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  • 1
    Article
    Article
    Language: English
    In: Wiener klinische Wochenschrift, 2016, Vol.128(17), pp.609-610
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00508-016-1039-0 Byline: Walter Klepetko (1) Author Affiliation: (1) Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria Article History: Registration Date: 16/06/2016 Online Date: 25/07/2016 Article note: W. Klepetko on behalf of the members of the Austrian Mesothelioma Interest Group (AMIG).
    Keywords: Mesothelioma;
    ISSN: 0043-5325
    E-ISSN: 1613-7671
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  • 2
    Language: English
    In: The Annals of Thoracic Surgery, July 2018, Vol.106(1), pp.1-7
    Keywords: Laryngostenosis -- Surgery;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 3
    Language: English
    In: Biochemical and Biophysical Research Communications, 30 March 2012, Vol.420(1), pp.96-101
    Description: ► Receptor for advanced glycation endproducts “RAGE” in myasthenia gravis. ► Myasthenic patients show lower levels of soluble RAGE. ► sRAGE and esRAGE are reduced. ► RAGE levels are reduced irrespective of autoantibody status. ► RAGE concentrations are not influenced by pharmacological therapy. Myasthenia gravis (MG) is a T- and B-cell mediated autoimmune disorder affecting the neuromuscular junction. The receptor for advanced glycation endproducts (RAGE) plays a role in the amplification of chronic inflammatory disorders and autoimmune diseases. We sought to investigate the role of RAGE and its ligands in the pathophysiology of MG. In this cross-sectional study we enrolled 42 patients with MG and 36 volunteers. We employed enzyme-linked immunosorbent assays to determine the concentration of soluble RAGE (sRAGE) and high mobility group box 1 (HMGB1) in serum of patients and volunteers. In a subpopulation of patients we measured the serum levels of endogenous secretory (es) RAGE and various RAGE ligands, such as S100B, S100A8 and advanced glycation endproducts (AGE-CML). Reported are means and standard error mean. We found significantly reduced levels of the soluble receptors sRAGE and esRAGE in patients with MG compared to volunteers without MG (sRAGE [pg/ml] 927.2 ± 80.8 vs. 1400.1 ± 92.4; 〈 0.001; esRAGE [pg/ml] 273.5 ± 24.6 vs. 449.0 ± 22.4; 〈 0.001). Further categorization of patients with MG according to the distribution of muscle involvement revealed the following sRAGE concentrations: generalized MG 999.4 ± 90.8 and ocular MG 696.1 ± 161.8 (vs. control; One-way ANOVA: 〈 0.001; analysis: generalized vs. ocular MG: = 0.264, generalized MG vs. control: = 0.008, ocular MG vs. control: = 0.001). In patients with detectable antibodies specific for acetylcholine receptors (Anti-AChR positive) the sRAGE concentration was 970.0 ± 90.2 compared to those without (seronegative) 670.6 ± 133.1 (vs. control; One-way ANOVA: 〈 0.001; analysis: Pos vs. Neg.: = 0.418, Pos vs. control: = 0.003, Neg. vs. control: = 0.008). We next investigated the role of RAGE ligands in MG. The concentrations of RAGE ligands in patients with MG and controls were as follows: (HMGB1 [ng/ml] 1.7 ± 0.1 vs. 2.1 ± 0.2; = 0.058; S100B [pg/ml] 22.5 ± 22.5 vs. 14.4 ± 9.2; = 0.698; S100A8 [pg/ml] 107.0 ± 59.3 vs. 242.5 ± 103.6; = 0.347; and AGE-CML [ng/ml] 1100.8 ± 175.1 vs. 1399.8 ± 132.8; = 0.179). Our data suggest a role for the RAGE pathway in the pathophysiology of MG. Further studies are warranted to elucidate more about this immunological axis in patients with MG.
    Keywords: Myasthenia Gravis ; Receptor for Advanced Glycation Endproducts ; Rage Ligands ; Autoimmunity ; Biology ; Chemistry ; Anatomy & Physiology
    ISSN: 0006-291X
    E-ISSN: 1090-2104
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  • 4
    Language: English
    In: PLoS ONE, 01 January 2015, Vol.10(3), p.e0122975
    Description: The human Torque Teno virus (TTV) causes persistent viremia in most immunocompetent individuals. Elevated TTV levels are observed after solid organ transplantation and are related to the extent of immunosuppression especially during the phase of maintenance immunosuppression. However, the extent to which the TTV increase in the early phase post-transplantation is associated with the patient's immunosuppressive state is unclear.In this study, we assessed the TTV increase dynamics in detail during the first three months after lung transplantation under a defined immunosuppressive regimen and in relation to the pre-transplant TTV level.Forty-six lung transplant recipients (LTRs) were included in this prospective longitudinal study. All received alemtuzumab induction combined with tacrolimus and corticosteroids immunosuppressive therapy. Plasma TTV DNA was monitored before transplantation and regularly within the first three months post-transplantation (n = 320 samples; mean sampling interval: 12.2 days).In 43/46 LTRs (93%), TTV DNA was detectable before transplantation (median 4.4 log10 copies/mL; range: 2.0-6.4). All 46 LTRs showed a TTV increase post-transplantation, which followed a sigmoidal-shaped curve before the median peak level of 9.4 log10 copies/mL (range: 7.6-10.7) was reached at a median of day 67 (range: 41-92). The individual TTV DNA doubling times (range: 1.4-20.1 days) significantly correlated with the pre-transplant TTV levels calculated over 30 or 60 days post-transplantation (r = 0.61, 0.54, respectively; both P 〈 0.001), but did not correlate with the mean tacrolimus blood levels. Pre-transplant TTV levels were not associated with time and level of the patients' post-transplant TTV peak load.The TTV level may be used to mirror the state of immunosuppression only after the patients' initial peak TTV level is reached.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: The Annals of Thoracic Surgery, December 2016, Vol.102(6), pp.2137-2137
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.athoracsur.2016.04.094 Byline: Thomas Schweiger, Walter Klepetko, Konrad Hoetzenecker Author Affiliation: Division of Thoracic Surgery, Medical University of Vienna, Wahringer Gurtel 18-20, Vienna, Austria 1090 Article History: Accepted 28 April 2016
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 6
    Language: English
    In: The Annals of Thoracic Surgery, 2011, Vol.92(1), pp.264-270
    Description: The international experience with resection of advanced thoracic malignancies performed with extracorporeal membrane oxygenation (ECMO) support is limited. We examined our results to assess the risks and benefits of this approach. We retrospectively analyzed all patients with thoracic malignancies who underwent tumor resection with ECMO support in our department between 2001 and 2010. Nine patients (aged 21 to 71 years; mean, 54.8 ± 7.5 years) underwent complex tracheobronchial resections (n = 6) or resections of greater thoracic vessels (n = 3) under venoarterial (VA) ECMO support. In 7 patients the underlying pathologic condition was non-small cell lung cancer, in 1 patient it was carcinoid tumor, and in 1 patient it was synovial sarcoma. The indication for extracorporeal support was complex tracheobronchial reconstruction (n = 5), resection of the descending aorta (n = 2), and resection of the inferior vena cava (n = 1). ECMO cannulation was central (n = 4), peripheral (n = 4), or combined (n = 1). Mean time on bypass was 110 ± 19 minutes (range 40 to 135 minutes). A complete resection (R0) was achieved in 8 patients (89%). One patient died perioperatively as a result of hepatic necrosis. Eight patients were discharged from the hospital after 7 to 42 days (median, 10 days). Median time in the intensive care unit was 1 day (range, 0 to 36 days). The only complication related to the use of ECMO was a lymphatic fistula in the groin. Mean follow-up time was 38 ± 42 months (range, 9 to 111 months). The actuarial 3-month survival was 88.9%, and the 1-year, 3-year, and 5-year survival was 76.7%. Based on this experience, we consider VA ECMO support to be a safe alternative to cardiopulmonary bypass (CPB) for advanced general thoracic operations.
    Keywords: 10 ; 25;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 7
    Language: English
    In: Annals of Thoracic Surgery, June, 2011, Vol.91(6), p.1702(7)
    Description: Background Forequarter amputation combined with chest wall resection is a rarely performed procedure. Six patients were treated for advanced malignancies with this operation in our institution since 1993. Uncontrollable pain, lymphedema, loss of function of the affected limb and, in some patients, localized ulceration of the tumor at the time of presentation, provided the indication for the operation. All patients underwent radical amputation of the upper limb and the structures of the shoulder girdle, in combination with resection of the thoracic chest wall in an extent of 2 to 7 ribs. Methods Chest wall reconstruction was achieved by implantation of a polytetrafluoroethylene patch (n = 5) or a combination of a metal implant (Stratos System R, MedXpert GmbH, Heitersheim, Germany) and a polytetrafluoroethylene patch (n = 1). Myocutaneous coverage of the defects was achieved by use of pedicled flaps from adjacent tissue (n = 3) or by free myocutaneous flaps harvested from the amputated forearm (n = 3). Results No perioperative mortality occurred; however, significant morbidity was seen after the use of the free forearm flaps based on occurring vascular problems. All 3 patients had to undergo surgical revision of the flap. Survival ranged from 5 to 50 months (median = 23.5 months) with 3 patients still alive at the time of this investigation. Conclusions Forequarter amputation in combination with chest wall resection is a feasible and potentially curative treatment for malignant tumors of the shoulder girdle with invasion of the chest wall. The operation results in immediate palliation and long-term survival can be obtained in selected cases.
    Keywords: Amputation ; Plastic Surgery
    ISSN: 0003-4975
    E-ISSN: 15526259
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  • 8
    Language: English
    In: Annals of Thoracic Surgery, 2015, Vol.99(3), p.1067(3)
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.athoracsur.2014.04.143 Byline: Thomas Schweiger, Konrad Hoetzenecker, Andreas Bacher, Clemens Aigner, Walter Klepetko Abstract: Herein we report the case of a 60-year-old female patient who developed severe respiratory failure after right-sided pneumonectomy starting 2 hours after uneventful surgery. A computed tomographic scan revealed a completely congested left lower lobe. The underlying pathomechanism of this unique finding was a kinking effect of the left lower lobe vein over the descending aorta, caused by the shifting of the heart toward the right side. Even with immediate reintubation and aggressive ventilation it was impossible to stabilize the patient and therefore an extracorporal membrane oxygenation (ECMO) had to be implanted. The ECMO support and right-lateral and prone positioning of the patient markedly improved oxygenation. After a stabilization period of 2 days the ECMO could be removed and the patient was extubated on the ninth postoperative day. To the best of our knowledge, this is the first reported case of a unilobar edema caused by a transiently impaired venous drainage after pneumonectomy. The combination of immediate ECMO support together with right-lateral and prone positioning resulted in restoration and stabilization of the patient's cardiorespiratory function. Author Affiliation: (a) Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria (b) Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria (c) Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria Article History: Accepted 1 April 2014
    Keywords: Pneumonectomy ; Heart
    ISSN: 0003-4975
    Source: Cengage Learning, Inc.
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  • 9
    Language: English
    In: Journal of Thoracic Oncology, January 2017, Vol.12(1), pp.S46-S48
    Keywords: Medicine
    ISSN: 1556-0864
    E-ISSN: 1556-1380
    Source: ScienceDirect Journals (Elsevier)
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  • 10
    Language: English
    In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 01 February 2017, Vol.51(2), pp.283-284
    Keywords: Living-Donor Lobectomy ; Pulmonary Arterioplasty ; Pulmonary Artery ; Surgical Technique ; Pneumonectomy ; Tissue Donors
    ISSN: 10107940
    E-ISSN: 1873-734X
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