Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis

2014 ◽  
Vol 52 (08) ◽  
Author(s):  
J Hartl ◽  
H Ehlken ◽  
C Weiler-Normann ◽  
M Sebode ◽  
R Zenouzi ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Patient Selection ◽  
Treatment Duration ◽  
Treatment Withdrawal ◽  
Success Rates

Patient selection based on treatment duration and liver biochemistry increases success rates after treatment withdrawal in autoimmune hepatitis

2015 ◽  
Vol 62 (3) ◽  
pp. 642-646 ◽  
Author(s):  
Johannes Hartl ◽  
Hanno Ehlken ◽  
Christina Weiler-Normann ◽  
Marcial Sebode ◽  
Benno Kreuels ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Patient Selection ◽  
Treatment Duration ◽  
Treatment Withdrawal ◽  
Success Rates

A lesson in history: the evolution of endoscopic third ventriculostomy

2012 ◽  
Vol 33 (2) ◽  
pp. E11 ◽  
Author(s):  
Paul J. Schmitt ◽  
John A. Jane
Keyword(s):  
Patient Selection ◽  
Endoscopic Third Ventriculostomy ◽  
Lessons Learned ◽  
New Technique ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Success Rates ◽  
Effective Implementation ◽  
Remarkable Improvement ◽  
History Of

The history of endoscopic third ventriculostomy (ETV) demonstrates the importance of studying neurosurgery's history. A story that began with numerous technological advancements started to fizzle as neurosurgeons were stymied by problems encountered during the infancy of the technology they were still developing. The new technique, although sound in theory, failed to deliver a realistic solution for managing hydrocephalus; it lost the battle to the valved shunt. Over the last 15–20 years, a clearer understanding of pathophysiological mechanisms underlying various forms of hydrocephalus, along with effective implementation of evidence-based practice, has allowed for optimization of patient selection and a remarkable improvement in ETV success rates. Neurosurgeons would be wise to take the lessons learned in modernizing the ETV procedure and reassure themselves that these lessons do not apply to other methods that are tempting to dismiss as antiquated or archaic.

scholarly journals Sustained Remission After Treatment Withdrawal in Autoimmune Hepatitis: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Yasmina Ben Merabet ◽  
Coralie Barbe ◽  
Alexandra Heurgue-Berlot ◽  
Thierry Thévenot ◽  
Anne Minello ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Autoimmune Hepatitis ◽  
Hepatitis A ◽  
Treatment Withdrawal ◽  
Sustained Remission

Treatment Withdrawal in Autoimmune Hepatitis

2015 ◽  
Vol 33 (Suppl. 2) ◽  
pp. 88-93 ◽  
Author(s):  
Gerd Bouma ◽  
Carin M. van Nieuwkerk
Keyword(s):  
Maintenance Therapy ◽  
Autoimmune Hepatitis ◽  
Drug Withdrawal ◽  
Treatment Strategies ◽  
Liver Disorder ◽  
Current Treatment ◽  
Term Treatment ◽  
Treatment Withdrawal ◽  
Sustained Remission ◽  
Long Term Treatment

Background: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disorder of unknown aetiology, which when left untreated can lead to liver cirrhosis and hepatic failure. Current treatment strategies include long-term treatment with corticosteroids and/or azathioprine. Most patients respond well to immunosuppressive therapy and treatment usually results in an asymptomatic course of AIH in remission. Nevertheless, both drugs are associated with serious side effects that can sometimes be severe and may necessitate drug withdrawal. Whether or not treatment in patients who are in longstanding remission can be discontinued is unknown. Key Messages: Available data rely on retrospective data sets and are not conclusive. Some studies indicate that a sustained remission after treatment withdrawal is feasible, whereas other studies have found relapse rates in up to 90% of patients, even in patients with established histological remission. Patients who relapse after drug withdrawal have a high probability for a re-relapse to occur. Life-long maintenance therapy should be strongly considered in these patients, since patients who have multiple relapses are more likely to progress to cirrhosis, liver transplantation and death from liver failure. Conclusion: For a majority of patients, AIH is a lifelong disease requiring permanent treatment. Patients in longstanding clinical remission on monotherapy, with complete normalisation of aminotransferases and IgG could be offered one attempt of drug withdrawal. The risk of disease progression after a single relapse appears low, while a patient's realization that infinite maintenance therapy is mandatory may improve drug adherence.

scholarly journals Recent updates on the management of autoimmune hepatitis

2021 ◽  
Vol 27 (1) ◽  
pp. 58-69
Author(s):  
Atsumasa Komori
Keyword(s):  
Autoimmune Hepatitis ◽  
Clinical Manifestations ◽  
Serum Biochemistry ◽  
Acute Onset ◽  
Relative Increase ◽  
Treatment Withdrawal ◽  
First Line ◽  
Drug Induced ◽  
Smooth Muscle Antibody ◽  
First Line Therapy

Autoimmune hepatitis (AIH) is an immunoinflammatory chronic liver disease with dynamic and rather heterogeneous disease manifestations. A trend of increasing prevalence of AIH has been observed worldwide, along with a relative increase in the percentage of male patients. AIH is characterized and diagnosed based on serum biochemistry and liver histology: elevated aminotransferases and serum immunoglobulin G (IgG), the presence of serum anti-nuclear antibody or anti-smooth muscle antibody, and interface lympho-plasmacytic hepatitis. Clinical manifestations differ among disease subtypes with distinct time-frames, i.e., AIH with a chronic insidious onset, and acute-onset AIH (the diagnosis of which is often challenging due to the lack of typical serum findings). The absence of disease-specific biomarkers or histological findings may expand the disease phenotype into drug-induced AIH-like liver injury. Corticosteroids and azathioprine are recommended first-line treatments for AIH. The complete normalization of aminotransferases and serum IgG is an essential treatment response to ensure long-term overall survival. An incomplete response or intolerance to these drugs is considered an indication for second-line treatment, especially with mycophenolate mofetil. Life-long maintenance treatment is required for the majority of patients, but the few who achieve prolonged and stringent biochemical remission with lower alanine aminotransferase and IgG within the normal range may be able to discontinue the medications. In the future, the quality of life of AIH patients should be managed by personalized medicine, including the appropriate selection and dosing of first-line therapy and perhaps alternating with potential therapeutics, and the prediction of the success of treatment withdrawal.

scholarly journals Predictors of success for combined endoscopic third ventriculostomy and choroid plexus cauterization in a North American setting: a Hydrocephalus Clinical Research Network study

2019 ◽  
Vol 24 (2) ◽  
pp. 128-138
Author(s):  
Jay Riva-Cambrin ◽  
John R. W. Kestle ◽  
Curtis J. Rozzelle ◽  
Robert P. Naftel ◽  
Jessica S. Alvey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Research ◽  
Choroid Plexus ◽  
Patient Selection ◽  
Operative Technique ◽  
Intraventricular Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Success Rates ◽  
Choroid Plexus Cauterization

OBJECTIVEEndoscopic third ventriculostomy combined with choroid plexus cauterization (ETV+CPC) has been adopted by many pediatric neurosurgeons as an alternative to placing shunts in infants with hydrocephalus. However, reported success rates have been highly variable, which may be secondary to patient selection, operative technique, and/or surgeon training. The objective of this prospective multicenter cohort study was to identify independent patient selection, operative technique, or surgical training predictors of ETV+CPC success in infants.METHODSThis was a prospective cohort study nested within the Hydrocephalus Clinical Research Network’s (HCRN) Core Data Project (registry). All infants under the age of 2 years who underwent a first ETV+CPC between June 2006 and March 2015 from 8 HCRN centers were included. Each patient had a minimum of 6 months of follow-up unless censored by an ETV+CPC failure. Patient and operative risk factors of failure were examined, as well as formal ETV+CPC training, which was defined as traveling to and working with the experienced surgeons at CURE Children’s Hospital of Uganda. ETV+CPC failure was defined as the need for repeat ETV, shunting, or death.RESULTSThe study contained 191 patients with a primary ETV+CPC conducted by 17 pediatric neurosurgeons within the HCRN. Infants under 6 months corrected age at the time of ETV+CPC represented 79% of the cohort. Myelomeningocele (26%), intraventricular hemorrhage associated with prematurity (24%), and aqueductal stenosis (17%) were the most common etiologies. A total of 115 (60%) of the ETV+CPCs were conducted by surgeons after formal training. Overall, ETV+CPC was successful in 48%, 46%, and 45% of infants at 6 months, 1 year, and 18 months, respectively. Young age (< 1 month) (adjusted hazard ratio [aHR] 1.9, 95% CI 1.0–3.6) and an etiology of post–intraventricular hemorrhage secondary to prematurity (aHR 2.0, 95% CI 1.1–3.6) were the only two independent predictors of ETV+CPC failure. Specific subgroups of ages within etiology categories were identified as having higher ETV+CPC success rates. Although training led to more frequent use of the flexible scope (p < 0.001) and higher rates of complete (> 90%) CPC (p < 0.001), training itself was not independently associated (aHR 1.1, 95% CI 0.7–1.8; p = 0.63) with ETV+CPC success.CONCLUSIONSThis is the largest prospective multicenter North American study to date examining ETV+CPC. Formal ETV+CPC training was not found to be associated with improved procedure outcomes. Specific subgroups of ages within specific hydrocephalus etiologies were identified that may preferentially benefit from ETV+CPC.

scholarly journals Autogenous Tooth Transplantation from Ectopic Position: A Case Report and Review of Literature

1970 ◽  
Vol 24 (2) ◽  
pp. 79-85 ◽  
Author(s):  
MMR Howlader ◽  
S Begum ◽  
D Naulakha
Keyword(s):  
Case Report ◽  
Patient Selection ◽  
Functional Results ◽  
Tooth Replacement ◽  
Review Of Literature ◽  
Success Rates ◽  
Tooth Transplantation ◽  
Careful Patient Selection ◽  
Careful Patient

Autogenous tooth transplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. Once thought to be experimental, autotransplantation has achieved high success rates and is an excellent option for tooth replacement. Although the indications for autotransplantation are narrow, careful patient selection coupled with an appropriate technique can lead to exceptional esthetic and functional results. One advantage of this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is not needed. This article highlights the indications for autogenous tooth transplantation using one case report as example. Reviews of previous works as well as success rates are also discussed. (J Bangladesh Coll Phys Surg 2006; 24: 79-85)

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