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Biomedical subjects

Roland Fischer

Publications and source records attributed to Roland Fischer.

18 recordsLinked to original sources
PubMed2006

A prospective randomized controlled trial on the safety and efficacy of alternating deferoxamine and deferiprone in the treatment of iron overload in patients with thalassemia.

We compared the safety and efficacy of alternating deferoxamine and deferiprone with that of deferoxamine monotherapy. Sixty transfusion-dependent thalassemia patients regularly treated with deferoxamine were randomized to continue deferoxamine alone or to receive an alternating therapy for one year. Both arms resulted in equivalent decreases of serum ferritin and liver iron concentration. There was no significant difference in the proportion of patients with adverse events in the two therapy groups although the nature of the adverse events differed according to the chelation regimen.

Adolescent↗
PubMed2005

Synthesis of a hafnocene disilene complex.

Reaction of the magnesium transmetalation product of a 1,2-dipotassiodisilane with hafnocene dichloride gives a disilene hafnocene complex. X-ray crystallography of the respective trimethylphosphane adduct provides structural proof for this assignment.

Journal Article↗
PubMed2005

Bioavailability of oral iron drugs as judged by a 59Fe-whole-body counting technique in patients with iron deficiency anaemia. Therapeutic efficacy of iron(II)-glycine sulfate.

The bioavailability of the oral iron compound iron(II)-glycine sulfate (ferro sanol duodenal, FSD, 1 x 100 mg Fe/d) was studied in 56 patients with iron deficiency anaemia using a 59Fe-labelling technique and 59Fe-whole-body counting. This technique measures the individual iron loss and allows in patients with substantial blood loss under iron medication a reliable information on the bioavailability of the drug. In all patients, the increased loss of iron (mean 5.8 +/- 4.4 mg/d) was clearly compensated by the iron utilisation (mean: 11.1 +/- 5.6 mg/d) from a daily dosage of 100 mg iron from FSD. A significant increase in the haemoglobin concentration was observed within the monitored treatment period of 6-10 weeks (mean Hb increase from 10.7 +/- 1.7 to 12.1 +/- 1.8 g/dl). FSD has therefore documented a bioavailability of at least 11% from a single daily dose of 100 mg Fe and was effective in the treatment of the anaemia in almost all patients under study.

Adult↗
PubMed2005

Long-term treatment with deferiprone in a L1 veteran.

We studied a patient with mild beta-thalassaemia major under treatment with the oral chelator deferiprone (DFP or L1) for about 10 yr (L1 veteran). Due to poor compliance with desferrioxamine, the patient started compassionate use of DFP at an age of 23 yr with a serum ferritin of 5200 microg/L. Monitoring iron overload by SQUID biosusceptometry revealed a dramatic decrease of liver iron concentrations from 4500 to 950 microg/g(liver) within 9.5 yr. A good clinical response to chelation treatment with DFP was observed together with an improvement of liver and cardiac function and a reduction in the hepatitis virus load.

Administration, Oral↗
PubMed2005

Monitoring long-term efficacy of iron chelation treatment with biomagnetic liver susceptometry.

In patients with thalassemia, the assessment of liver iron concentration (LIC) can be used to initiate chelation treatment with desferrioxamine (DFO), deferiprone (DFP), or novel chelators (deferasirox); to adjust chelation dose according to the actual blood transfusion rate; and to monitor chelation efficacy. The results from measurements by SQUID biomagnetic liver susceptometry in the LIC range 17-11,500 microg/g of liver in about 1000 patients were used to derive nonstandard parameters, which may be useful in the treatment monitoring of patients with thalassemia. From these measurements, including liver volumes, the documented chelation dose rates, and the blood transfusion rates, the chelator index (equivalent Therapeutical Index), the total body iron elimination rate, and the molar efficacy were calculated. Chelator indices (CIs) ranged from 0.1 to 11.7 mmol/d/g of Fe for DFO, with a threshold of CI greater than 1.2 mmol/d/g of Fe indicating DFO toxicity. For DFP, CI ranged from 0.1 to 23.2 mmol/d/g of Fe. In long-term studies (2 and 4 years), mean molar efficacies of DFO and DFP were found to be quite stable with 17.6 +/- 4.8% and 4.9 +/- 1.4%, respectively. Currently, specific chelation dose is based upon body weight. Because liver iron measurements by biosusceptometry are now regularly available in Europe and America, as well as quantitative MRI worldwide, these methods may be used to adjust chelation treatment regimens to body iron stores.

Algorithms↗
PubMed2005

A simple model to assess and improve adherence to iron chelation therapy with deferoxamine in patients with thalassemia.

Adherence to deferoxamine (DFO) is vital for the long-term survival of patients with thalassemia; however, currently no measure exists to quantify adherence directly. In this study, 90 patients with thalassemia major underwent liver iron concentration (LIC) assessment by SQUID biosusceptometer, were asked to rate their adherence to DFO using a Numerical Likert Scale (NLS), and were educated about complications of iron overload. Of 38% (n = 28) of patients who rated themselves as very compliant, 19 had elevated LIC related to inadequate dosing of DFO and nine reported nonadherence in the past. Adherence improved after counseling and LIC decreased by 25% (7-60%) in eight previously noncompliant patients who returned for subsequent LIC over 15 months. In conclusion, the NLS seems to be a simple but reliable tool to assess patients' adherence to DFO. Education and frequent noninvasive LIC assessments can improve adherence and iron burden. Elevated LIC does not necessarily reflect concurrent noncompliance; however, it can be an indication of nonadherence in the past.

Adolescent↗
PubMed2005

Non-transferrin-bound iron during blood transfusion cycles in beta-thalassemia major.

Serum non-transferrin-bound iron (NTBI) levels assessed at arbitrary time points during transfusion cycles may not be representative if NTBI is undergoing significant changes during transfusion cycles. In 15 patients with beta-thalassemia major (age: 21 +/- 6 years, liver iron concentration: 2200 +/- 1200 microg/g-liver), NTBI and other hematologic parameters (transferrin saturation, transferrin receptor) were measured weekly. The largest variation of NTBI levels between individual patients was observed at midcycle. For long-term monitoring of NTBI levels, a particular time point relative to the last blood transfusion should be selected for blood drawing.

Adolescent↗
PubMed2005

Variability in hepatic iron concentration in percutaneous needle biopsy specimens from patients with transfusional hemosiderosis.

In patients with sickle cell disease or beta-thalassemia receiving RBC transfusions for a long period, a precise knowledge of the liver iron concentration (LIC) is essential for treatment. Patients underwent LIC and liver pathology assessment by duplicate biopsies in 2 passes from the same local liver site. Fresh tissue cores in trace element-free containers and tissues from dissolved paraffin-embedded cores were analyzed. LIC measurements in each of 2 paraffin-embedded cores did not differ significantly (median, 12,455 vs 12,153 microg/g dry weight; n = 29). A significant difference was observed when 1 fresh tissue sample and 1 paraffin-embedded core were analyzed (median, 11,716 vs 12,864 microg/g dry weight; n = 16; P < .001) with a median disagreement between LIC measurements of 23.0%. We found high agreement in LICs between liver biopsy specimens processed by the paraffin-embedding technique but overestimation of LICs in comparison with desiccated fresh tissue samples.

Biopsy, Needle↗
PubMed2004

Open, cyclic, and bicyclic compounds of double silylated phosphorus and boron.

Salt elimination reactions of tris(trimethylsilyl)silyl potassium (1), and two 1,4-dipotassiooligosilanes (3, 5) with 2,2,6,6-tetramethylpiperidinodichloroborane and diethylaminodichlorophosphane have generated open (2), cyclic (4) and bicyclic (6) bora- and phosphaoligosilanes. A monosilylated phosphane and the two five-membered cyclosilanes have been subjected to single crystal X-ray diffraction analysis.

Journal Article↗
PubMed2004

Adamantanes, nortricyclenes, and dendrimers with extended silicon backbones.

By reaction of the hexabromoheptasilane MeSi(SiMe(2)SiMeBr(2))(3) (1 a) with H(2)O, H(2)S, NH(3), and H(2)NMe the heptasilaadamantanes MeSi(SiMe(2)SiMeO)(3) (4), MeSi(SiMe(2)SiMeS)(3) (5), MeSi(SiMe(2)SiMeNH)(3) (6 a), and MeSi(SiMe(2)SiMeNMe)(3) (6 b), respectively, were prepared in good to moderate yields. Molecular structures of 4, 5, 6 a, and 6 b were determined by X-ray crystallography. The symmetry of the cages is approximately C(3v), and the geometry around the nitrogen atoms is essentially planar. Ab initio SCF/HF calculations with the 6-31G* basis set confirm these results. Reduction of MeSi(SiMe(2)SitBuBr(2))(3) (1 b) with lithium naphthalenide afforded the heptasilanortricyclene MeSi(SiMe(2)SitBu)(3) (7). The (29)Si NMR spectrum of 7 consists of three signals with chemical shifts that agree closely with values predicted by ab initio calculations. (29)Si INADEQUATE spectra also strongly support the nortricyclene structure. Ab initio SCF/HF calculations were performed for the parent molecule Si(7)H(10), and the ring strain of the cage was estimated as 168.8 kJ mol(-1) by using the homodesmic reaction Si(7)H(10) + 3 Si(2)H(6)-->Si(13)H(28). Compound 1 a also served as the starting material for the preparation of first-generation dendrimer 2 a by reaction with six equivalents of Ph(2)MeSiLi. Subsequent protodearylation with HBr and reaction with (Me(2)PhSi)(2)SiMeK afforded second-generation dendrimer 3. All dendrimers were characterized by multinuclear NMR spectroscopy.

Journal Article↗
PubMed2003

The first stable beta-fluorosilylanion.

The reaction of 2 equiv of tris(trimethylsilyl)silylfluoride with potassium tert-butoxide in the presence of donor molecules (THF, DME, 18-crown-6) leads to the clean formation of an adduct of 1-potassio-2-fluorotetrakis(trimethylsilyl)disilane. Attempts to transmetalate this compound effect the elimination of metal fluoride accompanied by the formation of tetrakis(trimethylsilyl)disilene. The latter can either be trapped in a cycloaddition reaction or in the absence of trapping reagents dimerizes to octakis(trimethylsilyl)cyclotetrasilane.

Journal Article↗
PubMed2003

Monitoring long-term efficacy of iron chelation therapy by deferiprone and desferrioxamine in patients with beta-thalassaemia major: application of SQUID biomagnetic liver susceptometry.

In this non-randomized prospective study, liver and spleen iron concentrations were monitored annually over a 4-year period by non-invasive Superconducting Quantum Interference Device biomagnetometry in 54 beta-thalassaemia major patients (age, 7-22 years) receiving treatment with deferiprone (75 mg/kg/d). Median liver iron concentrations increased significantly from 1456 to 2029 and 2449 microg/g(liver) at baseline, after 2.0 and 3.2 years respectively. Another group of 51 thalassaemic patients (aged 4-34 years) who received desferrioxamine s.c. for 1.9 years increased their liver iron concentration from 1076 to 1260 microg/g(liver). Taking into account the increase of the daily iron input from transfusions of 3.6 mg/d, caused by weight gain in 67% of the patients treated with deferiprone, a larger total body iron elimination rate was achieved after 2 years than at baseline. A negative ferritin change was observed in 51% of the patients. In 15 non-splenectomized patients, liver iron significantly increased from 1260 to 1937 microg/g(liver) (P < 0.01), but serum ferritin remained stable at 2100 microg/l, as did the spleen iron concentration at 1200 microg/g(spleen). A two-compartment model may predict an average chelation efficacy for desferrioxamine and deferiprone, with a saturation effect of the latter, for a certain chelation and transfusion regimen by a single liver iron quantification.

Adolescent↗
PubMed2003

Effective treatment of hereditary haemochromatosis with desferrioxamine in selected cases.

The treatment of iron overload by s.c. desferrioxamine (DFO) was studied in three patients with hereditary haemochromatosis in which phlebotomy treatment was not, or transiently not, possible because of their serious clinical condition or the lack of appropriate peripheral veins. Repeated non-invasive liver iron concentration measurements by superconducting quantum interference device biosusceptometry showed that DFO treatment (2 g/d for 9-11 months) was as effective (liver iron elimination rate: 12 mg/d) as normal phlebotomy treatment (5.9 or 14.3 mg/d respectively) with weekly 500-ml blood removals. This demonstrates that DFO is an effective alternative therapy for haemochromatosis when phlebotomy is not possible.

Deferoxamine↗
PubMedDate not supplied

Non-invasive liver iron quantification by SQUID-biosusceptometry and serum ferritin iron as new diagnostic parameters in hereditary hemochromatosis.

In the HFE-gene era, precise diagnostic parameters remain important to characterize individual iron stores, because the indication for therapy and prognosis are mainly related to the extent of iron loading. The frequently used serum ferritin interferes with non-iron related factors such as inflammation and may produce falsely positive values. We used a SQUID-biosusceptometer in a large series of patients (n = 679) to measure liver iron concentration in the differential diagnosis and therapy control of hereditary hemochromatosis (SQUID = superconducting quantum interference device). This truly non-invasive technique is sensitive, reliable, fast (online results), and also cost-effective when compared to invasive liver biopsy. Recently, ferritin iron content was propagated as a better parameter than ferritin protein. However, we found a poor correlation between ferritin iron and individual liver iron concentrations in patients with iron overload. Ferritin iron saturation varied in a range between 3 and 10%, independent from liver iron concentration. No differences were found between patients with hemochromatosis and secondary iron overload disease. Only patients with liver cell damage had increased ferritin iron saturations. In conclusion the diagnostic values of serum ferritin protein and iron to assess iron overload are limited.

Ferritins↗