causing gene mutation, phenotypic expression, therapy and prognosis. Besides the standard drug treatment, there are several therapeutic options available for severe refractory symptomatic HCM with obstruction. Dual-chamber pacing and transcoronary ablation of septal hypertrophy (TASH) have recently emerged as alternatives to myectomy. However, myectomy remains the current gold standard of therapy for HCM until the promising initial follow-up data for TASH can be transferred into a long-term follow-up period, or prospective randomized comparative trials between these therapies are available. However, even now, TASH represents an important therapeutic alternative in patients with relevant co-morbidities and a high operative risk. Despite significant gradient reduction and amelioration of clinical symptoms, none of these treatment strategies has a proven influence on the natural history of HCM. Hence, regarding the long-term prognosis of the disease, risk stratification of sudden cardiac death using non-invasive risk assessment has become of paramount importance, while genotyping might become the determinant and stratifying marker in the near future. At present, according to secondary prevention, treatment with an implanted cardioverter-defibrillator +/- amiodarone therapy is mandatory, while according to primary prevention treatment should particularly depend on the individual risk profile.
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MESH Headings
- Cardiomyopathy, Hypertrophic/classification
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/therapy
- Cardiovascular Agents/therapeutic use
- Combined Modality Therapy/methods
- Combined Modality Therapy/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Heart Septum/physiopathology
- Heart Septum/surgery
- Humans
- Minimally Invasive Surgical Procedures
- Pacemaker, Artificial
- Survival Rate
- Ventricular Outflow Obstruction/classification
- Ventricular Outflow Obstruction/mortality
- Ventricular Outflow Obstruction/physiopathology
- Ventricular Outflow Obstruction/therapy
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Affiliation(s)
- S Reith
- Medizinische Klinik I, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany.
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Volk O, Reith S, Saehn C, Haars P, Bach D, Klues HG. [Attempted suicide by intravenous injection of metasystox]. Anasthesiol Intensivmed Notfallmed Schmerzther 2002; 37:280-3. [PMID: 12015685 DOI: 10.1055/s-2002-30127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A 27-year old man was admitted to the hospital after having attempted suicide by injection of 30 ml of metasystox (demeton-s-methyl), an organophosphate compound, in a cubital vein of the left arm. He was suffering from the typical cholinergic symptoms. Local examination of the injection site revealed a local inflammation extending from the middle of the left upper arm to the distal forearm. Surgical débridement became necessary. In the third week of treatment he developed a rhabdomyolysis (CK 66.300 U/l) with an acute renal failure and needed haemodialysis. Later he showed signs of an intermediate syndrome.
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Affiliation(s)
- O Volk
- Medizinische Klinik I, Klinikum Krefeld, Krefeld, Germany.
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Ortlepp JR, Vosberg HP, Reith S, Ohme F, Mahon NG, Schröder D, Klues HG, Hanrath P, McKenna WJ. Genetic polymorphisms in the renin-angiotensin-aldosterone system associated with expression of left ventricular hypertrophy in hypertrophic cardiomyopathy: a study of five polymorphic genes in a family with a disease causing mutation in the myosin binding protein C gene. Heart 2002; 87:270-5. [PMID: 11847170 PMCID: PMC1767035 DOI: 10.1136/heart.87.3.270] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is an inherited disease of the sarcomere characterised clinically by myocardial hypertrophy and its consequences. Phenotypic expression is heterogeneous even within families with the same aetiological mutation and may be influenced by additional genetic factors. OBJECTIVE To determine the influence of genetic polymorphisms of the renin-angiotensin-aldosterone system (RAAS) on ECG and two dimensional echocardiographic left ventricular hypertrophy (LVH) in genetically identical patients with HCM. PATIENTS AND METHODS Polymorphisms of five RAAS components were determined in 26 gene carriers from a single family with HCM caused by a previously identified myosin binding protein C mutation. Genotypes associated with a higher activation status of the RAAS were labelled "pro-LVH genotypes". RESULTS There was a non-biased distribution of pro-LVH genotypes in the gene carriers. Those without pro-LVH genotypes did not manifest cardiac hypertrophy whereas gene carriers with pro-LVH genotypes did (mean (SD) left ventricular muscle mass 190 (48) v 320 (113), p = 0.002; interventricular septal thickness 11.5 (2.0) v 16.4 (6.7), p = 0.01; pathological ECG 0% (0 of 10) v 63% (10 of 16), respectively). Multivariate analysis controlling for age, sex, and hypertension confirmed an independent association between the presence of pro-LVH polymorphisms and left ventricular mass. When each polymorphism was assessed individually, carriers of each pro-LVH genotype had a significantly greater left ventricular mass than those with no pro-LVH mutation; these associations, with the exception of cardiac chymase A AA polymorphism (p = 0.06), remained significant in multivariate analysis. CONCLUSION Genetic polymorphisms of the RAAS influence penetrance and degree of LVH in 26 gene carriers from one family with HCM caused by a myosin binding protein C mutation.
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Affiliation(s)
- J R Ortlepp
- Medical Clinic I, Department of Cardiology, University Hospital of Aachen, Aachen, Germany.
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Reith S, Körtke H, Volk O, Klues HG. [Current diagnosis and therapy in heart valve diseases]. Z Kardiol 2002; 90 Suppl 6:13-21. [PMID: 11826816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We present a survey of the current standard in diagnosis and therapy of the most frequent heart valve lesions. During the last 50 years there has been a dramatic shift concerning the etiology of valve lesions with a rise of the age-dependent degenerative towards rheumatic valve diseases. The aim of the diagnostic evaluation of valve lesions is primarily the clinical and hemodynamic grading of the severity of the valve disease, the recognition of relevant coexisting cardiac and extracardiac diseases and furthermore, an optimal timing of surgery in close correlation with the cardiac surgeons.
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Affiliation(s)
- S Reith
- Medizinische Klinik I Klinikum Krefeld Lutherplatz 40 47805 Krefeld, Germany.
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Abstract
The elective PTCA of a highly stenotic right coronary artery was complicated by intracoronary entrapment of the guidewire. After transfer to a hospital with a stand-by cardiosurgical team, the interventional mobilization and withdrawal of the wire was performed. Initially the attempt to position a balloon-catheter through the entrapped guidewire failed due to a localized radiolucent piece of material attached to the tip of the wire. After introduction of an additional guidewire and consecutive dilation of the stenosis, gradual mobilization and removal of the wire was successful. During this maneuver the distal part of the guidewire ruptured and was caught in a side branch of the right femoral artery, where it could finally be retrieved, using a conventional retrieving device in a crossover technique. Intracoronary entrapment is a rare but potentially dangerous complication during coronary interventions, every cardiologist should be aware of, especially when treating tortuous vessels.
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Affiliation(s)
- S Reith
- Medizinische Klinik I Klinikum Krefeld Lutherplatz 40 47805 Krefeld, Germany.
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28
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Abstract
We present a survey of the current standard in diagnosis and therapy of the most frequent heart valve lesions. During the last 50 years there has been a dramatic shift concerning the etiology of valve lesions with a rise of the agedependent degenerative towards rheumatic valve diseases. The aim of the diagnostic evaluation of valve lesions is primarily the clinical and hemodynamic grading of the severity of the valve disease, the recognition of relevant coexisting cardiac and extracardiac diseases and furthermore, an optimal timing of surgery in close correlation with the cardiac surgeons.
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Affiliation(s)
- S Reith
- Medizinische Klinik I, Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Germany,
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Affiliation(s)
- O Volk
- Medizinische Klinik I Klinikum Krefeld Lutherplatz 40 47805 Krefeld.
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Reith S, Radke PW, Volk O, vom Dahl J, Klues HG. The place of rotablator for treatment of in-stent restenosis. Semin Interv Cardiol 2000; 5:199-208. [PMID: 11244517 DOI: 10.1053/siic.2000.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In-stent restenosis (ISR) is still a growing problem in interventional cardiology due to the increasing number of stent implantations. Various treatment modalities are available at present. As a non ablative strategy balloon angioplasty is the strategy of choice for focal ISR, while ablative techniques such as directional coronary atherectomy, Excimer laser coronary angioplasty and rotational atherectomy are used preferentially in diffuse restenosis processes. These debulking techniques are optimized by peri-interventional use of intravascular ultrasound and adjunctive balloon angioplasty. Study data comparing different interventional approaches, usually with adjunct balloon angioplasty, have not proven an optimal treatment modality for ISR yet.
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Affiliation(s)
- S Reith
- Medizinische Klinik I, Klinikum Krefeld, Germany.
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Moolman JA, Reith S, Uhl K, Bailey S, Gautel M, Jeschke B, Fischer C, Ochs J, McKenna WJ, Klues H, Vosberg HP. A newly created splice donor site in exon 25 of the MyBP-C gene is responsible for inherited hypertrophic cardiomyopathy with incomplete disease penetrance. Circulation 2000; 101:1396-402. [PMID: 10736283 DOI: 10.1161/01.cir.101.12.1396] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a myocardial disorder resulting from inherited sarcomeric dysfunction. We report a mutation in the myosin-binding protein-C (MyBP-C) gene, its clinical consequences in a large family, and myocardial tissue findings that may provide insight into the mechanism of disease. METHODS AND RESULTS History and clinical status (examination, ECG, and echocardiography) were assessed in 49 members of a multigeneration family. Linkage analysis implicated the MyBP-C gene on chromosome 11. Myocardial mRNA, genomic MyBP-C DNA, and the myocardial proteins of patients and healthy relatives were analyzed. A single guanine nucleotide insertion in exon 25 of the MyBP-C gene resulted in the loss of 40 bases in abnormally processed mRNA. A 30-kDa truncation at the C-terminus of the protein was predicted, but a polypeptide of the expected size ( approximately 95 kDa) was not detected by immunoblot testing. The disease phenotype in this family was characterized in detail: only 10 of 27 gene carriers fulfilled diagnostic criteria. Five carriers showed borderline hypertrophic cardiomyopathy, and 12 carriers were asymptomatic, with normal ECG and echocardiograms. The age of onset in symptomatic patients was late (29 to 68 years). In 2 patients, outflow obstruction required surgery. Two family members experienced premature sudden cardiac death, but survival at 50 years was 95%. CONCLUSIONS Penetrance of this mutation was incomplete and age-dependent. The large number of asymptomatic carriers and the good prognosis support the interpretation of benign disease.
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Affiliation(s)
- J A Moolman
- Department of Experimental Cardiology, Max-Planck-Institute for Physiological and Clinical Research, Bad Nauheim, Germany
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Messmer BJ, Klues HG, Reith S, Schoendube FA, Hanrath P. Hypertrophic obstructive cardiomyopathy. Adv Card Surg 1999; 10:245-70. [PMID: 9917908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Irish D, Eltringham I, Teall A, Pickett H, Farelly H, Reith S, Woodford N, Cookson B. Control of an outbreak of an epidemic methicillin-resistant Staphylococcus aureus also resistant to mupirocin. J Hosp Infect 1998; 39:19-26. [PMID: 9617681 DOI: 10.1016/s0195-6701(98)90239-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [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: 02/07/2023]
Abstract
An epidemic methicillin-resistant Staphlococcus aureus (EMRSA-3) appeared in a District hospital in June 1989 as part of a regional outbreak. The dynamics of the outbreak were complex and involved patient transfer between hospitals and wards. Control measures followed UK guidelines and included the use of nasal mupirocin. During these efforts a mupirocin-resistant MRSA [MuMRSA: mupirocin minimum inhibitor concentration (MIC) > 256 mg/L] emerged, probably in a patient who had been given eight mupirocin courses over nine months. The MuMRSA had a narrower phage-typing pattern than EMRSA-3, but was indistinguishable by pulsed-field gel electrophoresis of SmaI chromosomal restriction enzyme digests and its susceptibility pattern to other antibiotics. The results of in vitro curing and gene probing indicated that mupirocin resistance was encoded on a 48 Md plasmid. MuMRSA spread occurred in 12 patients and 11 staff. The affected patients were nursed on the same ward. The strain was eradicated from patients with oral ciprofloxacin and rifampicin, triclosan skin treatment and nasal fusidic acid and bacitracin cream. The control of the outbreak had significant medical, social and financial implications. Fortunately, there were alternative topical agents to mupirocin, an agent which has played such a key role in MRSA eradication in recent years.
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Affiliation(s)
- D Irish
- Department of Microbiology, Greenwich Hospital, London, UK
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Barnham M, Horton R, Smith JM, Richardson J, Marples RR, Reith S. Methicillin-resistant Staphylococcus simulans masquerading as MRSA in a nursing home. J Hosp Infect 1996; 34:331-3. [PMID: 8971622 DOI: 10.1016/s0195-6701(96)90113-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Schoendube FA, Klues HG, Reith S, Flachskampf FA, Hanrath P, Messmer BJ. Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 1995; 92:II122-7. [PMID: 7586394 DOI: 10.1161/01.cir.92.9.122] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.2] [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: 01/26/2023]
Abstract
BACKGROUND The standard surgical approach to hypertrophic obstructive cardiomyopathy (HOCM) was modified in the present series with a combination of extended myectomy with partial excision and mobilization of the papillary muscles. METHODS AND RESULTS Between 1979 and 1992, 58 patients (38 men and 20 women; mean age, 49 +/- 24 years) with HOCM were operated on with the use of this different technique. Their intraventricular gradients were 79 +/- 33 (+/- SD) mm Hg at rest and increased to 147 +/- 48 mm Hg with provocative maneuvers. Mild-to-moderate mitral regurgitation was present in 60% of the patients, and severe regurgitation was present in 5%. Ten patients required additional aortocoronary bypass graft surgery. Follow-up (mean, 84 months) was complete (100%). Hemodynamic improvement was documented by a significant (P < .01) decrease in left ventricular end-diastolic pressure from 19 +/- 9 to 14 +/- 6 mm Hg and reduction of basal outflow tract gradients to 5 +/- 7 mm Hg at rest and 16 +/- 24 mm Hg after provocation. Late mortality was 1.4% per patient-year, and no sudden cardiac deaths occurred during follow-up. Functional status was excellent for 84% of the patients; 8 patients were in New York Heart Association functional class III, and none were in class IV. Echocardiography revealed no outflow tract obstruction. CONCLUSIONS Extended myectomy and reconstruction of the subvalvular mitral apparatus in HOCM result in excellent functional improvement with relief of outflow tract obstruction. The technique can be performed safely despite its more aggressive surgical nature and allows an individualized strategy depending on the patient's extent and distribution of left ventricular hypertrophy.
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Affiliation(s)
- F A Schoendube
- Department of Thoracic Cardiovascular Surgery, Klinikum RWTH Aachen, Germany
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Dave J, Reith S, Nash JQ, Marples RR, Dulake C. A double outbreak of exfoliative toxin-producing strains of Staphylococcus aureus in a maternity unit. Epidemiol Infect 1994; 112:103-14. [PMID: 8119349 PMCID: PMC2271472 DOI: 10.1017/s0950268800057460] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [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: 01/28/2023] Open
Abstract
This report describes a double outbreak of staphylococcal scalded skin syndrome (SSSS) in which two distinct tetracycline-resistant strains of Staphylococcus aureus producing different exfoliative toxins were involved. In the first phase the daytime staff of the delivery unit and eczematous skin conditions in midwives were implicated as the probable source. In the second phase a source within a post-natal ward was suggested with local cross-infection. In the final phase both sources were epidemiologically linked to cases of SSSS. Because early discharge was the policy of the unit many cases presented in the community rather than in the hospital. Confirmation of epidemiological findings was provided by additional laboratory studies. Two distinct strains of S. aureus could be defined, differing in phage-typing patterns, the exfoliative toxin produced, plasmid profile, cadmium resistance and bacteriocin production. Strict care in hand washing with a chlorhexidine-containing detergent was an important control measure.
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Affiliation(s)
- J Dave
- Leeds Public Health Laboratory
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Schoendube FA, Klues HG, Reith S, Messmer BJ. Surgical correction of hypertrophic obstructive cardiomyopathy with combined myectomy, mobilisation and partial excision of the papillary muscles. Eur J Cardiothorac Surg 1994; 8:603-8. [PMID: 7893501 DOI: 10.1016/1010-7940(94)90044-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A modified surgical technique for correction of hypertrophic obstructive cardiomyopathy (HOCM) with extended myectomy together with mobilisation and partial excision of papillary muscles was performed between 1/79 and 12/92 in 58 severely symptomatic patients refractory to medical treatment. Low hospital mortality rate (1.7%) and perioperative complication rate, an equally low linear mortality 1.4% per patient year and excellent functional status (77% class I or II NYHA) of the patients at follow-up demonstrate the necessity of a comprehensive approach for correction of severely symptomatic patients with HOCM and the feasibility of our operative strategy.
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Affiliation(s)
- F A Schoendube
- Department of Thoracic and Cardiovascular Surgery, Klinikum RWTH Aachen, Germany
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Richards J, Williams H, Warner M, Johnson AP, Reith S, Woodford N, Marples RR, George RC. Nosocomial spread of Staphylococcus aureus showing intermediate resistance to methicillin. J Hosp Infect 1993; 25:91-6. [PMID: 7903092 DOI: 10.1016/0195-6701(93)90099-l] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A nosocomial outbreak of infection and colonization involving six patients and caused by a strain of Staphylococcus aureus showing intermediate resistance to methicillin (MIC = 4-8 mg l-1) is described. The outbreak was associated with skin-carriage of the epidemic strain by a nurse suffering from severe eczema. The reduced susceptibility of the outbreak strain to methicillin was associated with beta-lactamase production. Elimination or inhibition of beta-lactamase activity produced a two-fold decrease in methicillin MIC. There was no evidence for the presence of either penicillin-binding protein 2a or the corresponding mec gene, which mediate resistance in fully methicillin-resistant strains.
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Abstract
A strain of methicillin-resistant Staphylococcus aureus (MRSA), EMRSA-15, was isolated in both the Midlands and south-east of England. This strain could be distinguished from another, very similar strain, found in the north of England, by both conventional and molecular typing. Conventional typing allowed distinction between the Midlands and southern variants of EMRSA-15, while molecular typing (pulse-field gel electrophoresis) allowed recognition of local variants in the south. In this investigation conventional and molecular typing methods were complementary.
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Marples RR, Reith S. Methicillin-resistant Staphylococcus aureus in England and Wales. Commun Dis Rep CDR Rev 1992; 2:R25-9. [PMID: 1285095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) were detected soon after the introduction of methicillin in 1960, and reports of their isolation increased up to 1971. Changes in antibiotic usage were associated with a fall and then, in the early 1980s, a further rise in the number of reports. This article reviews the various surveys that have been conducted to establish the frequency, distribution and strain varieties of MRSA. The first strain to be recognised as epidemic (ie, affecting more than one hospital), was defined by phage typing and antibiogram, confirmed with molecular typing, and designated EMRSA-1. It was first detected in 1981 and became progressively more widespread until it began to decline in 1987. Only three health regions reported this strain in the first quarter of 1991. EMRSA-2 has remained restricted to the South East and South West Thames regions. EMRSA-3 appeared in the South East Thames region in 1987 and has since spread, being reported from eight health regions in the first quarter of 1991. At least 11 other strains of MRSA affecting more than one hospital have been detected and ten endemic strains (restricted to single hospitals) have been identified. Imported strains of MRSA, often introduced following the repatriation of road traffic accident victims, may include strains with epidemic potential and local spread has followed importation in at least two incidents. Continued surveillance of epidemic MRSA strains and the search for simple and widely applicable markers, such as unusual antibiotic resistance patterns or biochemical features, are needed for the prompt application of control measures.
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Reith S, Graham JL, McEwan C. Diabetes under your control: microcomputer quiz--a pilot study. Diabet Med 1984; 1:318. [PMID: 6242825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Graham JL, McEwan C, Reith S. Video medicine. West J Med 1983. [DOI: 10.1136/bmj.286.6377.1576-b] [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]
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Reith S. Nursing care study: pregnancy complicated by renal failure. Nurs Times 1982; 78:1753-6. [PMID: 6924240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Lowe GD, Lowe JM, Drummond MM, Reith S, Belch JJ, Kesson CM, Wylie A, Foulds WS, Forbes CD, MacCuish AC, Manderson WG. Blood viscosity in young male diabetics with and without retinopathy. Diabetologia 1980; 18:359-63. [PMID: 7429058 DOI: 10.1007/bf00276814] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Blood viscosity (shear rates 100s-1 and 0.94s-1) and several of its major determinants (haematocrit, plasma fibrinogen and plasma viscosity) have been measured in 38 male insulin-treated diabetics, aged 18-50 years, and in 38 non-diabetic control subjects matched for age and smoking habit. Diabetics without fundoscopic retinopathy (n=20) had higher mean blood viscosity than controls at the high shear rate (7.07 cP vs 6.75 cP, p < 0.05) and the low shear rate (21.2 cP vs 18.7 cP, p < 0.025). These differences persisted after correction of blood viscosity to a standard haematocrit, and were associated with increased plasma viscosity (1.41 cP vs 1.34 cP, p < 0.025) and plasma fibrinogen (2.9 g/L vs. 2.5 g/L, p < 0.025). Diabetics with retinopathy (n = 18) had higher mean blood viscosity than diabetics without retinopathy at the high shear rate (7.53 cP vs 7.07 cP, p < 0.05) and the low shear rate (24.3 cP vs. 21.2 cP, p < 0.05), associated with a higher haematocrit (p < 0.05). Blood viscosity and haematocrit correlated with the duration of diabetes (r > 0.32, p < 0.05).
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