Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

2011 ◽  
Vol 62 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Qian Qin ◽  
Libin Wang ◽  
Hong Li ◽  
Aihui Li ◽  
Jie Ouyang ◽  
...  
Keyword(s):  
Efficacy And Safety ◽  
Right Hemihepatectomy ◽  
Retrohepatic Tunnel ◽  
The Right

EXPERIENCE OF USING TOCILIZUMAB IN THERAPY OF TAKAYASU ARTERITIS IN CHILDREN

2021 ◽  
Vol 100 (5) ◽  
pp. 145-151
Author(s):  
V.A. Podzolkova ◽  
◽  
G.A. Lyskina ◽  
Yu.O. Kostina ◽  
V.A. Seraya ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Standard Therapy ◽  
Adverse Reactions ◽  
Activity Index ◽  
Active Form ◽  
P Value ◽  
Efficacy And Safety ◽  
Reactive Protein ◽  
Maintenance Of Remission ◽  
The Right

The prognosis of Takayasu arteritis (TA) depends on timely and adequate therapy, but in about half of patients, the disease is refractory to standard therapy or recurs against the background of a decrease in the dose of glucocorticoids (GCs). The use of biological disease-modifying antirheumatic drugs (bDMARDs) in the treatment of TA looks promising, however, the experience of their use in TA in children is presented by isolated observations. Objective of the study: to evaluate the efficacy and safety of tocilizumab (TCZ) in the treatment of refractory and recurrent forms of TA in children. Materials and methods of research: the study retrospectively included 9 children who were prescribed TCZ when standard therapy was ineffective. Before starting TCZ therapy, all patients were diagnosed with an active form of the disease. The median duration of TCZ therapy was 24 months. Results: against the background of TCZ therapy, the median ESR decreased from 22 to 5 mm/h (p value <0,01), the level of C-reactive protein from 6 to 0 mg/l (p value <0,025). All patients achieved remission. No relapses were observed. The median GCs dose decreased from 0,377 to 0,15 mg/kg/day for prednisolone, 2 patients with GCs were completely canceled. The ITAS.A activity index decreased from 3–12 (median 7) to 0 in 7 and to 1 in 2 more patients. The drug was well tolerated. Adverse reactions included one case of pityriasis versicolor and one case of postoperative phlegmon of the neck and subclavian region on the right. Conclusion: TCZ has shown efficacy and safety for the induction and maintenance of remission in children with TA. The presented results of the study indicate the prospects for further study of the use of TCZ for TA in pediatric practice.

scholarly journals USING OBSERVATIONAL DATA TO INFORM CANDIDATE PHENOTYPES FOR GEROSCIENCE TRIALS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S745-S745
Author(s):  
Jason L Sanders ◽  
Alice Arnold ◽  
Robert Boudreau ◽  
Stephen Kritchevsky ◽  
Anne Newman
Keyword(s):  
Observational Data ◽  
Observational Studies ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Efficacy And Safety ◽  
Circulating Biomarkers ◽  
Operational Characteristics ◽  
Aging Mechanisms ◽  
The Right

Abstract Geroscience trials will manipulate aging mechanisms which may have pleiotropic effects and alter multiple biologic processes and clinical outcomes. Determining an intervention’s efficacy and safety will require measuring several aspects of aging and intermediate endpoints with less regard to specific diseases. Picking the right measurements will significantly impact a trial’s cost-effectiveness and chance of success. Observational studies are ideal resources to test candidate phenotypes before investing in trials. We present a decade’s worth of results from the Cardiovascular Health Study as examples of using observational data to inform measurement in geroscience trials. Specifically, we illustrate the underlying theory, construction, operational characteristics, and inter-relationships of candidate phenotypes spanning circulating biomarkers, tissue and organ structure, and functional status, all of which can be used in geroscience trials depending on the intervention’s target and predicted outcome.

scholarly journals The scientific basis of rational prescribing. A guide to precision clinical pharmacology based on the WHO 6-step method

2020 ◽  
Author(s):  
G. A. Rongen ◽  
◽  
P. Marquet ◽  
J. M. A. van Gerven
Keyword(s):  
Clinical Pharmacology ◽  
Clinical Trials ◽  
Clinical Outcome ◽  
Drug Development ◽  
Clinical Efficacy ◽  
Efficacy And Safety ◽  
In Vivo Models ◽  
Patient Groups ◽  
The Right ◽  
Ethical Review Process

Abstract Background and methods This opinion paper expanded on the WHO “six-step approach to optimal pharmacotherapy,” by detailed exploration of the underlying pharmacological and pathophysiological principles. This exercise led to the identification of a large number of domains of research that should be addressed to make clinical pharmacology progress toward “precision clinical pharmacology,” as a prerequisite for precision medicine. Result In order to improve clinical efficacy and safety in patient groups (to guide drug development) as well as in individuals (to guide therapeutic options and optimize clinical outcome), developments in clinical pharmacology should at least tackle the following: (1) molecular diagnostic assays to guide drug design and development and allow physicians to identify the optimal targets for therapy in the individual patient in a quick and precise manner (to guide selection of the right drug for the right patient); (2) the setting up and validation of biomarkers of target engagement and modification as predictors of clinical efficacy and safety; (3) integration of physiological PK/PD models and intermediate markers of pharmacological effects with the natural evolution of the disease to predict the drug dose that most effectively improves clinical outcome in patient groups and individuals, making use of advanced modeling technologies (building on deterministic models, machine-learning, and deep learning algorithms); (4) methodology to validate human or humanized in vitro, ex vivo, and in vivo models for their ability to predict clinical outcome with investigational therapies, including nucleic acids or recombinant genes together with vectors (including viruses or nanoparticles), cell therapy, or therapeutic vaccines; (5) methodological complements to the gold-standard, large Phase 3 randomized clinical trial to provide clinically relevant and reliable data on the efficacy and safety of all treatment options at the population level (pragmatic clinical trials), as well as in small groups of patients (as low as n = 1); (6) regulatory science, so as to optimize the ethical review process, documentation, and monitoring of clinical trials, improve efficiency, and reduce costs of clinical drug development; (7) interventions to effectively improve patient compliance and to rationalize polypharmacy for the reduction of adverse effects and the enhancement of therapeutic interactions; and (8) appraisal of the ecological and societal impact of drug use to safeguard against environmental hazards (following the “One Health” concept) and to reduce drug resistance. Discussion and conclusion As can be seen, precision clinical pharmacology aims at being highly translational, which will require very large panels of complementary skills. Interdisciplinary collaborations, including non-clinical pharmacologists, will be key to achieve such an ambitious program.

scholarly journals Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient

2018 ◽  
Vol 90 (2) ◽  
pp. 127 ◽  
Author(s):  
Pietro Ferrara ◽  
Ester Del Vescovo ◽  
Francesca Ianniello ◽  
Giulia Franceschini ◽  
Luciana Romaniello ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Nocturnal Enuresis ◽  
Bladder Function ◽  
Efficacy And Safety ◽  
Nocturnal Polyuria ◽  
First Line ◽  
Normal Bladder ◽  
Increased Risk ◽  
The Right ◽  
Line Drug

Background: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). Objective: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. Materials and methods: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day.Results. We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. Conclusions: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.

scholarly journals Primary yolk sac tumour of liver with unusual clinical presentation mimicking acute appendicitis

2014 ◽  
Vol 13 (3) ◽  
pp. 33-37 ◽  
Author(s):  
M Hosala ◽  
L Laca ◽  
J Hosalova Matisova ◽  
J Janik ◽  
M Adamik ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Presentation ◽  
Right Hemicolectomy ◽  
Yolk Sac ◽  
Rare Tumour ◽  
Regional Lymph Nodes ◽  
Right Hemihepatectomy ◽  
Exact Etiology ◽  
Yolk Sac Tumour ◽  
The Right

Abstract Primary hepatic yolk sac tumour (YST) is an extremely rare tumour of the liver. The exact etiology of primary hepatic YST is still unclear. This tumour is very aggressive with ability to spread into distant sites, where it can lead to the first clinical presentation. The authors present a case of a 20-year-old woman with fever and pain in the epigastrium, which later on moved to the right hypogastrium clinically resembling acute appendicitis. Ultrasound revealed tumorous mass in the liver and hypoechogenous tumorous mass in the area of right adnexes and terminal ileum. Tumorous mass in the liver was confirmed on the CT scan. Markedly raised levels of serum α-fetoprotein concentration were detected. Laparoscopic appendectomy was performed and there was bioptically verified a diagnosis of YST. Afterwards, patient underwent right hemihepatectomy, right hemicolectomy and right adnexectomy. There was found no evidence of the gonadal, mediastinal, retroperitoneal and central nervous system origin of the YST. Histological findings from the liver proved primary yolk sac tumour of the liver with the metastatic spread into the appendix, caecum and regional lymph nodes.

scholarly journals Left-side vs. right-side hepatectomy for hilar cholangiocarcinoma: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wenxuan Wu ◽  
Qiyang Cheng ◽  
Junru Chen ◽  
Diyu Chen ◽  
Xiaode Feng ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Hilar Cholangiocarcinoma ◽  
Meta Analysis ◽  
Operation Time ◽  
R0 Resection ◽  
Right Hemihepatectomy ◽  
Left Hemihepatectomy ◽  
The Right ◽  
Hepatectomy Group

Abstract Goals We aim to draw a conclusion which type of hepatectomy could be the priority for hilar cholangiocarcinoma patients. Background Surgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which includes left hemihepatectomy, extended left hemihepatectomy, and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy, and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma. Study We systematically retrieved the MEDLINE, PubMed, and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and the secondary outcome includes 1-, 3-, and 5-year survival rates, morbidity, mortality, R0 resection rate, and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis. Results Eleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients who underwent left-side hepatectomy was comparable to that of patients who underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98–1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89–1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80–1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67–1.01]) rates between the left-side hepatectomy group and the right-side hepatectomy group. Comparing with the right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in the left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71–0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56–0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09–0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23–0.70]) in the left-side hepatectomy group were better than those of the right-side hepatectomy group. Besides, the R0 resection rate was similar between the left-side hepatectomy group and the right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87–1.03]). And the operation time for the left-side hepatectomy was significantly longer than that for the right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41–69.95]). Conclusion Through meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in the left-side hepatectomy group as is compared to the right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy depends on the site of hilar cholangiocarcinoma in every patient.

Abstract 2847: The Feasibility, Efficacy And Safety Of Transbrachial Approach For Carotid Artery Stenting

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Yuichi Miyazaki ◽  
Masahito Nakazaki
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cardiovascular Events ◽  
Neurological Deficits ◽  
Efficacy And Safety ◽  
Transfemoral Approach ◽  
Stent Restenosis ◽  
Major Cardiovascular Events ◽  
Transbrachial Approach ◽  
The Right

Backgrounds and Purpose Transfemoral approach for carotid artery stenting (CAS) is a common technique, but patients must be bedridden for several hours following CAS. If CAS can be performed through the brachial artery route, it is less invasive for patients. The purpose of our study was to investigate the feasibility, efficacy and safety of transbrachial approach for CAS. Materials and Methods Transbrachial approach for CAS was started at October 2010 and data was collected prospectively. Included for analysis were patients who underwent transbrachial elective CAS from October 2010 to July 2011. Every CAS was started through the right brachial route with a 6Fr (ID) guiding sheath specifically designed for the brachial approach under local anesthesia. Technical success, periprocedural complications, 30-day major cardiovascular events (stroke, myocardial infarction and death) and 3- month stent restenosis were investigated. Results Forty-five patients underwent transbrachial CAS. Procedures were successful through the brachial route in every case. Periprocedural complications occurred in three cases; confusion following CAS in one case, hypotension in one case and gastrointestinal hemorrhage in one case. Three patients returned to the previous state within a few days and had no neurological deficits. No access-site related complications occurred. Patients were free on the bed immediately after CAS even during hemostasis. Neither 30- day major cardiovascular events nor 3-month stent restenosis occurred. Conclusions Transbrachial CAS is feasible and safe, and has the same efficacy as transfemoral CAS.

Traumatic neuroma of the right hepatic duct undertaken right hemihepatectomy

2009 ◽  
Vol 79 (1-2) ◽  
pp. 91-92 ◽  
Author(s):  
Sae Byeol Choi ◽  
Young Nyun Park ◽  
Kyung Sik Kim
Keyword(s):  
Hepatic Duct ◽  
Traumatic Neuroma ◽  
Right Hemihepatectomy ◽  
The Right
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