scholarly journals Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

2015 ◽  
Vol 100 (1) ◽  
pp. 142-154 ◽  
Author(s):  
Afshin Parsikia ◽  
Stalin Campos ◽  
Kamran Khanmoradi ◽  
John Pang ◽  
Manjula Balasubramanian ◽  
...  

Abstract Kidney transplantation alone in clinically compensated patients with cirrhosis is not well documented. Current guidelines list cirrhosis as a contraindication for kidney transplantation alone. This is an Institutional Review Board–approved retrospective study. We report our experience with a retrospective comparison between transplants in hepatitis C virus–positive (HCV+) patients without cirrhosis and HCV+ patients with cirrhosis. All of the patients were followed for at least a full 3-year period. All of the deaths and graft losses were recorded and analyzed using Kaplan-Meier methodology. One- and three-year cumulative patient survival rates for noncirrhotic patients were 91% and 82%, respectively. For cirrhotic patients, one- and three-year cumulative patient survival rates were 100% and 83%, respectively (P = NS). One- and three-year cumulative graft survival rates censored for death were 94% and 81%, and 95% and 82% for the noncirrhosis and cirrhosis groups, respectively (P = NS). Comparable patient and allograft survival rates were observed when standard kidney allograft recipients were analyzed separately. This study is the longest follow-up document in the literature showing that HCV+ clinically ompensated patients with cirrhosis may undergo kidney transplantation alone as a safe and viable practice.

2005 ◽  
Vol 44 (05) ◽  
pp. 185-191 ◽  
Author(s):  
H. Wieler ◽  
S. Birtel ◽  
E. Ostwald-Lenz ◽  
K. P. Kaiser ◽  
H. P. Becker ◽  
...  

Summary:Aim: For the surgical therapy of differentiated thyroid cancer precise guidelines are applied by the German medical societies. In a retrospective multicenter study, we investigated the following issues: Are the current guidelines respected?. Is there a difference concerning the surgical radicalism and the outcome?. Does the perioperative morbidity increase with the higher radicalism of the procedure?. Patients, methods: Data gained from 102 patients from 17 regional referral hospitals who underwent surgery for thyroid cancer and a following radioiodine treatment (mean follow up: 42.7 [24-79] months) were analyzed. At least 71 criterias were analyzed in a SPSS file. Results: 46.1% of carcinomas were incidentally detected during goiter surgery. The thyroid cancer (papillary n = 78; follicular n = 24) occurred in 87% unilateral and in 13% bilateral. Papillary carcinomas <1 cm were detected in 25 cases; in five of these cases (20%) contralateral carcinomas <1 cm were found. There were significant differences concerning the surgical radicalism: a range from hemithyroidectomy to radical thyroidectomy with lateral neck dissection. Analysis of the histopathologic reports revealed that lymph node dissection was not performed according to guidelines in 55% of all patients. The perioperative morbidity was lower in departments with a high case load. The postoperative dysfunction of the recurrent laryngeal nerve (mean: 7.9% total / 4.9% nerves at risk) variated highly, depending on differences in radicalism and hospitals. Up to now these variations in surgical treatment have shown no differences in their outcome and survival rates, when followed by radioiodine therapy. Conclusion: Current surgical regimes did not follow the guidelines in more than 50% of all cases. This low acceptance has to be discussed. The actual discussion about principles of treatment regarding, the socalled papillary microcarcinomas (old term) has to be respected within the current guidelines.


Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 905-911 ◽  
Author(s):  
Jason Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford

Abstract OBJECTIVE Hemangiopericytomas are highly aggressive meningeal tumors with tendencies for recurrence and metastasis. The purpose of this retrospective, single-institution review was to evaluate the efficacy and role of stereotactic radiosurgery in the management of recurrent hemangiopericytomas. METHODS We reviewed data for patients who underwent stereotactic radiosurgery at the University of Pittsburgh between 1987 and 2001. Fourteen patients underwent radiosurgery for 15 discrete tumors. Prior treatments included transsphenoidal resection (n = 1), craniotomy and resection (n = 27), embolization (n = 1), and conventional radiotherapy (n = 7). Clinical and radiological responses were evaluated. Follow-up periods varied from 5 to 76 months (mean, 31.3 mo; median, 21 mo). The mean radiation dose to the tumor margin was 15 Gy. RESULTS Seventy-nine percent of patients (11 of 14 patients) with recurrent hemangiopericytomas demonstrated local tumor control after radiosurgery. Twelve of 15 tumors (i.e., 80%) dramatically decreased in size on follow-up imaging scans. Regional intracranial recurrences were retreated with radiosurgery for two patients (i.e., 15%); neither of those two patients experienced long-term tumor control. Local recurrences occurred 12 to 75 months (median, 21 mo) after radiosurgery. Local tumor control and survival rates at 5 years after radiosurgery were 76 and 100%, respectively (Kaplan-Meier method). We could not correlate prior irradiation or tumor size with tumor control. Twenty-nine percent of the patients (4 of 14 patients) developed remote metastases. Radiosurgery did not seem to offer protection against the development of intra- or extracranial metastases. CONCLUSION Gamma knife radiosurgery provided local tumor control for 80% of recurrent hemangiopericytomas. When residual tumor is identified after resection or radiotherapy, early radiosurgery should be considered as a feasible treatment modality. Despite local tumor control, patients are still at risk for distant metastasis. Diligent clinical and radiological follow-up monitoring is necessary.


2020 ◽  
pp. 112070001989697 ◽  
Author(s):  
Nam Hoon Moon ◽  
Won Chul Shin ◽  
Min Uk Do ◽  
Suk-Woong Kang ◽  
Sang-Min Lee ◽  
...  

Background: Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture’s polyethylene liner for >15 years in terms of survival and wear rate. Methods: This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined. Results: HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups. Conclusions: Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.


1999 ◽  
Vol 29 (2) ◽  
pp. 485-489 ◽  
Author(s):  
J. J. CLAUS ◽  
G. J. M. WALSTRA ◽  
P. M. BOSSUYT ◽  
S. TEUNISSE ◽  
W. A. VAN GOOL

Background. We studied whether heterogeneous profiles of cognitive function are relevant to survival in patients with early Alzheimer's disease.Methods. CAMCOG subscales of cognitive function were used as predictors of survival, together with gender in 157 consecutively referred patients with early Alzheimer's disease. Statistical analysis was performed with Cox proportional hazards analysis and Kaplan–Meier survival curves. Survival rates were compared with those in the general population.Results. Eighty patients (51%) died during the follow-up that extended to 5·7 years, with a median survival of 4·4 years after entry. Only the praxis subscore was statistically significant related to survival (P<0·0001). Its predictive power was based on only two items, including copying ability for a spiral and a three-dimensional house, independent of age, sex, education, overall CAMCOG score, dementia severity and symptom duration. Kaplan–Meier curves for the combined score of these items (0, 1, or 2) showed three groups with significantly different survival rates for both men and women. Comparison of gender specific survival rates with data from the general population showed that excess mortality was statistically significant (P<0·01) higher in men (51%) than in women (21%) after follow-up extending to 5 years.Conclusions. A simple test of copying ability defines subgroups of AD patients with large differences in survival rates. This suggests that parietal lobe impairment is an important predictor of mortality in AD. Also, the course of AD may be more benign in women than in men.


2009 ◽  
Vol 29 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Chih-Chung Shiao ◽  
Tze-Wah Kao ◽  
Kuan-Yu Hung ◽  
Yin-Cheng Chen ◽  
Ming-Shiou Wu ◽  
...  

Background There are no Taiwanese publications and only a few Asian publications on the long-term outcome of peritoneal dialysis (PD) patients. The aim of this study was to evaluate the outcome of PD patients in Taiwan during a 7-year follow-up period. Patients and Methods This study enrolled 67 patients (23 males, mean age 46.2 ± 14.5 years) on maintenance PD. We administered the Short-Form questionnaire on 30 September 1998 and recorded major events and outcomes until 30 September 2005. We compared differences in initial parameters between groups categorized by PD patient survival and PD technique survival. Causes of mortality and transfer to hemodialysis were determined. PD patient and PD technique survival rates were measured and risk factors for patient mortality and PD technique failure were analyzed. Results Those in patient survival or PD technique survival groups had lower mean age ( p < 0.001 and 0.018 respectively) and higher serum albumin level ( p = 0.015 and 0.041 respectively) compared to those that died or failed PD. The 7-year patient survival rate was 77% and the PD technique survival rate was 58%. The independent predictors for PD technique failure included lower Mental Component Summary scores [hazard ratio (HR) = 0.85, p = 0.031] and diabetes mellitus (HR = 4.63, p < 0.001), whereas lower serum albumin level (HR = 0.22, p = 0.031), lower Physical Component Summary scores (HR = 0.67, p = 0.047), and presence of diabetes mellitus (HR = 5.123, p = 0.009) were the independent predictors for patient mortality. Conclusion For our PD patients, both patient and technique survival rates are good. Better glycemic control, adequate nutrition, and enhancement of health-related quality of life are all of potential prognostic benefit.


2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Fatmah N. AlMotawah ◽  
Sharat Chandra Pani ◽  
Tala AlKharashi ◽  
Saleh AlKhalaf ◽  
Mohammed AlKhathlan ◽  
...  

Aim. This study aimed to retrospectively compare the survival outcomes over two years between teeth with proximal dental caries that were restored with stainless-steel crowns to those that were pulpotomized and then restored with a stainless-steel crown in patients who were rehabilitated under general anesthesia. Participants and Methods. The records of 131 patients aged between two to six years who had stainless-steel crowns placed under general anesthesia and had two-year follow-up were screened. 340 teeth with moderate proximal caries on the radiograph (D2) were included in the study. Of these, 164 teeth were treated with a pulpotomy and stainless-steel crown, while 176 teeth were crowned without a pulpotomy. The type of each tooth was compared using the Chi-squared test and Kaplan–Meier survival analysis, and curves were plotted based on the two-year outcomes. Results. Treatment: the sample comprised 59 males (mean age 4.73 years, SD ± 1.4 years) and 72 females (mean age 5.2 years, SD ± 2.0 years). The Kaplan–Meier regression model showed no significant difference in survival outcomes between teeth that had been pulpotomized and those that had not ( p  = 0.283). Conclusion. Within the limitations of the current study, we can conclude that performing a pulpotomy does not influence the survival outcome of mild/moderate proximal caries restored with stainless-steel crowns under general anesthesia.


2019 ◽  
Vol 45 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Farhad Farzaliyev ◽  
Hans-Ulrich Steinau ◽  
Halil-Ibrahim Karadag ◽  
Alexander Touma ◽  
Lars Erik Podleska

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan–Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III


2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 559-559 ◽  
Author(s):  
Kevin Knopf ◽  
Sheikh Usman Iqbal ◽  
Stephen F Thompson ◽  
Elisabetta Malangone ◽  
Magdaliz Gorritz-Kindu ◽  
...  

559 Background: The increase in survival seen in recent years in patients with mCRC has been attributed to improvements in treatments, including the introduction of targeted biologic agents. The objectives of this retrospective, observational study are to investigate recent treatment patterns in US mCRC patients and examine real-world survival outcomes. Methods: Data were obtained from a large U.S. database (SDI/IMS Health) of mCRC patients diagnosed from January 1, 2004 to June 30, 2011, ≥18 y at diagnosis, and who received chemotherapy and/or biologic treatment. Complete follow-up was defined as those who either died before June 2011 or who had at least 1 claim within 30 days of June 30, 2011. Kaplan-Meier curves were generated to determine overall survival (OS) from the date of mCRC diagnosis. Results: 1,066 stage IV mCRC patients with complete follow-up were identified (57.5% male; mean age, 61.6 y). Approximately 80% were diagnosed with mCRC after 2006; 51.7% had liver metastases. The most common 1L, 2L, and 3L regimens were FOLFOX plus bevacizumab (34.52%), FOLFIRI plus bevacizumab (21.83%), and irinotecan plus cetuximab (15.83%), respectively. A total of 445 patients died during the study period, yielding a mortality rate of 41.74%. Mean time from diagnosis to first treatment was 3.31 months (SD=7.13). All patients received 1L therapy; OS from diagnosis was 35.77 months (95% CI: 32.57-38.10); 5-year survival was approximately 28%. After 1L, 591/1066 (55%) patients went on to receive 2L therapy; for these patients, median survival from diagnosis was 37.13 months (95% CI: 34.07-40.43) and 5-year survival was approximately 25%. After 2L, 278/591 (47%) patients received 3L therapy; for these patients, median survival from diagnosis was 38.10 months (95% CI: 34.83-43.13); 5-year survival was approximately 25%. Conclusions: In this study, OS (35.77 months) was longer than for other mCRC observational studies that have reported survival from start of treatment, but is more comparable when the ~3 months from diagnosis to start of treatment are not included. Addition of targeted agents and novel chemotherapy has prolonged OS in mCRC patients. Because of poor 5-year survival rates, the need for additional agents in later lines of therapy still exists.


2012 ◽  
Vol 4 (4) ◽  
pp. 35 ◽  
Author(s):  
Turgay Efe ◽  
Philip P. Roessler ◽  
Thomas J. Heyse ◽  
Carsten Hauk ◽  
Caroline Pahrmann ◽  
...  

The aim of the study was to evaluate the mid-term clinical results and survivorship of a rotating-hinge knee prosthesis (LINK® Endo-Model) in difficult primary and complex revision situations. Results after primary implantation were compared with those of revision procedures. Forty-nine prostheses in 45 patients were reviewed clinically during follow up. Twenty-one of these were implanted in primary and 28 in revision situations. Outcome was evaluated using commonly used scores (Knee Society, UCLA Activity, Lequesne) and a visual analog scale after a mean follow up of 56±37 months for 49 prostheses. Implant survival was analyzed using the Kaplan-Meier method. There were no significant differences in clinical examination and evaluation scores between the two groups (P&gt;0.05). Survival rates at final follow up were 95% after primary implantation and 76% in revision procedures. The risk of prosthesis loss (odds ratio 5.7) was significantly higher after revision procedures (P=0.004). These data suggest that rotating-hinge knee prostheses provided good clinical and functional results in selected cases of advanced primary gonarthrosis associated with severe bone loss, ligamentous instability or comminuted fractures. They also provide good results in revision situations. However, the failure rate was significantly higher in cases of revision surgery.


2020 ◽  
Vol 14 (1) ◽  
pp. 13
Author(s):  
AseemKumar Tiwari ◽  
Geet Aggarwal ◽  
Dinesh Arora ◽  
Gunjan Bhardwaj ◽  
Manish Jain ◽  
...  

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